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2222 RFP 19/20-47 Insurance & Wellness Study - Siver Ins• PURCHASING DEPARTMEW TRANsMITTAL MEMORANDUM TO: City Clerk/Mayor RE: RFP 19/20-47 Insurance and Wellness Study The item(s) noted below is/are attached and forwarded to your office for the following action(s): [] Development Order ❑ Mayor's signature F-1 Final Plat (original mylars) Fj Recording ❑ Letter of Credit R Rendering ❑ Maintenance Bond Z Safe keeping (Vault) ❑ Ordinance ❑ Deputy City Manager ❑ Performance Bond ❑ Payment Bond ❑ Resolution ❑ City Manager Signature City Clerk Attest/Signature ❑ City Attorney/Signature Once completed, please: F-1 Return originals to Purchasing- Department F-1 Return copies Special Instructions: 1 i,y+.olye,y r3oja&zi4e,,- From SharePoint—Finance—Purchasing_yorms - 2018.doc 51712-02-0 Date AGREEMENT BETWEEN CITY OF SANFORD AND E. W. SIVER & ASSOCIATES, INC. D/B/A SIVER INSURANCE CONSULTANTS; RFP 19/20-47; HEALTH INSURANCE & WELLNESS STUDY PROGRAM THIS AGREEMENT (hereinafter the "Agreement") is made and entered by and between the City of Sanford, Florida, a Florida municipality, (hereinafter referred to as the "City"), whose mailing address is 300 North Park Avenue, Sanford, Florida 32771, and E. W. Siver & Associates, Inc., a Florida corporation, doing business as Siver Insurance Consultants, whose principal address is 801 94th Avenue North, # 202, St. Petersburg, Florida 33702, (hereinafter referred to as "Siver"). The City and Siver may be collectively referenced herein as the "parties". WITNESSETH: IN CONSIDERATION of the mutual covenants, promises, and representations contained herein and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the parties hereto agree as follows: Section 1. Recitals. The above statements are true and form a material part of this Agreement upon which the parties have relied. Section 2. Authority. Each party hereto represents to the other that it has undertaken all necessary actions to execute this Agreement, and that it has the legal authority to enter into this Agreement and to undertake all obligations imposed on it. The persons executing this Agreement for each party certify that they are authorized to bind the party fully to the terms of this Agreement. Section 3. Scope of Agreement; Direction of the Provision of Services. (a). This Agreement is for the provision of services set forth in the attachments hereto and Siver agrees to accomplish the timely provision of services specified in the attachments for the compensation set forth herein relating the provision of the City's health insurance and wellness study program as well as providing such other services during the life of this Agreement as may be agreed upon by the parties as set forth in issued purchase/work orders. With regard to the initial services, Siver shall also provide an additional 90 days of question and answer services to the City relative to the services initially provided to the City. (b). It is recognized that Siver shall provide services as directed by the City. (c). The City's contact/project manager for all purposes under this Agreement shall be the following: Marisol Ordonez Purchasing Manager IIPage Finance -Purchasing Division City of Sanford Post Office Box 1788 Sanford, Florida 32772-1788 Phone: 407.688.5028 Email: Marisol.ordonez@sanfordfl.gov Section 4. Effective Date and Term of Agreement. This Agreement shall take effect on the date that this Agreement is fully executed by the parties hereto. This Agreement shall be in effect for a term of 1 year with the opportunity for additional 1 -year renewal periods when in the best interest of the City in its sole discretion. However, the total length of this Agreement, including all renewals, shall not exceed 5 years. The decision to renew or extend this Agreement shall be at the discretion of the City. Siver shall review the quality and status of the services pertaining to the provision of the City's health insurance and wellness study program, and such other services as may be procured by the City from Siver, with the City on an annual basis at which time(s) the City may terminate this Agreement is its sole and absolute discretion. In any event, this Agreement shall remain in effect until the services to be provided by Siver to the City under each purchase/work order have been fully provided in accordance with the requirements of the City; provided, however, that, the indemnification provisions and insurance provisions of the standard contractual terms and conditions referenced herein shall not terminate and the protections afforded to the City shall continue in effect subsequent to such services being provided by Siver. No goods, services or actions have been provided prior to the execution of this Agreement that would entitle Siver for any compensation therefor. Section 5. Compensation. The parties agree to compensation in an amount not to exceed $25,000.00 with regard to the initial purchase of services being in the amounts set forth in the attachments hereto and, subsequently, as may be agreed upon by the parties as set forth in issued purchase/work orders. Compensation shall be calculated at the rates set forth in Tab "E" of Siver's procurement submittal. Section 6. Standard Contractual Terms and Conditions. All "Standard Contractual Terms and Conditions", as provided on the City's website, apply to this Agreement. Such Terms and Conditions may be found at the City's website; which can be reached at: (https://www.sanfordfl.gov/departments/finance/purchasing/contract- terms-and conditions or www. Sanford FL.gov). The parties shall also be bound by the purchasing policies and procedures of the City as well as the controlling provisions of Florida law. Purchase/work orders shall be used, in accordance therewith, in the implementation of this Agreement to the extent deemed necessary by the City in its sole and absolute discretion. 21PaV-_e Section 7. Siver's Mandatory Compliance with Chapter 119, Florida Statutes, and Public Records Requests. (a). In order to comply with Section 119.0701, Florida Statutes, public records laws, Siver must: (1). Keep and maintain public records that ordinarily and necessarily would be required by the City in order to provide services. (2). Provide the public with access to public records on the same terms and conditions that the City would provide the records and at a cost that does not exceed the cost provided in Chapter 119, Florida Statutes, or as otherwise provided by law. (3). Ensure that public records that are exempt or confidential and exempt from public records disclosure requirements are not disclosed except as authorized by law. (4). Meet all requirements for retaining public records and transfer, at no cost, to the City all public records in possession of Siver upon termination of the contract and destroy any duplicate public records that are exempt or confidential and exempt from public records disclosure requirements. All records stored electronically must be provided to the City in a format that is compatible with the information technology systems of the City. (b). If Siver does not comply with a public records request, the City shall enforce the contract provisions in accordance with this Agreement. (c). Failure by Siver to grant such public access and comply with public records requests shall be grounds for immediate unilateral cancellation of this Agreement by the City. Siver shall promptly provide the City with a copy of any request to inspect or copy public records in possession of Siver and shall promptly provide the City with a copy of Siver's response to each such request. (d). IF THE CONTRACTORIVENDOR HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO THE CONTRACTOR'S (VENDOR'S) DUTY TO PROVIDE PUBLIC RECORDS RELATING TO THIS CONTRACT, CONTACT THE CUSTODIAN OF PUBLIC RECORDS AT (407) 688-5012, TRACI HOUCHIN, CMC, ECRM, CITY CLERK, CITY OF SANFORD, CITY HALL, 300 NORTH PARK AVENUE, SANFORD, FLORIDA 32771, TRACI.HO00HIN@SANFORDFL.GOV. 31Page_. Section 8. Time is of the Essence. Time is hereby declared of the essence as to the lawful performance of all duties and obligations set forth in this Agreement. Section 9. Entire Agreement/Modification. This Agreement, together with all "Standard Contractual Terms and Conditions", as provided on the City's website and the attachments hereto (the documents relative to the procurement activity of the City leading to the award of this Agreement) constitute the entire integrated agreement between the City and Siver and supersedes and controls over any and all prior agreements, understandings, representations, correspondence and statements whether written or oral in connection therewith and all the terms and provisions contained herein constitute the full and complete agreement between the parties hereto to the date hereof. This Agreement may only be amended, supplemented or modified by a formal written amendment of equal dignity herewith. In the event that Siver issues a purchase/work order, memorandum, letter, or any other instrument addressing the services to be performed pursuant to this Agreement, it is hereby specifically agreed and understood that any such purchase/work order, memorandum, letter, or other instrument shall have no effect on this Agreement unless agreed to by the City, specifically and in writing in a document of equal dignity herewith, and any and all terms, provisions, and conditions contained therein, whether printed or written or referenced on a Web site or otherwise, shall in no way modify the covenants, terms, and provisions of this Agreement and shall have no force or effect thereon. Section 10. Severability. If any term, provision or condition contained in this Agreement shall, to any extent, be held invalid or unenforceable, the remainder of this Agreement, or the application of such term, provision or condition to persons or circumstances other than those in respect of which it is invalid or unenforceable, shall not be affected thereby, and each term, provision and condition of this Agreement shall be valid and enforceable to the fullest extent permitted by law when consistent with equity and the public interest. Section 11. Waiver. The failure of the City to insist in any instance upon the strict performance of any provision of this Agreement, or to exercise any right or privilege granted to the City hereunder shall not constitute or be construed as a waiver of any such provision or right and the same shall continue in force. Section 12. Captions. The section headings and captions of this Agreement are for convenience and reference only and in no way define, limit, describe the scope or intent of this Agreement or any part thereof, or in any way affect this Agreement or construe any provision of this Agreement. Section 13. Counterparts. This Agreement may be executed in any number of counterparts, each of which shall be deemed an original, but all of which, taken together, shall constitute one and the same document. Section 14. Binding Effect. This Agreement shall be binding upon and inure to the benefit of the successors in interest, transferees and assigns of the parties. 41Page Each party hereto represents to the other that it has undertaken all necessary actions to execute this Agreement, and that it has the legal authority to enter into this Agreement and to undertake all obligations imposed on it. The signatories hereof represent that they have the requisite and legal authority to execute this Agreement and bind the respective parties herein. Section 15. Remedies. The rights and remedies of the parties, provided for under this Agreement, are in addition to any other rights and remedies provided by law or otherwise necessary in the public interest. Section 16. Governing law, Venue and Interpretation. This Agreement is to be governed by the laws of the State of Florida. Venue for any legal proceeding related to this Agreement shall be in the Eighteenth Judicial Circuit Court in and for Seminole County, Florida. This Agreement is the result of bona fide arms length negotiations between the City and Siver, and all parties have contributed substantially and materially to the preparation of the Agreement. Accordingly, this Agreement shall not be construed or interpreted more strictly against any one party. than against any other party and all provisions shall be applied to fulfill the public interest. IN WITNESS WHEREOF, the City and Siver have executed this instrument for the purpose herein expressed and Siver represents and affirms that the signatories below have full and lawful authority to bind Siver in every respect. Entered the date last set forth below or, in the event that the Vendor fails to date, the date of execution by the City. A ATTEST: 1i1OPP)PQ Q Traci Houchin, CMC, FCRM a� City Clerk ,aw CITY OF SANFORD fwTriplett t Approved as to form and legal sufficiency. zI William L. Colbert, City Attorney ADDITIONAL SIGNATURE BLOCK FOLLOWS: A TTES P George Erickson Vice P Iii Cd ent/Treas urer/S ecreta ry/D i rector E. W. SIVER & ASSOCIATES, INC., a Florida corporation, doing business as SiVer. Inpurance Consultants. By: ePce 5 1 d 6- n FDated: -3-3;1-1 2. 7 6 1 P a e REQUEST FOR PROPOSALS RFP 19/20-47 me nommelm-:4-1 r r 1 Due on January 30, 2020 2:00 PM Proposed by SIVER INSURANCE CONSULTANTS Kathy Gordon, ARM, AAI Vice President 80194 1h Avenue North, Suite 202 St. Petersburg, Florida 33702 Phone: (727) 577-2780 www.siver.com TABLE OF CONTENTS Tab A — Firm Oualifications and Exnerience • Letter of Transmittal • Minimum Requirements 1 • Individuals and Qualifications 1 o Consultants' CVs • Litigation 8 • Financial Information 8 • Currently Valid Certificates of Insurance 8 • Local Business Tax Receipt 8 Tab B — Similar Proiects Tab C — Project Approach 9 12 Tab D — Forms • Attachment "B" — Bid Price Schedule and Acceptance of Bid Terms and Conditions • Attachment "D" — Conflict of Interest Statement • Attachment "C" — Non -Collusion Affidavit • Attachment "I" — Drug -Free Workplace Certification • Attachment "N" — Addendum Receipt Acknowledgement Certification o Addendum #1 (dated 1/22/2020) • Corporate Standing and Authorized Signatories o State of Florida, Department of State — Certificate of Status o State of Florida, Department of State, Division of Corporations — Detail by Entity Name Listing Corporate Officers from Sunbiz.org o Attachment "P" — Organizational Information o Evidence of Signatory Authority: Authorized Signatories Letter on Siver Letterhead • Attachment "R" — Proposed Schedule of Subcontractor Participation • Attachment "M" — Insurance Requirements o Please see Tab A for current certificates of insurance • Attachment "O" — References • Proof of Licenses/Certification o For Siver Insurance Consultants: State of Florida, Department of State — Certificate of Status o For Individual Consultants: Florida Department of Financial Services Licensee Detail Table of Contents — Page 1 • W-9 Form • Attachment "E" — Public Entity Crimes Statement • Attachment "F" — Compliance with the Public Records Law Affidavit • Attachment "G" — Certification of Non -Segregated Facilities Form • Attachment "H" — Disputes Disclosure Form • Attachment "J" — Unauthorized (Illegal) Alien Workers • Attachment "K" — E -Verify Compliance Affidavit • Attachment "L" — American with Disabilities Act Affidavit • Attachment "Q" — Contractor Certification Regarding Scrutinized Companies Tab E — Fee Schedule Tab F — Additional Information • 2016 Health Insurance Plan Review — City of Hallandale Beach, Florida Confidential documents submitted in separate envelope per RFP 19/20-47, Section 3.12 — Proprietary Information Table of Contents — Page 2 Insurance Consultants SIVER 801 94`h Avenue North, Ste. 202 St. Petersburg, Florida 33702-2479 Post Office Box 21343 St. Petersburg, Florida 33742-1343 - Telephone: (727) 577-2780 Email: kgordon@siver.com siver.com January 28, 2020 City of Sanford Purchasing Division ATTN: Marisol Ordonez, Purchasing Manager 300 N. Park Avenue, Suite 243, 2°d Floor Sanford, FL 32771 RE: Solicitation RFP 19/20-47 — Health Insurance & Wellness Program Study Dear Ms. Ordonez: In response to the Request for Proposals (RFP), Siver Insurance Consultants (Siver) is pleased to provide this proposal for Health Insurance & Wellness Program Study to the City of Sanford (City). Location: St. Petersburg, Florida Organization Structure: Corporation (Florida) FIRM PHILOSOPHY AND SIVER'S QUALIFICATIONS We believe that Siver is uniquely qualified to perform an independent and unbiased Health Insurance Program and Wellness Program Study sought by the City. In our opinion, what Siver offers is best summarized as: • Independence • Expertise • Objectivity • Experience • Integrity Independence, Objectivity and Integrity Siver is not an insurance company, insurance agency, insurance broker, third party administrator, or employee. Siver is not owned or controlled by an insurance company, insurance sales organization, or third party administrator. Further, Siver does not own or control any insurance company, insurance sales organization or third party administrators. Siver is independently and entirely owned by its officers and employees. We do not sell insurance. We do not receive, directly or indirectly, any commissions, contingent commissions or overrides. All of our income is directly derived from the fees we charge our clients. All income we receive as the result of, or in connection with, our services to a client will appear on SIVER INSURANCE CONSULTANTS - Marisol Ordonez January 28, 2020 Page 2 our invoice to that client. We adhere to a strict code of ethics. We do not accept gifts, trips, prizes, or anything else of any value from vendors. In short, we serve only you, our client. This approach assures our clients that Siver never has any vested interest in anything other than our clients' best interests, and that they may rely on our objective recommendations. Expertise and Experience Established in 1970, Siver provides corporate and governmental clients with independent advice and opinions on matters involving insurance, risk management, and employee benefits. Siver's employee benefits expertise includes, in part, medical, prescription, life, disability, dental, vision benefits plans, funding mechanisms, claims handling and flexible benefits. If we are selected for this project and any subsequent services, most or all of the following team of our professional staff would likely perform the services: Kathy Gordon, ARM, AAI Vice President and Senior Consultant Theresa Conley, MPA, CEBS, RHU Senior Consultant We also have other professional staff that could perform back-up services if needed. They include: George Erickson, JD, CPCU, LLM Exec Vice President & Senior Consultant Laura Rybka, JD Consultant All Siver consultants work together from a single office. As a result, the various skills of each are readily available to our clients. Siver staff performs active peer review to assure quality and accuracy of our work. Siver strives to make all work products accurate and easy to read for both the insurance professional and lay people. Siver's philosophy is that our reports and written correspondence should make complex issues as clear and easy to understand as possible. Is iTIM14 rM4 We appreciate the opportunity to provide the City with this proposal. If you have any questions or need any additional information regarding our firm or any of the information contained in this letter, please let us know. Respectfully, SIVER INSURANCE CONSULTANTS Kathy Gordon, ARM, AAI Vice President and Senior Consultant TAB A FIRM QUALIFICATIONS AND EXPERIENCE _ SECTION 1.04 — MINIMUM REQUIREMENTS A. The Proposer shall have been in business for a minimum of three (3) consecutive years and shall currently be licensed to perform services within the State of Florida. Number of Years in Business: 50 years (since 1970) State of Incorporation: Florida Currently Licensed in Florida: Yes — Please see Tab D for the State of Florida, Department of State, Certificate of Status for E. W. Siver and Associates, Inc. showing the corporation is in good standing. Consultants' Licenses: We have included proof of the State of Florida licenses for Siver's consultants in Tab D. B. Demonstration of Experience: Knowledgeable on the equipment and parts. Siver is knowledgeable as to the scope of services requested in the City's RFP. Please see Tab A (Firm Qualifications and Experience), Tab B (Similar Projects), and Tab C (Project Approach) for detailed information. B. INDIVIDUALS AND QUALIFICATIONS SIVER'S QUALIFICATIONS For 50 years, Siver has preserved the principal philosophies established by its founders: • Independence • Objectivity • Integrity • Expertise • Experience In our opinion, one of the most important qualities we offer clients is that we are independent consultants and are not affiliated with any insurance organization. Our clients recognize that they can rely upon our independent and objective recommendations. 1 In addition, we believe that one of the most important business philosophies we adhere to at Siver is to ensure that our consultants are available to meet our clients' needs. This includes not only our formal training and continuing education, but also being available to our clients. Independence, Objectivity and Integrity Siver is not an insurance company, insurance agency, insurance broker, third party administrator, or employee. Siver is not owned or controlled by an insurance company, insurance sales organization, or third party administrator. Further, Siver does not own or control any insurance company, insurance sales organization or third party administrators. Siver is independently and entirely owned by its officers and employees. We do not sell insurance. We do not receive, directly or indirectly, any commissions, contingent commissions or overrides. All of our income is directly derived from the fees we charge our clients. All income we receive as the result of, or in connection with, our services to a client will appear on our invoice to that client. We adhere to a strict code of ethics. We do not accept gifts, trips, prizes, or anything else of any value from vendors. In short, we serve only you, our client. This approach assures our clients that Siver never has any vested interest in anything other than our clients' best interests, and that they may rely on our objective recommendations. Expertise and Experience Established in 1970, Siver provides corporate and governmental clients with independent advice and opinions on matters involving insurance, risk management, and employee benefits. Siver's employee benefits expertise includes, in part, medical, prescription, life, disability, dental, vision benefits plans, funding mechanisms, claims handling and flexible benefits. EMPLOYEE BENEFITS EXPERTISE Siver consultants are recognized experts in the field of employee benefit programs. Our services to Florida governments have ranged in complexity and magnitude from assisting in the design, marketing and analysis of typical benefit plans, to the drafting (subject to review by our client's counsel) of manuscript insurance policies and plan documents for self-insured programs, cafeteria plans and the like. Additionally, we have performed numerous health plan and prescription audits in the past sixteen (16) years. We provide consulting services regarding our clients' health plans, both self-insured and fully insured, life insurance plans, disability insurance plans, dental plans and long term care plans. Services include: • Comparison of clients' employee benefits programs with those offered by similar organizations or competitors. • Claims processing accuracy, timeliness and eligibility audits of self-insured and 2 fully insured group medical programs, including prescription benefits. • Assistance with the procurement process and renewal negotiations for employee benefit plans. • Assistance with review of benefit design changes. • Extensive experience with all aspects of the design and use of cafeteria plans. EXTENSIVE EXPERIENCE WITH FLORIDA PUBLIC ENTITIES At Siver, we pride ourselves on our extensive experience and knowledge of the insurance industry, specifically the insurance needs and issues of Florida public entities including those needs specific to the City. We are experienced with benefits that the City provides to its employees and retirees. Because of Siver consultants' experience assisting our clients with procurements related to employee benefits coverages and services, we are familiar with all of the major insurers and administrators for Florida Govermments. We typically know which fines to expect as proposers and which fines will be likely to provide competitive pricing. Our Government Client List included in this tab demonstrates our extensive experience with governments in the State of Florida. CONSULTANTS' EXPERIENCE WITH EMPLOYEE BENEFITS INSURANCE All of Siver's consultants work from the same location at 80194 th Avenue N., Suite 202, St. Petersburg, Florida. Primary Co -Lead Consultants: We are proposing Kathy Gordon and Theresa Conley as the City's primary co -lead consultants and will perform the services included in the scope of services in the RFP. We have included the CVs of the proposed consultants in this tab. Kathy Gordon, ARM, AAI Vice President and Senior Consultant Ms. Gordon will be the co -lead consultant for the City and one of the primary contacts for the City. Ms. Gordon will attend all City meetings, including City Commissioner meetings and implementation and plan design meetings. Kathy Gordon is a consultant for both Employee Benefits and Property and Casualty Insurance. She has over 32 years of experience in the insurance industry and 19 years of consulting experience. Kathy has been a consultant with Siver since 2001. 3 Summary of Employee Benefits Experience: Ms. Gordon has extensive experience in various benefits programs, including but not limited to group health (both self-insured and fully insured), life, disability, dental, vision and Medicare insurance, employee assistance programs, flexible spending accounts, health savings accounts, and health reimbursement accounts. She has been performing audits of employee benefit plans for over sixteen (16) years. Additionally, she has assisted Siver's clients in the design, marketing and analysis of typical benefit plans and has drafted plan documents for self-insured programs and cafeteria plans. Professional Education: • Graduate of St. Lawrence University in 1986 with a B.A. majoring in Philosophy — graduated with Honors and Magna Cuni Laude • Completion of three parts of the Chartered Property and Casualty Underwriter (CPCU) curriculum • Associate in Risk Management (ARM) • Accredited Adviser in Insurance (AAI) • 218 Life and Health License • 220 General Lines (Property and Casualty) License Professional Experience: • Senior consultant for property and casualty and employee benefits accounts • Extensive experience in: analysis of insurance coverage, marketing of property and casualty and employee benefit programs and administrative services, implementation and auditing of insurance, risk management and employee benefits programs for governments and private enterprise, review of self-funded programs and captives, audits of employee benefit plans, employee benefit surveys and support for litigation services • Over 9 years of experience in workers' compensation and casualty claims auditing Theresa Conley, MPA, CEBS, RHU Senior Consultant Ms. Conley will be the co -lead consultant for the City and one of the primary contacts for the City. She will be available to attend any City meetings if Ms. Gordon is unavailable. Theresa Conley is a consultant for Employee Benefits Insurance. She has over 32 years of experience in the insurance industry and 19 years of consulting experience. Kathy has been a consultant with Siver since 2007. Summary of Employee Benefits Experience: Ms. Conley has extensive experience in various benefits programs, including but not limited to medical and prescription claim audits, group health (both self-insured and fully insured), life, disability, dental, vision and Medicare insurance, employee assistance programs, and flexible spending accounts, health savings accounts and health reimbursement accounts. She has been performing both medical and prescription audits of employee benefit plans for over 13 years. Additionally, she has assisted Siver's clients in the design, marketing and analysis of typical benefit plans and has drafted plan documents for self-insured programs and cafeteria plans. Professional Education: • Graduate of University of South Florida in 2010 with a Master in Public Administration (MPA) • Graduate of University of South Florida in 2004 with a B.A. majoring in Business Administration • Received the Certified Employee Benefits Specialist (CEBS) designation from the International Foundation of Employee Benefits and the Wharton School of the University of Pennsylvania, 2014 • Received the Registered Health Underwriter (RHU) designation from the American College, 2007 • 215 Health, Life and Variable Annuities License Professional Experience: • Senior consultant for property and casualty and employee benefits accounts • Extensive experience in: analysis of insurance coverage, marketing of employee benefit programs and administrative services, implementation and auditing of health and prescription claims for governments, review of self-funded programs, and employee benefit surveys • Over 9 years of experience in workers' compensation and casualty claims auditing Assistant Consultants/Team Members: The Assistant Consultants/Team Members will be available to assist the City and the Primary Consultants, as needed. George W. Erickson, JD, CPCU, LLM Executive Vice President and Senior Consultant George Erickson is a consultant for Property and Casualty and for Employee Benefits. He has over 27 years of experience in the insurance 5 industry and 23 years of consulting experience. George has been a consultant with Siver since 1997. Professional Education: • Graduate of Duke University School of Law (Juris Doctor and Masters - International and Comparative Law), 1996; Attended the Institute of Transnational Law, Brussels, Belgium, 1994 • Cum Laude Graduate of University of South Florida (B.A. - Finance), 1992 • Received the Chartered Property and Casualty Underwriter (CPCU) designation from the American Institute for Chartered Property and Casualty Underwriters (AICPCU), 2001 • 220 General Lines (Property and Casualty) License Professional Experience: • Senior consultant for property and casualty and employee benefits accounts • Extensive experience in: analysis of insurance coverage; contractual risk management; litigation support consulting and expert witness testimony for insurance claims and coverage issues; marketing, implementation and auditing of insurance and risk management programs for governments and private enterprise • Over 9 years of experience in workers' compensation and casualty claims auditing Laura M. Rybka, JD Consultant Laura Rybka is a consultant for both Property and Casualty Insurance and Employee Benefits. She has over 15 years' experience in the litigation of insurance matters and 6 years of consulting experience. Laura has been a consultant with Siver since 2014. Professional Education: • Graduate of DePaul University College of Law (Juris Doctor), 2002; received the General Intellectual Property Certificate • Graduate of the University of Illinois at Urbana -Champaign (B.S. —Psychology), 1996 • Completion of two parts of the Associate in Risk Management (ARM) curriculum • 215 Health, Life and Variable Annuities License • 220 General Lines (Property and Casualty) License Professional Experience: • Consultant for property and casualty accounts and employee benefits accounts • Extensive experience in: analysis of insurance coverage; marketing of property and casualty and employee benefit programs and administrative services; contractual risk management; employee benefit surveys and support for litigation services • Over 6 years of experience in workers' compensation and casualty claims auditing • 220 General Lines (Property and Casualty) License [remainder ofpage left blank] 7 SIVER INSURANCE CONSULTANTS KATHLEEN M. GORDON, ARM, AAI Vice President and Senior Consultant EDUCATION Graduate of St. Lawrence University in 1986 with a B.A. majoring in Philosophy. Graduated with Honors and Magna Cum Laude. Member of Phi Beta Kappa. Holds both 218 and 220 Florida Insurance License. Various Insurance Continuing Education courses to include completion of three parts CPCU, three parts AAI, and three parts ARM. BUSINESS EXPERIENCE Has worked in all facets of the insurance industry, including underwriting, agency sales, agency service and management and consulting. Specifically, has worked nine years in insurance agencies with responsibilities varying from large account service management to accounting. Further, has 18 years of insurance and employee benefits consulting experience where projects handled included insurance coverage reviews, marketing of property and casualty and employee benefit programs and administrative services, review of self-funded programs and captives, audits of employee benefit plans, employee benefit surveys and support for litigation services. AREAS OF EXPERTISE Senior consultant for property and casualty and employee benefits accounts. Over 20 years experience in: analysis of insurance coverage, marketing, implementation and auditing of insurance, risk management and employee benefits programs for governments and private enterprise. Extensive experience in the specific insurance needs and issues of Florida public entities of all sorts. Has been a guest lecturer at Public Risk Management Association (PRIMA), Florida Education Risk Management Association (FERMA), Florida Chapters of the National Institute of Governmental Purchasing (NIGP), and Risk and Insurance Management Society (RIMS) on various insurance related topics of relevance to risk managers. SIVER INSURANCE CONSULTANTS THERESA M. CONLEY, MPA, CEBS, RHU Senior Consultant EDUCATION Graduate of the University of South Florida in December 2010 with a Master in Public Administration (MPA). Graduate of the University of Florida in May 2004 with a Bachelor of Arts in Business Administration. Holds a Florida 215 Health, Life and Variable Annuities License. Received the Certified Employee Benefits Specialist (CEBS) designation from the International Foundation of Employee Benefits and the Wharton School of the University of Pennsylvania in August 2014. Received the Registered Health Underwriter (RHU) designation from the American College in 2007. BUSINESS EXPERIENCE Consultant with Siver Insurance Consultants since 2007. Three years prior experience with human resources, workers compensation and health programs including: group medical insurance, group dental insurance, life and Accidental Death & Dismemberment Insurance (AD&D) and short-term disability programs. Human resources experience includes management of the benefit programs and enrollment process for over four hundred employees. Health insurance experience includes claims processing experience. AREAS OF EXPERTISE Consultant for employee benefit services and risk management retainer activities. Health and prescription claims auditing experience. SIVER INSURANCE CONSULTANTS GEORGE W. ERICKSON, JD, CPCU, LLM Executive Vice President and Senior Consultant EDUCATION Graduate of Duke University School of Law (Juris Doctor and Masters - International and Comparative Law), 1996; Attended the Institute of Transnational Law, Brussels, Belgium, 1994; Cum Laude Graduate of University of South Florida (B.A. - Finance), 1992. Received the Chartered Property and Casualty Underwriter (CPCU) designation from the American Institute for Chartered Property and Casualty Underwriters (AICPCU) in 2001. BUSINESS EXPERIENCE Admitted to The Florida Bar, October 1996; Senior Consultant with Siver Insurance Consultants since 1997; Two years with a local agency as Property -Casualty and Life - Health Agent; Two years with an excess and surplus lines broker specializing in aviation and marine insurance and making placements with Lloyd's of London and other overseas and domestic insurance syndicates. AREAS OF EXPERTISE Senior consultant for property and casualty accounts. Extensive experience in: analysis of insurance coverage; contractual risk management; litigation support consulting and expert witness testimony for insurance claims and coverage issues; marketing, implementation and auditing of insurance and risk management programs for governments and private enterprise. Has been a guest lecturer on numerous insurance and risk management related -topics at educational events for the Risk and Insurance Management Society (RIMS), the Public Risk Management Association (PRIMA), the Florida Trial Lawyers Academy (FTLA), the Coalition of Florida Condominium Associations (CFCA), the Florida Educational Risk Management Association (FERMA), and the Association of Legal Administrators (ALA). PROFESSIONAL ASSOCIATIONS Florida Bar Society of Chartered Property and Casualty Underwriters Risk and Insurance Management Society (RIMS) Public Risk Management Association (PRIMA) Florida Educational Risk Management Association (FERMA) Florida Association of Self -Insureds (FASI) SIVER INSURANCE CONSULTANTS LAURA M. RYBKA, JD Consultant EDUCATION Graduate of DePaul University College of Law (Juris Doctor), 2002; received the General Intellectual Property Certificate; Graduate of the University of Illinois at Urbana - Champaign (Bachelor of Science — Psychology), 1996. Holds a FL 215 Health, Life and Variable Annuities License and a FL 220 General Lines Property and Casualty License. BUSINESS EXPERIENCE Admitted to The Illinois Bar, 2002; Admitted to The Florida Bar, 2016; Consultant with Siver Insurance Consultants since 2014; Over fifteen years' experience in the litigation of property and casualty matters, including first and third party claims, insurance coverage disputes, commercial liability, workers' compensation, directors and officers, personal injury coverage, insurance fraud and defense and prosecution of insurance bad faith claims. Five years prior experience with human resources and health programs including group medical insurance, group dental insurance, long-term and short-term disability programs; Two years management of benefit programs. AREAS OF EXPERTISE Consultant for property and casualty and employee benefits accounts. Extensive experience in: analysis of insurance coverage; marketing of property and casualty and employee benefit programs and administrative services; contractual risk management; employee benefit surveys and support for litigation services; workers' compensation and casualty claims audits. PROFESSIONAL ASSOCIATIONS Illinois Bar Florida Bar Chicago Bar Association American Bar Association Public Risk Management Association (PRIMA) Risk and Insurance Management Association (RIMS) C. LITIGATION Siver has not been involved in any past or pending litigation or disputes relating to the work described in the RFP within the last five (5) years. D. FINANCIAL INFORMATION We acknowledge that the RFP requests that we provide a letter from our financial institution detailing the financial status of our corporation. We respectfully request that the City accept Siver's 2018 Accountant's Compilation Report and balance sheet in lieu of a letter from our financial institution to demonstrate our financial solvency. This financial document is included with the "original" copy in a separate envelope and marked as "Confidential Matter" pursuant to Florida Statute 815.045. Please note that the 2019 Accountant's Compilation Report and balance sheet are not yet available at the time of this submission. If selected by the City, Siver will produce the 2019 report upon request. CERTIFICATES OF INSURANCE and LOCAL BUSINESS TAX RECEIPT Included in this Tab A are copies of Siver's current Certificates of Insurance and 2020 Local Business Tax Receipt pursuant to the RFP, Section 3.09 — Completeness. Current Certificates of Insurance: We are attaching a copy of Siver's current certificates of insurance pursuant to the RFP. Local Business Tax Receipt: We are attaching a copy of Siver's 2020 Local Business Tax Receipt issued by the City of St. Petersburg, Florida. ALCOR" CERTIFICATE 4F LIABILITY INSURANCE DATE (MM/DD/YYYY) CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 1/14/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Condon -Meek, Inc. 1211 Court St _NAME__„_.. _ PHONE - -- —�-- FAX - -- (AJC NQ, EXt) 72�-446 5051 ext. 2295 — tA/c rvo� 727-449-1964 _ - -- Clearwater FL 33756 E-MAIL _ADDRESS: COI@condonmeek.com PRODUCTS - COMP/OP AGG $ 2,000,000 — — --- — - - - — — `$ -- INSURER(S)_AFFORDING COVERAGE —_— NAIC # INSURER A: American Casualty Company of Reading, PA__ ;_20427 — INSURED INSURER B: CONTINENTAL CAS CO 20443 E W SIVER & ASSOCIATES INC _ 805 Executive Center INSURER C: Cont_inenta_I_C_asualty Company 20443 — Suite 110 INSURER D: -- -- ---- St PetersburgFL 33702 - INSURER E : i _{Per accidentL— — INSURER F: n0VF:PAnPS rI=RTIEIrATE NIIMRFR• 1An77gd791 REVISION NUMRFR- THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR-----------_--_------------_---- ADDL SUER'---------------- LTR. TYPE OF INSURANCE ! I y ':. POLICY NUMBER --^ POLICY EFF T POLICY EXP '----i^ ! MMIDD/YYYY MMIDDIYYYY ' LIMITS A X COMMERCIAL GENERAL LIABILITY 1023174390 10/15/2019 i 10/15/2020 EACH OCCURRENCE $1 000,000 -� � I CLAIMS-MADE X OCCUR I � DAMAGE TO RENTED - (PREMISES LEa occurrence] $ 300 000 j MED EXP (Any one person) $ 10,000 - I L PERSONAL & ADV INJURY i $ 1,000,000 _ GEN'L AGGREGATE LIMIT APPLIES PER: i ! GENERAL AGGREGATE $ 2,000,000 _POLICY PRO - X !ECT LOC Ji PRODUCTS - COMP/OP AGG $ 2,000,000 — — --- — - - - — — `$ -- OTHER: ! AUTOMOBILE LIABILITY r - ! COMBINED SINGLE LIMIT I $ -____-- ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY .' AUTOS HIRED I NON-OWNEDPROPERTY i DAMAGE $ AUTOS ONLY AUTOS ONLY i _{Per accidentL— — C X UMBRELLA LIAB X1023174437 1023174437 10/15!2019 ! 10/15/2020 EACH OCCURRENCE i $ 3,000,0_00 — EXCESS UAB CLAIMS MADE ( AGGREGATE — — $ 3,000,0.00_ — DED X RETENTION $ 1 p nnn$ B WORKERS COMPENSATION 1023174423 10/15/2019 10/15/2020 ;X PER i I OTH- STATUTE ER AND EMPLOYERS' LIABILITYY 1 N _ _—j ANYPROPRIETOR/PARTNER/EXECUTIVEE.L. EACH ACCIDENT j $ 100,000 OFFICER/MEMBEREXCLUDED?---- (Mandatory in NH) �i` E.L. DISEASE - EA EMPLOYEE? $ 100,000 Ifes, describe under y `DESCRIPTION OF OPERATIONS below t E.L. DISEASE - POLICY LIMIT J $ 500,000 j DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) '.__. CFRTICICATF FI(ll r)f=R (_ANCFI 1 ATInN ACORD 25 (2016/03) U 1985-2015 AGUKD GUKPUKA IIUN. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Sanford ACCORDANCE WITH THE POLICY PROVISIONS. Finance Department, Purchasing Division 300 N. Park Avenue AUTHORIZED REPRESENTATIVE Suite 243, 2nd Floor Sanford FL 32771 ACORD 25 (2016/03) U 1985-2015 AGUKD GUKPUKA IIUN. All rights reserved. The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY DATE (MMIDDIYYYY) 01 /14/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed, If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(sl. IINSURED INSURER B: 4 _......._._...___._____._...-,_._..._._...._.__._....__...,._...,._.._..______..._.__._`.____.,._._..__.__._......_,_.._v.._..,._.._-- E.W. Siver Associates: INSURER a :ry i Siver Insurance Consultan INSURER D: 801 94th Ave N Ste 202 INsuRER E —__ _ _..__.�__._._......_. ._.._.___.__.._.__,_____ _._ ..____....,,-_.___._,..__ Stett?rSOUg, FL $3702 INSURER F M1=VI0IVf4 IMUfVIt$tK: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED PRODUCER co CT Fatima Hughes HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, __ _. Southern Guard Insurance PHONE 1-888-875-0028 GENERAL LIABILITY i 10000 Stirling Rd Ste 6 ER .Ext!;_ ` EACH OCCURRENCE } 3 _O)WNGE I COMMERCIAL GENERAL tIABILrrY i � (---) 1 CLAIMS•MADE 4__J OCCUR ( � t d RAN rcD r 6?rcEfatSES (�a occuirarcoel}__� z —? ` # Cooper City Ft_ 33024 ` ------------------_ IINSURED INSURER B: 4 _......._._...___._____._...-,_._..._._...._.__._....__...,._...,._.._..______..._.__._`.____.,._._..__.__._......_,_.._v.._..,._.._-- E.W. Siver Associates: INSURER a :ry i Siver Insurance Consultan INSURER D: 801 94th Ave N Ste 202 INsuRER E —__ _ _..__.�__._._......_. ._.._.___.__.._.__,_____ _._ ..____....,,-_.___._,..__ Stett?rSOUg, FL $3702 INSURER F M1=VI0IVf4 IMUfVIt$tK: THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, __ _. ____-_ ___ ._ __ ___ _ INS R iALi0IaSUBR: - LTR ` TYPE OF INSURANCE '- I POLICY NUMBER .________. .__ .._,_... i Poi.tCY EFF i MM1DDtY Y 3 MMIDDfYYYY $ LIMITS GENERAL LIABILITY i E ii ` EACH OCCURRENCE } 3 _O)WNGE I COMMERCIAL GENERAL tIABILrrY i � (---) 1 CLAIMS•MADE 4__J OCCUR ( � t d RAN rcD r 6?rcEfatSES (�a occuirarcoel}__� z —? ` # MED EYP (Any one person) S __....____._..—...._... ` ------------------_ I PERSONALS ADV INJURY s 5 F ENERAL AGGREGATE S GEN'L AGGREGATE LIMIT APPLIESPER. I _�; p { PRODUCTS -COMP OP i POLICY PR 4- LOC JEC AUTOMOBILE LIABILITY �J I ANY AUTO i COMBl v DSIM1IT t (Ea acclderttl t 5 1,000,000 s _. . �5ALL /4 1 1 BODILY INJURY (Per porsnn) �+ A I AUTOS ED �Iti, SCHEDULED. iSl 02[),3$898-710115/2019; AUTOS k p L._._......_. ._____.._._.. __—_.. _.....__._ ._ __............._, 10115/2019 i 10115.2020 BODILY INJURY (Per accident) S { NON -OWNED i _^. HIRED AUTOS AUTOS (PROPERTY OrtHL�GE 4 `� r— Pc+r � orient i Is l UMBRELLA LIAO OCCUR t EACH OCCURRENCE $ I EXCESS LIAt3 CLAIMS-MAOE E ; AGGREGATE is OED RETENTION S WORKERS COMPENSATION I I AND FNIPLOYER5'lJABItITY `ANY Y! N s is VC STATU- OTH-: .�I4RX1LhitT.S i F„i� PROPRIETORtPARTNER+EXcCUTIVE i I OFFICER/MFMBER EXCLUDED? f N f A i �_ E.L.EACHACCIDENT CCIDENT 5 (Mandatory in NH) i If describe under i EA E L DISEASE - EA EMPLOYEE yes, DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY-LIP ttF = S 11 Ij i � i 1 k ! DESCRIPTION OF OPERATIONS ! LOCATIONS ! VEHICLES (Attach ACORD 101, Additional Remarks Scheduler If more space is required) CFE2TlFlf`IlTC unt r1ir-0 _ _ - • _ —. _ _ _._ - City of Sanford Finance Department, Purchasing Division 300 N. Park Avenue, Suite 243, 2nd Floor Sanford, Florida 32771 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF NOTICE WILL BE DELIVERED IN ACCORDANCE WITIII(THE POLICY PJEOVISION.9 AUTHORtZEO ACORD 25 (2010105) O988- 10 AC RD CORPORATION. All rights reserved. The ACORD name and logo are registered marks o ACORD FA iTIMIiCI=i7 14ACC>Rf" CERTIFICATE 4F LIABILITY INSURANCE DATE (MMIDDIYYYY) F01/14/2020 TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTANAME: P&C - Direct Business Professional Services MiniCo INS Agency LLC ----- _ __._ _CHIC ,-EXtl 800..528 1056 ! c NoZ 602.760_._305_7_ 10851 N Black Canyon Hwy Ste200 E-MAILs: ADDRES------ Phoenix, AZ 85029 -- j $ _ INSURER(S) AFFORDING COVERAGE NAIC # - - -- - - - - _ �-----._...---.._..-----_ INSURER A: Beazley Ins Co Inc. INSURED EW Siver & Associates dba INSURER B: Siver Mgmt Consultants ---------._____ __.____ 801 94th Ave N Ste 202 INSURER C St Petersburg, FL 33702-2780 INSURER D ------ ---- $— _ _ INSURER E: INSURER F: COVFRAGFS CFRTIFICATF NUMBER- REVISION NUMBER: THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ----- ------- -------------- _%ADDL-SUBR---�_--------------' POLICY EFF POLICY EXP '- LTR , TYPE OF INSURANCE POLICY NUMBER . MMIDDIYYYY MMIDDNYYY '� LIMITS COMMERCIAL GENERAL LIABILITY ; EACH OCCURRENCE $ i CLAIMS -MADE i OCCUR j PREMISES �Ea occurrence] j $ _ MED EXP (Any one person)- $ - - j PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: I--- GENERAL AGGREGATE $ �, PRO- -- POLICY i JECT LOC -------------- PRODUCTS - COMP/OP AGG — ----- ------ ---- $— _ _ OTHER_ $ j AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident] $ ANY AUTO BODILY INJURY (Per person) ! $ — ALL OWNED SCHEDULED— BODILY INJURY (Per accident) $ ?AUTOS AUTOS —1 NON -OWNED li ROPERTY-)DAMAGE $ HIRED AUTOS AUTOS _(Per accident _.- $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB t CLAIMS -MADE! AGGREGATE $ DED I RETENTION$ $ WORKERS COMPENSATION !, .PER OTH AND EMPLOYERS' LIABILITY YIN i f i STATUTE 3ER ---__ ANY PROPRIETOR/PARTNERIEXECUTIVE 1 E.L. EACH ACCIDENT $ j OFFICERIMEMBER EXCLUDED? NIA (Mandatory in NH) E.L. DISEASE - EA EMPLOYES $ If yes, describe under - -- -- - - - — - -- --- -- _.-- - DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT !; $ A !Prof Liability V11D9819PNPM 08/28/2019 ; 08/28/2020 ]per claim 5,000,00 i aggregate 5,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CITY009 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cit of Sanford THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y ACCORDANCE WITH THE POLICY PROVISIONS. Finance Department, Purchasing Division 300 N Park Ave AUTHORIZED REPRESENTATIVE Ste 243, 2 nd floor Sanford, FI- 32771�K ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD F.", I El F RM)"RG, FLOR11DA. L 0 C A I- B �IJ S N E S S T"Alt X R E C E � P T' ACCOUNI kks 'J. 11427 BUSINESS: September 25, 2019 al 01), at"'Ip, u Yr„ fir. PIM,"S 9/30/2020 0111r, AIW1011111 01111111" " � � , "Y111111A WHIM4,111" 011 rwwflffls'� E.W. SIVER AND ASSOCIATES INC 801 94TH AVE N 202 SAINT PETERSBURG FL 33702-2482 20-00062753 DESCRIPTION OF OCCUPATION, PROFESSION, OR BUSINESS COUNSELING/CONSULTING MAIL: INSLYRANCE E.W. SIVER AND ASSOCIATES INC 801 94TH AVE N #202 SAINT PETERSBURG FL 33702 092319 65.00 1070698 TOTAL d d )ns �n hushnc"5:-'�s m"Ik/Iiyj [r[,",vy �equi�n ack:Hfiand cankiaci d -lis nH'Ice, k)ef,-,)I-e charj�"jcs or �f the" orl (his doe,s nc)t mflect your bus[ness „�IdJvity. addI�Jon�al I r 11 @IlM r4 !() Hl,l-IBarr e, (flab., n-iay � es,(ffl in �)enadty fe(=,,s h�-ng ,assessed, D�,sr)lay ffi�s rxmspic;I,�oushy at @H tillies Irl the, �-"dac'e (:�)[ busilless. if is no o� !")u,3iness' rl[us� b(�a tc) any ,,ffice- (:rroMcet ofHh(,', cify Lq.)on their ' k/kanytaxc�s fmn-� cwlc' ovvnc,� 1c) anothc-.�l`, �oca�icl,n tc)'an(j(h("[' Tc) this con�,--fct cMI- office h Vnfnrniai on '-ind ffld fffl ill TKI Iwy' fights, tax �c'ceII')t hh 65.00 0.00 0.00 0.00 ch), ordl�ytamce or is "of uin 0", a� djsa�pqprtan d oktho l"'o4de""s SIdH or k"u, rvcf'lJpl! k' rt'uprool, of flic v('nq;l wm. or o. if"hv' h"00wr vvflh odie�" LUIOSII regular(ion's fw s'll"""tuhwds' In 2dh'fiH^ 'n a' O'bil"aining 'lhis �ocal !"'w'Jl1e',s Gov lmldt'r sha'H hu Y' fc/ comrflyhIg aviIlh afl hw''s. and 4jc�u('Hnl�� ho� Hntt Acd ro the Cow"rrmAou nod" zor,raJ'q (Pari(" W n°v ovvncr) Ovvncr) ouIlv�ondny H r oj 6'I ,�)J'l I tO I'll, F:'hom1 893 /241 t TAB B SIMILAR PROJECTS TYPE OF CLIENT/ CLIENT NAME AND ADDRESS/ TERM OF DESCRIPTION OF CLIENT CONTACT ENGAGEMENT CONSULTING SERVICES CITY OF WINTER HAVEN Municipality Review of Employee Benefit programs 451 Third Street NW Winter Haven, FL 33883-2277 1983 to Present Developed RFPs and Analyzed proposals for Medical services Ms. Michele Stayner Tel.: (863) 291-5600 Audit of Self -Funded Medical plan Email: mstUner@mMinterhaven.com Mr. Cal Bowen General Employee Benefit retainer services Finance Director Tel.: (863) 291-5667 Email: cbowen@myEinterhaven.com CITY OF LARGO Municipality Developed RFPs and Analyzed proposals 201 Highland Ave NE for Medical services, Dental, Life, Largo, FL 33779-0296 1981 to Present Employee Health Clinic Ms. Susan Sinz Provided Analysis and Recommendation Director of Human Resources Tel.: (727) 587-6716 Clinic Feasibility study Fax: (727) 587-6782 Email: ssinz@largo.com Renewal rates and terms negotiations SOUTH BROWARD HOSPITAL DISTRICT Hospital Evaluation of Disability, Life, LTC, and 3501 Johnson Street Excess Loss. Hollywood, FL 33021 1998 to Present Develop RFPs for Disability Products, Mr. Ed Werner Life, Long Term Care Insurance and Administrative Director, HR Claims Administration Services Tel.: (954) 265-5467 Email: EWemer@MHS.net Proposal Analysis and Recommendations Following Bid Openings and renewals SCHOOL BOARD OF HIGHLANDS School Board Marketing of Employee Benefits, Analysis COUNTY and Recommendation 426 School Street 1999 to Present Sebring, FL 33870 Develop RFPs for Medical (Fully insured and ASO), Stop Loss, Prescription, Life, Mr. Richard "Bo" Birt LTD, Vision, Dental, Life Insurance, Director of Finance Flexible Benefits Administration Services Tel.: (863) 471-5664 Fax: (863) 471-5612 Renewal rates and terms negotiations Email: birtr@highlands.k12.f1.us Clinic Feasibility Report CLIENT NAME AND ADDRESS/ CLIENT CONTACT TYPE OF CLIENT/ TERM OF ENGAGEMENT DESCRIPTION OF CONSULTING SERVICES Ongoing participation in Employee Benefits Insurance Committee SCHOOL DISTRICT OF MARION School Board Marketing of Medical Plan, Analysis and COUNTY Recommendation 1105 SW 7`h Road 2012 to Present Ocala, FL 34471 Develop RFPs for Medical, Dental and Vision Lori Lively, BA, ARM Director, Risk Management Renewal rates and terms negotiations Tel: (352) 671-6910 Fax: (352) 671-4100 General employee benefit retainer services Email: lori.lively@marion.kl2.f1.us Total Annual Amount of Contract: Siver's compensation varies according to each project. Below is a summary of project amounts for these references. 1. Winter Haven (Self -Insured): a. Renewals: most recent included 2020 renewal at standard billing hourly rates. b. Medical Audit: most recent audit included a project budget of $20,000 flat fee. c. Surveys and ongoing consulting: Intermittent and at standard billing hourly rates. d. RFP Projects: Intermittent and at standard billing hourly rates with project caps. 2. Largo: a. RFP for Group Life Insurance — 2019. $12,000 flat fee b. RFP for Group Long Term Disability — 2018. $12,500 flat fee c. Intermittent past projects including Medical RFP (Fully Insured with Consortiums allowed to propose), Dental (Fully Insured) and Employee Health clinic. Intermittent and at standard billing hourly rates with project caps. 3. South Broward Hospital District: a. RFP for Long Tenn Care Insurance — 2020 ongoing. Standard billing hourly rates. b. RFP for Group Voluntary Life Insurance — 2019/2020 ongoing. Standard billing hourly rates. c. RFP for Group Long Term Disability — 2019. Standard billing hourly rates. d. RFP for Pet Insurance — 2018. Standard billing rates with a project maximum of $20,000. 10 e. Intermittent past projects including RFP for Claims Administration Services and Short Term Disability/Critical Illness Insurance. Intermittent and at standard billing hourly rates with project caps. 4. School Board of Highlands County (Self -Insured): a. RFP for ASO Medical and Rx Claims Administration Services: 2018 and 2019. Standard billing hourly rates. b. Annual Medical and Prescription audits. 2016, 2017, 2018. $28,000 flat fee annually. c. Intermittent past projects including RFP for Claims Administration Services, Dental ASO services, other benefits. Intermittent and at standard billing hourly rates with project caps. d. Clinic Feasibility Report — 2017. Cap of $6,500. e. Ongoing consulting: Intermittent and at standard billing hourly rates. 5. School District of Marion County (Fully Insured): a. RFP for Dental (Fully Insured) Insurance — 2019. $18,000 flat fee. b. RFP for Medical and Rx (Fully Insured) Insurance — 2018. $32,000 flat fee. c. RFP for Group Life Insurance — 2018. $16,500 flat fee. d. RFP for Group Disability Insurance — 2018. $15,000 flat fee. e. Intermittent past projects including RFP for Medical RFP, Dental Insurance, Vision insurance. Intermittent and at standard billing hourly rates with project caps. f. Ongoing consulting: Intermittent and at standard billing hourly rates. Attachment "O" — References: We have included Attachment "O" — References in Tab D — Forms. 11 TAB C PROJECT APPROACH A. State your firm's technical approach to the proiect and the interpretation of the scope of services required. Siver understands the Scope of Service requested and listed under both Sections 1.04 (via updated addendum) and Section 2.05 of the City's RFP. From Minimum Qualifications: We are confirming that we have the experience with health and wellness program studies including the following areas: a. Health and wellness programs including insurance structure and policy; b. Health insurance benefits, such as co -pays, co-insurance, deductibles and various types of coverage; c. Program costs such as administrative fees and excess insurance; d. Claims cost and mitigation of claims cost; e. Wellness Program incentives and programs; f. Wellness Center viability and costs; and g. Contractual language of providers of health insurance and wellness related products. Please see our sample report from the City of Hallandale Beach in Section 5.07. We will be able to provide the following review as requested: a. Review the City's health insurance program, including insurance structure and policy; b. Review the City's health insurance benefits, such as co -pays, co-insurance, deductibles and various types of coverage; c. Review the program costs such as administrative fees and excess insurance; d. Review and access the claims cost and mitigation of claims cost; e. Review and provide an analysis on the wellness program incentives and programs; £ Review the Wellness Center viability and costs and current contract in place; and g. Review the contractual language between City and providers of health insurance and wellness related products in order to determine if the City's - programs and costs, based on number of members and demographics of the members, are or are not, reasonable and expected. 12 PROJECT EXPERIENCE AND APPROACH PART I — REVIEW Current Health Insurance Plan Review We will perform a comprehensive review of the City's current health insurance plan. This will include reviewing coverage and analyzing and evaluating all things related to this benefit including: benefit plan design, pricing of the insurance product, administration services and the contract, coverages, pooling and potential self-insured levels (i.e. stop -loss), claims experience and other factors to understand the "big picture" of your health insurance program. We routinely complete these types of benefit reviews for our current clients on retainer and those on a project basis. All items listed in 2.05, IV, we will include in this review. Benchmarking Other Entity's Benefits We will review and compare other Florida government entities' benefits to the City's health insurance plan. We anticipate being able to specifically review six to eight governments in the general size and area as the City. We also will use other client examples and provide other relative data from other government entities throughout the state that we believe will help show some of the same challenges as the City is experiencing and their outcomes. Our proposal does not include completing a formal survey for this report. Onsite Employee Health Clinic Review We will review how the onsite employee health clinic is financially affecting the health plan and employee population. Previously, we have assisted a few of our clients in the RFP process for reviewing the feasibility of a clinic. We currently work closely with Pasco Schools who previously was contracted with CareHere and now with MyHealth Onsite, so we have an understanding of how this entity has run their clinics, the effect on the health plan, funding, staffing, number of locations, services offered, reporting, etc. We understand that the City of Sanford shares a portion of the clinic services with other entities. We will also ensure that this is included in the review. Wellness Initiatives Without having a complete understanding of what wellness services are currently offered, we routinely recommend that our clients incorporate wellness initiatives to control costs on a long term basis and to improve productivity and absenteeism. We usually recommend that our clients review what services are available within the community and not duplicate existing services or programs. For example, many of our municipal clients have strong relationships with local hospital systems. These hospital systems often have strong programs established both for the community and for their employees. With the employee clinic, we will learn what wellness initiatives are running through the clinic, if any and provide feedback and review on incentives, programs and costs. We will review 13 for any return on investment numbers where appropriate and we feel comfortable with asserting. Pmereing Trends We strive to always maximize benefits for employees and their dependents within the available cost constraints. We strive to always be respectful of the effect of changes to both employees and their families and to our client. We will consider other items in the review which may include the following items that we've reviewed for other clients with similar requests: Disease Management Programs We recommend that our clients encourage their health administrators and insurers to provide disease management services for plan members who have certain diseases, such as diabetes, asthma and high blood pressure. Health outcomes, and subsequent costs, are significantly improved with improved education and other assistance for the plan member suffering the disease. For self-insured clients, we have seen separate vendors brought in to assist and coordinate with the administrator to provide disease management services. To consider, it can cause both privacy and coordination issues for a separate vendor to provide disease management services. Some of the various initiatives we have recommended our clients consider include: Health Risk Assessments and Biometric Screenings We have seen many of our clients push to begin health risk assessments and biometric screenings to have baseline health indicators for their employees. For those with more in depth wellness programs, these indicators help to guide employees and those involved in the wellness program including insurers, administrators, third party sources, etc. with what types of programs should be implemented across the board as a whole. Through HIPAA guidelines, this can also assist with what programs can be offered on a specific level to employees. We have seen premium credits been given on renewal for clients who have promised to enter into more in-depth wellness programs. We have frequently recommended that our clients incorporate some form of wellness into their programs to potentially help control future costs. Smoking Cessation Praerams We have recommended that our clients consider various different smoking cessation measures. Consideration can be given to amending prescription drug coverage to include popular drugs used to assist in quitting smoking, allowing organizations to use City facilities for classes or group meetings, encouraging participation in smoke free days, and not allowing smoking on City property. Weight Loss Pro rams We have recommended that our clients consider various different weight loss programs. Common examples include discounts for employees for Weight Watchers membership or other programs or allowing such programs to use City facilities for meetings for no or a reduced charge. 14 Health Fairs We have recommended that our clients consider health fairs to promote awareness of various different initiatives both in the community and within the wellness program. Exercise Programs We have recommended various different initiatives to encourage physical fitness, such as walking programs, pedometer give-away programs, and discounts to fitness centers. When a municipality includes police and fire fighter employees, it is recommended that wellness programs target these populations due to the workers' compensation presumption issues. Other Considerations The following are some of the concepts we have recommended to reduce and/or control health care costs: Program Competition While we do not recommend competition every year for all insurance plans, we do believe that it is important that the vendors involved with the program sense that if service or pricing is not advantageous to our client, the vendor will be replaced. While competition does not change many of the pressures driving health cost increases, it does help control having vendors make unnecessary profits at our clients and their employees expense. Plan DesL9n Changes Unfortunately, one way to control or reduce costs on the health plan is to make plan design changes. Increasing co -payments for primary and specialty care, increasing deductibles, increasing out of pocket maximums and increasing prescription co -payments are typical steps taken to reduce costs. Plan design changes cannot be avoided in many situations; however, we prefer to look at plan design changes which direct behavior, such as the addition of a non -preferred drug co -payment class, which can encourage plan members to question whether less expensive drugs are viable alternatives, or increasing the office visit co -payment for specialists while retaining a relatively low co -payment for primary care office visits, which can encourage members to visit primary care level providers. Employee Contributions The method that the cost for benefits is shared between the City and employees can be reviewed to determine if the correct contribution structure is consistent with the goals of the program. If the City would like, we can help evaluate alternative contribution structures. 15 PART 2 —DRAFTING OF REPORT Strategic Planning We will meet with City staff either at the beginning of the review or post review to discuss the findings to ensure that we are on the same page with the scope and any review not needed to be completed or items we missed. We are very flexible and want to ensure that we review what the City is requesting. After reviewing all the above issues, we will summarize, define and prioritize the health and other benefit plan objectives. We will discuss the long term ramifications of any potential benefit changes and the financial impact that they may have on the City. We assume that the City would like to maintain a flexible and competitive benefits package while maximizing resources and City dollars. We are always available by phone to discuss daily issues and anything that needs to be reviewed and discussed with staff in a timely manner. Financial Analysis and Recommendations We will provide a thorough and concise analysis of what is being requested by the City in a readable and understandable report format which will include supporting documentation and exhibits where appropriate. We will summarize the findings at the beginning of the report and then go into detail for each item throughout the report. Our reports are very detailed yet provided in a readable manner. Please see Tab F for a sample older report we completed for the City of Hallandale Beach. The report is not as recent as requested, which is why we did not include the project as a reference within the last three years, but it gives a great example of the detail that we are able to provide in our reports. In addition, it deals with many of the same items that the City of Sanford is requesting to review. B. Define the adequacy of resources, including personnel, labor, equipment and supply resources, and other requirements to provide the requested services. Our firm's resources include technology that allows our consultants to collaborate and work remotely, as needed. All consultants have 24/7 remote access to Siver's server and clients' documents, as well as the ability to communicate with each other and our clients through cell phone and email. Location of Consultants: Main Office 80194'11 Avenue North, Suite 202 St. Petersburg, Florida 16 Primary Co -Lead Consultants: We are proposing Kathy Gordon and Theresa Conley as the City's primary co -lead consultants and will perforin the services included in the scope of services in the RFP. Siver's employee benefits consultants routinely work together on all of their projects and provide back-up to all projects underway which allows them the ability to pick up where one has left off if needed. We strive to make all our clients feel important with both face to face meetings and via conference call whenever needed. Kathy Gordon, ARM, AAI Vice President and Senior Consultant Detailed Role: Ms. Gordon will be the co -lead consultant for the City and one of the primary contacts for the City. Ms. Gordon will attend all City meetings, including City Commissioner meetings and implementation and plan design meetings. She will be involved in all stages of the project as set forth in the RFP and in Siver's response. Summary of Employee Benefits Experience: Ms. Gordon has extensive experience in various benefits programs, including but not limited to group health (both self-insured and fully insured), life, disability, dental, vision and Medicare insurance, employee assistance programs, flexible spending accounts, health savings accounts, and health reimbursement accounts. She has been performing audits of employee benefit plans for over sixteen (16) years. Additionally, she has assisted Siver's clients in the design, marketing and analysis of typical benefit plans and has drafted plan documents for self-insured programs and cafeteria plans. Theresa Conley, MPA, CEBS, RHU Senior Consultant Detailed Role: Ms. Conley will be the co -lead consultant for the City and one of the primary contacts for the City. She will be available to attend any City meetings if Ms. Gordon is unavailable. Ms. Conley will be involved in all stages of the project as set forth in the RFP and in Siver's response. Summary of Employee Benefits Experience: Ms. Conley has extensive experience in various benefits programs, including but not limited to medical and prescription claim audits, group health (both self- insured and fully insured), life, disability, dental, vision and Medicare insurance, employee assistance programs, and flexible spending accounts, health savings accounts and health reimbursement accounts. She has been performing both medical and prescription audits of employee benefit plans for over 13 years. Additionally, she has assisted Siver's clients in the design, marketing and analysis 17 of typical benefit plans and has drafted plan documents for self-insured programs and cafeteria plans. Assistant Consultants/Team Members for the Contract Review: The Assistant Consultants/Team Members will be available to assist the City and the Primary Consultants, as needed. George Erickson, JD, CPCU, LLM Executive Vice President and Senior Consultant Detailed Role: Mr. Erickson will assist your primary consultants, as needed. He is able to provide additional legal consulting as relates to benefit compliance or other generalized legal expertise as needed. He will assist with the review of the contracts in place for the City. Summary of Employee Benefits Experience: Mr. Erickson has worked on various employee benefit project since he joined Siver in 1997. He has consulted regarding our clients' health plans, both self- insured and fully insured, life insurance plans, disability insurance plans, dental plans and has performed medical claim audits. Laura M. Rybka, JD Consultant Detailed Role: Ms. Rybka will assist your primary consultants, as needed. She is able to provide additional legal consulting as relates to benefit compliance or other generalized legal expertise as needed. She will assist with the review of the contracts in place for the City. Summary of Employee Benefits Experience: Ms. Rybka has worked on various employee benefit project since she joined Siver in 2014. She has consulted regarding our clients' health plans, both self-insured and fully insured, life insurance plans, disability insurance plans, dental plans and has performed medical claim audits. Outside of the computers and electronic resources, we do not anticipate any additional needs for equipment or supply resources that would add any extra cost to the project. 18 C. Provide a clear statement of the specific services and tasks to be performed. Include information concerning each task and staff committed to accomplish each task. 1. Kathy Gordon, ARM, AAI Detailed Role: Ms. Gordon will be the co -lead consultant for the City and one of the primary contacts for the City. She will be involved in all stages of the project as set forth in the RFP and in Siver's response. She will work directly on the project review, research and drafting of the report 2. Theresa Conley, MPA, CEBS, RHU Detailed Role: Ms. Conley will be the co -lead consultant for the City and one of the primary contacts for the City. Ms. Conley will be involved in all stages of the project as set forth in the RFP and in Siver's response. She will work directly on the project review, research and drafting of the report. Assistant Consultants/Team Members for the Contract Review: The Assistant Consultants/Team Members will be available to assist the City and the Primary Consultants, as needed. 3. George Erickson, JD, CPCU, LLM Detailed Role: Mr. Erickson will assist your primary consultants, as needed. He is able to provide additional legal consulting as relates to benefit compliance or other generalized legal expertise as needed. He will assist with the review of the contracts in place for the City including the medical and prescription ASO agreements and the clinic contract. 4. Laura M. Rybka, JD Detailed Role: Ms. Rybka will assist your primary consultants, as needed. She is able to provide additional legal consulting as relates to benefit compliance or other generalized legal expertise as needed. She will assist with the review of the contracts in place for the City including the medical and prescription ASO agreements and the clinic contract. Commitment to Accomplish Each Task We routinely work on multiple projects within the same timeframe. Based on the quick turnaround time that the City has requested in the RFP, we have confirmed internally that we have the time and ability to be able to complete the project and report but will need to extend the timeline by 30-45 days. We do believe the timeline is tight and will need to work with the City on the ability to start work as soon as possible. Once we are able to start on the project, we will move forward with the project in an expedient manner once approved. 19 D. Provide a typical response time and/or project implementation schedule for proposed services including any management and planning strategies. We are confirming that we will work with City staff to complete all work within the agreed upon timelines set forth at the beginning of the project. The deadline of March 31, 2020 will need to be extended 30-45 days to have all the required information reviewed and completed. The City and Siver will need to ensure that the consultant contract is completed timely so we can begin work immediately. We will move forward with the project in an expedient manner once approved. Draft Timeline: DATE ITEM January 30, 2020 RFP Due Date February 3 — February 14 Review of RFP Responses by the City February 17 — 28 Contract with Consultant March 2 — March 13 Begin work. Meet with Staff to determine all items for scope of work March 16 —April 10 Review of program(s); Survey Entities; Draft Report April 13 — 30 Finalize Report and all exhibits April 30 Present Report to City staff A number of assumptions are made for the timeline. We will work with the City to address any specific timing needs that are required. We have the staff to be able to complete the project in a timely manner that will work for both parties. E. Provide information regarding any proposed innovative concepts that may enhance the value and quality of the services to be performed. Please see Tab F for a sample report we completed for the City of Hallandale Beach. The report is outside the three-year window, which is why we did not include the project as a reference within the last three years, but it gives a great example of the detail that we are able to provide in our reports. In addition, it deals with many of the same items that the City of Sanford is requesting to review. We have the ability to customize the report to what the City is requesting. 20 Attachment "B" Bid Price Schedule and Acceptance of Bid Terms and Conditions *I I1➢f1S Section 1112.05(iature annai reviews) and Secion 2.05 Xlll unlirnited on-call support) - Please gee 1"ab f, ... ➢`eeSchedule] I/we, the undersigned, as authorized signatory to commit the firm, do hereby accept in total all the terms and conditions stipulated and referenced in this RFP document and do hereby agree that if a contract is offered or negotiated it will abide by the terms and conditions presented in the RFP document or as negotiated pursuant thereto. The undersigned, having familiarized him/herself with the terms of the RFP documents, local conditions, and the cost of the work at the place(s) where the work is to be done, hereby proposes and agrees to perform within the time stipulated, all work required in accordance with the scope of services and other documents including Addenda, if any, on file at the City of Sanford Purchasing Division for the price set forth herein in Attachment "B" Bid Price Schedule and Acceptance of Bid Terms and Conditions. The signature(s) below are an acknowledgment of my/our full understanding and acceptance of all the terms and conditions set forth in this RFP document or as otherwise agreed to between the parties in writing. Bidder/Contractor Name: E. W. Siver & Associates, Inc. dba Siver Insurance Consultants Mailing Address: P.O. Box 21343, St. Petersburg, FL 33742-1343 Tel p one Numbe : (727) 577-2780 Fax Number: n/a E-mail Address: kgordon(c),siyer.com Kathy Gordon Au orized Sjjnatory Printed Name Title Vice President Date COUNT' OF PINELLAS STATE OF FLORIDA FEIN: 59-1712226 On this a S/ iti day of January, 20 20 before me, the undersigned Notary Public of the State of Florida, personally appeared Kathy Gordon whose name(s) is/are subscribed to the within instrument, and he/she/they acknowledge that he/she/they executed it. WITNESS my hand and official seal. He/She is personally known to me or has produced J'),t i v '- '- -5 17G e y r S C , as identification. the County and State Aforementioned) RYPWMITCHELL SORBY .� A MY COMMISSI (Sg W i expires: Gtr 7 (� r.' t. 2 CG-?. 3 EXPIRES: October 8, 2023. Bonded Thru Notary Public UndanOters OMPLETE AND SUBMIT WITH FOUR RFP RESPONSE Failure to submit this form may be grounds for disqualification of your submittal's 30 City of Sanford I Finance Department I Purchasing Division 300 N. Park Avenue Suite 243 2°a Floor, Sanford Florida 32771 Phone: 407-688-5025, or 5030 1 Fax: 407-688-5021 FRJANC[ ()r.FARTh1FNT REQUEST FOR PROPOSALS (I FP)TERM OST CONTRACTTITLE: HEALTH INS NCE chi WELLNESS PROGRAM)Y Attachment "B" Bid Price Schedule and Acceptance of Bid Terms and Conditions *I I1➢f1S Section 1112.05(iature annai reviews) and Secion 2.05 Xlll unlirnited on-call support) - Please gee 1"ab f, ... ➢`eeSchedule] I/we, the undersigned, as authorized signatory to commit the firm, do hereby accept in total all the terms and conditions stipulated and referenced in this RFP document and do hereby agree that if a contract is offered or negotiated it will abide by the terms and conditions presented in the RFP document or as negotiated pursuant thereto. The undersigned, having familiarized him/herself with the terms of the RFP documents, local conditions, and the cost of the work at the place(s) where the work is to be done, hereby proposes and agrees to perform within the time stipulated, all work required in accordance with the scope of services and other documents including Addenda, if any, on file at the City of Sanford Purchasing Division for the price set forth herein in Attachment "B" Bid Price Schedule and Acceptance of Bid Terms and Conditions. The signature(s) below are an acknowledgment of my/our full understanding and acceptance of all the terms and conditions set forth in this RFP document or as otherwise agreed to between the parties in writing. Bidder/Contractor Name: E. W. Siver & Associates, Inc. dba Siver Insurance Consultants Mailing Address: P.O. Box 21343, St. Petersburg, FL 33742-1343 Tel p one Numbe : (727) 577-2780 Fax Number: n/a E-mail Address: kgordon(c),siyer.com Kathy Gordon Au orized Sjjnatory Printed Name Title Vice President Date COUNT' OF PINELLAS STATE OF FLORIDA FEIN: 59-1712226 On this a S/ iti day of January, 20 20 before me, the undersigned Notary Public of the State of Florida, personally appeared Kathy Gordon whose name(s) is/are subscribed to the within instrument, and he/she/they acknowledge that he/she/they executed it. WITNESS my hand and official seal. He/She is personally known to me or has produced J'),t i v '- '- -5 17G e y r S C , as identification. the County and State Aforementioned) RYPWMITCHELL SORBY .� A MY COMMISSI (Sg W i expires: Gtr 7 (� r.' t. 2 CG-?. 3 EXPIRES: October 8, 2023. Bonded Thru Notary Public UndanOters OMPLETE AND SUBMIT WITH FOUR RFP RESPONSE Failure to submit this form may be grounds for disqualification of your submittal's 30 City of Sanford I Finance Department I Purchasing Division (D 300 N. Park Avenue Suite 243 2nd Floor, Sanford Florida 32771 NFORD Phone: 407-688-5028 or 5030 1 Fax: 407-688-5021 FWAKE DEPARTMENT REQUEST FOR PROPOSALS (RFP) TERM CONTRACT Attachment I'D" Conflict of Interest Statement E. W. Siver & Associates, Inc. dba A. I am the of Vice President with a local office in Siver Insurance Consultants [Insert Tide] [Insert Company Name] and principal office in St. Petersburg,, Florida B. The entity hereby submits an offer to RFP 19/20-47 Health Insurance & Wellness Program Study C. The AFFIANT has made diligent inquiry and provided the information in this statement affidavit based upon its full knowledge. D. The AFFIANT states that only one submittal for this solicitation has been submitted and tendered by the appropriate date and time and that said above stated entity has no financial interest in other entities submitting a proposal for the work contemplated hereby. E. Neither the AFFIANT nor the above named entity has directly or indirectly entered into any agreement, participated in any collusion or collusive activity, or otherwise taken any action which in any way restricts or restraints the competitive nature of this solicitation, including but not limited to the prior discussion of terms, conditions, pricing, or other offer parameters required by this solicitation. F. Neither the entity nor its affiliates, nor anyone associated with them, is presently suspended or otherwise prohibited from participation in this solicitation or any contract to follow thereafter by any government entity, G. Neither the entity nor its affiliates, nor anyone associated with them, have any potential conflict of interest because and due to any other clients, contracts, or property interests in this solicitation or the resulting project. H. I hereby also certify that no member of the entity's ownership or management or staff has a vested interest in any City Division/Department/Office. I. I certify that no member of the entity's ownership or management is presently applying, actively seeking, or has been selected for an elected position within City of Sanford government. J. In the event that a conflict of interest is identified in the provision of services, I, the undersigned will immediately notify the City in writing. By the signature(s) below, I/we, the undersigned, as authorized signatory to commit the firm, certify that the information as provided in Attachment "D", Conflict of Interest Statement, is truthful and correct at the time of submission. Gti7 i , . AFFIANT SIGNATUIt:I: �'` Kathy Gordon Typed Name of AFFIANT Vice President Title COUNTY OF PMLLAS STATE OF FLORIDA On this_6_day of January , 2020 before me, the undersigned Notary Public of the State of Florida, personally appeared Kathy or 6h whose name(s) is/are subscribed to the knovun tome or has produced y g Y y e >s personally within s executed it. WITNESS m hand 1 seal. Hrk Sh.. ..s ......w . _.._. acknowledge that he/she/thee } instrument an e e e ac ow (Notary Public in and for the County and State Afor&no tioned) THERESA M. CONLEY Notary Public •Skate of Florida Commission " GG 909481 My p DE T, My Comm. Expires Sep 2, 2023 SEAL M commission expires: ' � a„��. �� p °� "�> PLEASE COMPLETE AND S1,41MIT 'WITH YOUR RFP RE,. PONSPnded through National Notary Assn. 'Failure to submit this form may be grounds for disqualification o your su initial City of Sanford J Finance Department I Purchasing Division 300 N. Park Avenue Suite 243 2°d Floor, Sanford Florida 32771 Phone: 407-688-5028, or 5030 1 Fag : 407-688-5021 S ORD ruNANCEDEPAUMENT REQUEST FOR PROPOSALS (RFP) TERM CONTRACT a 'I "Vale 1 i'111 DIMMOM k 11 Attachment "C" NON COLLUSION AFFIDAVIT The undersigned, by signing this document hereby certifies that the company named below hereby is or does: 1. States that the entity named below and the individual signing this document has submitted the attached bid or proposal: 2. He is fully informed respecting the preparation and contents of the attached proposal and of all pertinent circumstances respecting such proposal, 3. Said bid or proposal is genuine and is not a collusive or sham bid or proposal; 4. Neither the said bidder or proposer nor any of its officers, partners, owners, agents, representatives, employees or parties in interest, including this affiant, has in any way colluded, conspired, connived or agreed, directly or indirectly with any other bidder, proposer, firm or person to submit a collusive or sham bid or proposal in connection with the Contract for which the attached bid or proposal has been submitted or to refrain from bidding or proposing in connection with such Contract, or has in any manner, directly or indirectly, sought by agreement or collusion or communications or conference with any other bidder, proposer, firm or person to fix the price or prices in the attached bid or proposal or of any other bidder of proposer, or to fix any overhead, profit or cost element of the bid or proposal price or the bid or proposal price of any other bidder or proposer, or to secure through any collusion, conspiracy, connivance or unlawful agreement any advantage against the City of Sanford or any person interested in the proposed Contract. 5. The price or prices quoted in the attached bid or proposal are fair and proper and are not tainted by any collusion, conspiracy, connivance or unlawful agreement on the part of the bidder or proposer or any of its agents, representatives, owners, employees, or parties in interest, including the individual signing this document. E. W. Siver & Associates, Inc. dba Siver Insurance Consultants Bidder (�Vc 1—K-2020 Signature of Authorized Rel r) sentative (Affiant) Date Kathy Gordon, Vice President Printed or Typed Name and Title of Authorized Representative (Affiant) COUNTY OF PINELLAS STATE OF FLORIDA On this .. d day of January , 2o2O , before me, the undersigned Notary Public of the State of Florida, personally appeared Kathy Gor on whose name(s) is/are subscribed to the within instrument and he/she/they acknowledge at e s eeYexecuted it. WTNESS my hand and official seal. HeIS e is persona (kown to -me ior has produced lly as identification. (Notary Pdblic in and for the County and State ,4dit)rementioned) � ems=7- M. CONLEY State of FloridaSEAL My commission expires; �9481 �81 GG 9p 2, 2 �' d"'" 0I.V fres Se 2, 2023T__. Boional Notary Assn. PLEASE COMPLETE AND SUBMIT WITH YOUR RFP RE,.' 1() v S E or Failure to submit this form may be grounds for disqualification of your submittal'w City of Sanford I Finance Department I Purchasing Division 300 N. Park Avenue Suite 243 2nd Floor, Sanford Florida 32771 Phone: 407-688-5028, or 5030 1 Fax: 407-688-5021 "'S ORD FINANCE DRARVAUG REQUEST FOR PROPOSALS WP) TERM CONTRACT TITLE: HEALTH INSURANCE & WELLNESS PROGRAM STUDY Attachment "I" Drug -Free Workplace Certification When applicable, the drug-free certification form below must be signed and returned with the RFP response. In order to have a drug-free workplace program, a business shall: A. Publish a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees for violations of such prohibition. B. Inform employees about the dangers of drug abuse in the workplace, the business' policy of maintaining a drug-free workplace, any available drug counseling, rehabilitation, and employee assistance programs, and the penalties that may be imposed upon employees for drug abuse violations. C. Give each employee engaged in providing the commodities or contractual services that are under bid a copy of the statement specified in the first paragraph. D. In the statement specified in the first paragraph, notify the employees that as a condition of working on the commodities or contractual services that are under bid, the employee will abide by the terms of the statement and will notify the employer of any conviction of; or plea of guilty or nolo contendere to, any violation of chapter 893, Florida Statutes, or of any controlled substance law of the United States or any state, for a violation occurring in the workplace no later than five (5) days after such conviction. E. Impose a sanction on, or require the satisfactory participation in, a drug abuse assistance or rehabilitation program if such is available in the employee's community, by any employee who is so convicted. F. Make a good faith effort to continue to maintain a drag -free workplace through implementation of the foregoing provisions. By the signatife(s) below, I/we',.the Undersigned, as authorized signatory to commit the firm, certify that the information as provided in Attachment r rt r- Wdrkplac "L,�Cerdfica#on, is truthful and correct at the time of submission. AFFIANT SI6WkttjR.1-,; Kathy Gordon i I ) Typed Name of AFFIANT Vice President Title COUNTY OF PINELLAS STATE OF FLORIDA 'C PIP On this day of January 2020 before me, the undersigned Notary Public of the State of Florida, personally appeared Kath n whose name(s) is/are subscribed to the within instrument, and he/she/they acknowledge that he/she/they executed it. WITNESS my hand and official seal. He"IS'_h-e"ispeiriOnav, known to me"or has produced as identification. THERESA M. CONLEY Notary Public - State of Florida (Notary Public in and for the County and State Aforementioned) Commission # GG 909481 My commission expires: MY Comm. Expires Sep 2, 2023 SEAL Bonded through National Notary Assn. M:2 pqVIT. PLEASE COMPLETE AND S03MITVITH YOUR RFP RESPONSE w'Failure to submit this form may be grounds for disqualification of your submittal -w 140 City of Sanford ( Finance Department I Purchasing Division 300 N. Park Avenue Suite 243 2"a Floor, Sanford Florida 32771 Sk4FORD Phone: 407-688-5028, or 5030 1 Fax: 407-688-5021 REQUEST FOR PROPOSALS (RFP) TERM CONTRACT Attachment 'IN" Addendum Receipt Acknowledgement Certification The undersigned acknowledges receipt of the following addenda to the solicitation document(s) (Give number and date of each): Addendum No. Addendum No. Addendum No. Dated: January 22, 2020 Dated: Dated: Addendum No. Dated: Addendum No. Dated: By the signature(s) below, Uwe, the undersigned, as authorized signatory to commit the firm, certify that the information as provided in Attachment 'IN", Addendum Receipt Acknowledgement Certification, is truthful and correct at the time of submission. Bidder/Contractor Name: E. W. Siver & Associates, Inc. dba Siver Insurance Consultants Mailing Address: P.O. Box 21343, St. Petersburg, FL 33742-1343 Telephone Number: (727) 577-2780 Fax Number: n/a —E-mail Address: kgordon(d,)siver.corn Kathy Gordon FEIN: 59-1712226 Authorized Sionatory Vice President Title Printed Name 1, rr// - '7 Date PLEASE COMPLETE AND SUBMIT WITH YOUR RFP RESPONSE 'V'Failure to submit this form may be grounds for disqualification of your submittal'W RYAN MITCHELL SORBY MY COMMISSION # GG 920737 EXPIRES: October 8, 2023 %•'FOP Bonded Thru Notary Public Underwriters 47 DATE: J uary 22, 2029 TO: All Bidders/Pronosers FROM: Marisol Ordonez, Purchasing Manager City of Sanford Purchasing Division SUBJECT: RFP 19/20-47 Health Insurance & Wellness Study Program I ADDENDUM #1 This addendum is issued to provide additional information, clarification, corrections, additions, deletions and/or answers to questions concerning the above referenced solicitation. All information provided in this addendum is incorporated into the solicitation document as set forth therein. All other parts of the solicitation have been maintained as originally distributed. This addendum supersedes any verbal and/or other instructions given to any bidder/proposer qualified to respond pursuant to the requirements set forth in the solicitation document. "Noull"iiT:jl This Addendum does change the solicitation due date. The solicitation due date is hereby changed from Thursday, January 23, 2020 at 2:00 P.M. Local Time to Thursday, January 30, 2020 at 2:00 P.M. Local Time. H. QUESTIONS AND ANSWERS &A The City has received the following question(s) concerning the solicitation: Q1. Section 5.05 (I) Insurance Certificates of the RFP states "Provide copies of your current liability and workers' compensation Certificates of Insurance. The successful proposer(s) will be required to provide Certificate(s) of Insurance..." Please clarify if the City is requiring proposers to provide copies of COls as part of their response to the RFP as evidence of our current liability and workers' compensation coverage, or if the City will only require COIs (with the conditions shown in Attachment "M") from the successful proposer(s). Al. Please complete the attachment M and provide proof of insurance. The awardee will then provide the insurance based on the insurance requirements see also answer number A4. Q2. On Page 4 — Minimum Requirements — Item B — Can you clarify if you are looking for our experience in providing consulting services and review of health insurance and wellness programs or please explain what is meant by "knowledgeable on the equipment and parts". A2. Page 4 Minimum Requirements Item B is revise to read as follows; Health and Wellness program studies with related and completed findings and proposals to include the following areas: « Health insurance programs, including insurance structure and policy; « Health insurance benefits, such as co -pays, co-insurance, deductibles and various types of coverage; « Program costs such as administrative fees and excess insurance; « Claims cost and mitigation of claims cost; « Wellness program incentives and programs; PUR-F-212 j Rev. 11/2016 City of Sanford I Finance Department I Purchasing Division 300 N. Park Avenue Suite 236, Sanford, Florida 32771 Phone: 407-688-5028 or 5030 Fax: 407-688-5021 Emaik �e r l s cs ,;u- a of c cltl.,•ssa ADDENDUM HEALTH INSURANCE & WELLNESS STUDY `� MAWMIMMWNYR #1 PROGRAM DATE: J uary 22, 2029 TO: All Bidders/Pronosers FROM: Marisol Ordonez, Purchasing Manager City of Sanford Purchasing Division SUBJECT: RFP 19/20-47 Health Insurance & Wellness Study Program I ADDENDUM #1 This addendum is issued to provide additional information, clarification, corrections, additions, deletions and/or answers to questions concerning the above referenced solicitation. All information provided in this addendum is incorporated into the solicitation document as set forth therein. All other parts of the solicitation have been maintained as originally distributed. This addendum supersedes any verbal and/or other instructions given to any bidder/proposer qualified to respond pursuant to the requirements set forth in the solicitation document. "Noull"iiT:jl This Addendum does change the solicitation due date. The solicitation due date is hereby changed from Thursday, January 23, 2020 at 2:00 P.M. Local Time to Thursday, January 30, 2020 at 2:00 P.M. Local Time. H. QUESTIONS AND ANSWERS &A The City has received the following question(s) concerning the solicitation: Q1. Section 5.05 (I) Insurance Certificates of the RFP states "Provide copies of your current liability and workers' compensation Certificates of Insurance. The successful proposer(s) will be required to provide Certificate(s) of Insurance..." Please clarify if the City is requiring proposers to provide copies of COls as part of their response to the RFP as evidence of our current liability and workers' compensation coverage, or if the City will only require COIs (with the conditions shown in Attachment "M") from the successful proposer(s). Al. Please complete the attachment M and provide proof of insurance. The awardee will then provide the insurance based on the insurance requirements see also answer number A4. Q2. On Page 4 — Minimum Requirements — Item B — Can you clarify if you are looking for our experience in providing consulting services and review of health insurance and wellness programs or please explain what is meant by "knowledgeable on the equipment and parts". A2. Page 4 Minimum Requirements Item B is revise to read as follows; Health and Wellness program studies with related and completed findings and proposals to include the following areas: « Health insurance programs, including insurance structure and policy; « Health insurance benefits, such as co -pays, co-insurance, deductibles and various types of coverage; « Program costs such as administrative fees and excess insurance; « Claims cost and mitigation of claims cost; « Wellness program incentives and programs; PUR-F-212 j Rev. 11/2016 • Wellness Center viability and costs; • Contractual language of providers of health insurance and wellness related products; Q3. Section 3.18 (PDF page 13) and Section 6.15 (PDF page 22) — Per our retention procedures we need to maintain a copy of all materials that are produced. Is this acceptable to the City? A3. The City of Sanford follows chapter 119 Public Records see Attachment 'IF" 0199/0 Q4. Attachment M (PDF pages 44-46) - Insurance a. Commercial General Liability (PDF page 44) - References to XCU hazards are not applicable to the services we are proposing. Is it acceptable to the City not to include XCU hazards? b. Commercial General Liability (PDF page 44) - Gallagher's policy does not include Sexual Harassment, Abuse and Molestation coverage. Is it acceptable to the City not to include this within our GL policy? c. Builder's Risk, Garage Keepers and Garage Liability (PDF page 44) - These are N/A to the services we would be providing. Is it acceptable to the City not to include this liability? d. Section IV(b)(PDF page 45) - Gallagher can only agree to name the City as an additional insured on its Commercial General Liability Policy and it will be via a Certificate of Insurance, not an endorsement. Is that acceptable to the City? c. Section IV(h)(PDF page 45) - Please confirm if the City would allow the Awardee to advise that a cancelled or non -renewed policy would be replaced with no coverage gap and a current COI would be provided and not provide a cancellation notice, since coverage will be replaced with no gap. f. Please confirm if the City is willing to accept the Auto Liability based on Auto limits on any one accident or loss? g. Please confirm if the City is willing to accept that our professional liability limits are each wrongful act/annual aggregate and our policy has a $5 million retention. Our annual report is available online for the City to review. h. We can only agree to name the City as an additional insured on the Commercial General Liability Policy and we provide this via a Certificate of Insurance, not an endorsement. Will this be acceptable to the City? A4. a. Yes b. No c. Yes d. The City shall be named additional insurer on a COI in regards to GL, AL and Excess Umbrella. e. The City would require continuous coverage, whether one or multiple policy terms or carriers, with no gaps (no insurance coverage) and with same coverages at all times that the City has originally requested. f. Depends upon limits. g. No, not unless there is underlying coverage for the first $5,000,000. h. See I'D" above PUR-F-212 2 Rev. 11/2016 City of Sanford I Finance Department I Purchasing Division SX"' N. Park Avenue Suite 236, Sanford, Florida 32771 ig 1�� sardfl. Lov Phone- 407-688 -5028 or 5030 1 Fax: 407-688-50211 Email: p u rchsinnfo ADDENDUM 0300 N rORD FINAIKE HEALTH INSURANCE & WELLNESS STUDY #1 PROGRAM • Wellness Center viability and costs; • Contractual language of providers of health insurance and wellness related products; Q3. Section 3.18 (PDF page 13) and Section 6.15 (PDF page 22) — Per our retention procedures we need to maintain a copy of all materials that are produced. Is this acceptable to the City? A3. The City of Sanford follows chapter 119 Public Records see Attachment 'IF" 0199/0 Q4. Attachment M (PDF pages 44-46) - Insurance a. Commercial General Liability (PDF page 44) - References to XCU hazards are not applicable to the services we are proposing. Is it acceptable to the City not to include XCU hazards? b. Commercial General Liability (PDF page 44) - Gallagher's policy does not include Sexual Harassment, Abuse and Molestation coverage. Is it acceptable to the City not to include this within our GL policy? c. Builder's Risk, Garage Keepers and Garage Liability (PDF page 44) - These are N/A to the services we would be providing. Is it acceptable to the City not to include this liability? d. Section IV(b)(PDF page 45) - Gallagher can only agree to name the City as an additional insured on its Commercial General Liability Policy and it will be via a Certificate of Insurance, not an endorsement. Is that acceptable to the City? c. Section IV(h)(PDF page 45) - Please confirm if the City would allow the Awardee to advise that a cancelled or non -renewed policy would be replaced with no coverage gap and a current COI would be provided and not provide a cancellation notice, since coverage will be replaced with no gap. f. Please confirm if the City is willing to accept the Auto Liability based on Auto limits on any one accident or loss? g. Please confirm if the City is willing to accept that our professional liability limits are each wrongful act/annual aggregate and our policy has a $5 million retention. Our annual report is available online for the City to review. h. We can only agree to name the City as an additional insured on the Commercial General Liability Policy and we provide this via a Certificate of Insurance, not an endorsement. Will this be acceptable to the City? A4. a. Yes b. No c. Yes d. The City shall be named additional insurer on a COI in regards to GL, AL and Excess Umbrella. e. The City would require continuous coverage, whether one or multiple policy terms or carriers, with no gaps (no insurance coverage) and with same coverages at all times that the City has originally requested. f. Depends upon limits. g. No, not unless there is underlying coverage for the first $5,000,000. h. See I'D" above PUR-F-212 2 Rev. 11/2016 ' City of Sanford I Finance Department I Purchasing Division B 304 N. Park Avenue Suite 236, Sanford, Florida 32771 Phone: 407-688-5028 or 5030 Fax: 407-688-5021 I Email: sub a h asitt-. a +.as�fo df3.,g ADDENDUM �� ORD �tiAlnk C¢PhfiC&#£kE HEALTH INSURANCE & WELLNESS STUDY PROGRAM - #1 Q5. Indemnification - Please confirm if the City is willing to accept the indemnification be limited to losses and damages as a result of our negligence and covered under the terms of our general liability policy; any wrongful acts solely in rendering or failing to render professional services and covered under our professional liability policy; or, any claim alleging a security failure, privacy event or wrongful act and covered under our cyber liability policy (misappropriation of trade secret or, infringement of patent are exclusions in our cyber policy). A5. No. The provider will provide indemnification to the City for any claims, damages, charges awards suites, against the City, its employees, its officials, its designees, heir of employees, officials, its designees etc. as the result of any acts of negligence to any degree by the provider. Q6. Can you clarify that the City is NOT seeking to hire a benefits broker/advisor, and the this RFP is for a one-time (possibly annual) review/study of the City's benefits program with suggestions/recommendations for improving the program? Thank you. A6 Correct. Q7. On Page 5 — Introduction — We are a consulting firm and can work on an hourly basis or flat fee with regards to this project and not accept any commissions, overrides, etc. from any of the City's vendors. However, we also are eligible to receive commission compensation from other clients that we work with. Would this make us non -eligible to propose on this RFP? A7. Based upon the parameters in the RFP, yes. Q8. RFP Due Date: Would the City consider extending the closing date due to the shortime upon receipt of the addendum and considering Monday the 20th a Martin Luther King Holiday? A8. Yes. The due date has been extended to Thursday, January 30, 2020 at 2:00 P.M. Local Time. Q9 A typical study of this nature and scope takes between 45-60 days. What day in February will the project be awarded and allowed to begin? Will the city consider to make sure the scope and quality can be met? A9. Yes, only if needed and only if extended date is reasonable. Q10. Section 5.02 Item D- Will the City except our 10k report in lieu of a letter from a proposer financial institution? A10. No. Q11. Section 6.13(C) (PDF page 21) and Section 7.28 (PDF page 28) — are the agreements and contracts are available for review? We cannot agree to be bound by the terms and conditions referenced in these sections until it has had the opportunity to review. Is that acceptable to the City? All. A sample copy contract is attached for your review. Q12. Section 3.18 (PDF page 13) and Section 6.15 (PDF page 22) - We will retain sole and exclusive ownership of all right, title and interest in and to its intellectual property and derivatives thereof which no data or confidential information of the City was used to create and which was developed entirely using our own resources. To the extent our intellectual property is necessary for the City to use the services provided, we will grant to the City a non-exclusive, royalty -free PUR-F-212 3 Rev. 11/2016 license to our intellectual property solely for the City use of such services. Is this acceptable to the City? Al2. The City reserves all rights to answer that question once an agreement offered by the provider is reviewed. Q13. a. Does the City currently have a wellness program in place? b. If so, what programs/services are being offered through the wellness program. c. Does the City have an established Wellness Committee? A13. a. Yes. b. Wellness Monetary c. Yes. M. CHANGES, ADDITIONS AND/OR CLARIFICATIONS Page 4 has been modified; please replace page 4 with the current revised attachment. Sample- City contract; the City's terms and condition can be found and retrieved from the City's webpage W. SIGN -IN SHEET N/A V. ATTACHMENTS a. Sample Contract- 5 pages b. Page 4 revised rUK-11-212 4 Rev. 11/2016 City of Sanford I Finance Department I Purchasing Division S ORD 300 N. Park Avenue Suite 236, Sanford, Florida 32771 Phone: 407-6884028or50301 Fax: 407-08-5021 ADDENDUM MAN'$ 001MUMNI HEALTH INSURANCE & WELLNESS STUDY #1 PROGRAM L I license to our intellectual property solely for the City use of such services. Is this acceptable to the City? Al2. The City reserves all rights to answer that question once an agreement offered by the provider is reviewed. Q13. a. Does the City currently have a wellness program in place? b. If so, what programs/services are being offered through the wellness program. c. Does the City have an established Wellness Committee? A13. a. Yes. b. Wellness Monetary c. Yes. M. CHANGES, ADDITIONS AND/OR CLARIFICATIONS Page 4 has been modified; please replace page 4 with the current revised attachment. Sample- City contract; the City's terms and condition can be found and retrieved from the City's webpage W. SIGN -IN SHEET N/A V. ATTACHMENTS a. Sample Contract- 5 pages b. Page 4 revised rUK-11-212 4 Rev. 11/2016 Respondents must acknowledge receipt of this Addendum by signing this form below and returning it to the Procurement Division prior to the hour and date specified for receipt of bids/proposals or by including this Addendum with your submittal. Failure to comply may result in disqualification of your response. Acknowledgment is hereby made of Addendum #1 to RFP 19/20-47 Health Insurance & Wellness Study Program. E. W. Siver & Associates, Inc. dba Siver Insurance Consultants Name of Firm/Company 80194th Avenue N.. Suite 202 Street Address (7271577-2780 ____ Telephone Number Kathy Gordon Authorized Person Printed Name Authorized Person Signature PUR-F-212 5 keordonO.'siver com Contact Email St. Petersburg, FL 33702 City, State, Zip Code Fax Number Vice President Authorized Person Title Januarr23 2020 Date of Signature Rev. 11/2016 City of Sanford I Finance Department I Purchasing Division .° 308 N. Park Avenue Suite 236, Sanford, Florida 32771 Phone: 407-688-5828 or 5830 Fax: 407-6W5021 1 Email: urcha� sn sw Sanford ,goo ADDENDUM 0, T:NV .,; HEALTH INSURANCE & WELLNESS STUDY #1 PROGRAM Respondents must acknowledge receipt of this Addendum by signing this form below and returning it to the Procurement Division prior to the hour and date specified for receipt of bids/proposals or by including this Addendum with your submittal. Failure to comply may result in disqualification of your response. Acknowledgment is hereby made of Addendum #1 to RFP 19/20-47 Health Insurance & Wellness Study Program. E. W. Siver & Associates, Inc. dba Siver Insurance Consultants Name of Firm/Company 80194th Avenue N.. Suite 202 Street Address (7271577-2780 ____ Telephone Number Kathy Gordon Authorized Person Printed Name Authorized Person Signature PUR-F-212 5 keordonO.'siver com Contact Email St. Petersburg, FL 33702 City, State, Zip Code Fax Number Vice President Authorized Person Title Januarr23 2020 Date of Signature Rev. 11/2016 City of Sanford I Finance Department I Purchasing Division 300 N. Park Avenue Suite 243 211 Floor, Sanford Florida 32771 Phone: 407-689-5028, or 50301 Fax: 407-688-5021 REQUEST FOR PROPOSALS (RFP) TERM CONTRACT TITLE: HEALTH INSURANCE & WELLNESS PROGRAM STUDY 1.04 MINIMUM REQUIREMENTS. In order to be considered, the firm must meet all of the following criteria: The RFP is not for managed services or network design we are only soliciting hardware replacements for the switches discussed below and designated in the network diagram attached. We are also requesting proposals for a solution to deploy and manage the switches. The management solution should allow for easy central management of the switches to include features such as: A. The Proposer shall have been in business for a minimum of three (3) consecutive years and shall currently be licensed to perform services within the State of Florida. This requirement shall be based on the Solicitation's due date. Copies of documentation demonstrating meeting this minimum requirement shall be submitted with your response. Examples of documentation may include, but not be limited to; local business tax receipts for three (3) years, corporation documents with date of inception, certificate of authority, etcetera. 1. If the business headquarters is located outside of the state of Florida, they shall currently be licensed to perform services in both their home state and the state of Florida; and shall have been in business for a minimum of three (3) consecutive years. This requirement shall be based on the Solicitation's due date. Copies of documentation demonstrating meeting this minimum requirement shall be submitted with your response. Examples of documentation may include, but not be limited to, local business tax receipts for three (3) years, corporation documents with date of inception, certificate of authority, etcetera. a. In this case the Proposer shall submit to Purchasing a current Certificate of Authority, which is issued through the Department of State and in accordance with Florida Statute 607.1501, within ten (10) business days upon notice of intent to award. 2. The Proposer shall have held and maintained for a minimum of three (3) years a current State of Florida: a. Business or Corporation shall hold a Certificate of Authorization as a License Contractor to do business in the State of Florida; or b. Individual shall hold a current State of Florida license as required by your company rule, and have authority to submit certified reports to state agencies (if applicable). B. Demonstration of Experience: Health and Wellness program studies with related and completed findings and proposals to include the following areas: Health and Wellness programs including insurance structure and policy. Health insurance benefits, such as co -pays, co-insurance, deductibles and various types of coverage. Program cost such as administrative fees and excess insurance. Claims cost and mitigation of claims cost. Wellness Program incentives and programs. Wellness Center viability and costs. Contractual language of providers of health insurance and wellness related products. The proposer shall provide proof of the above minimum qualification by furnishing copies and or written documentation to substantiate meeting the requirements. Failure to provide said documentation with your proposal shall be grounds for deeming your proposal unresponsive and removing it from further consideration. This is a non-negotiable item. THE REMAINDER OF THIS PAGE LEFT INTENTIONALLY BLANK 4 AGREEMENT BETWEEN THE CITY OF SANFORD AND FLORIDA WATER FEATURES, INC./IFB NUMBER: 19120-01/FOUNTAIN INSPECTION AND CLEANING GOODS AND SERVICES THIS AGREEMENT (hereinafter the "Agreement") is made and entered into this day of December 2019, by and between the City of Sanford, Florida, a Florida municipality, (hereinafter referred to as the "City"), whose mailing address is 300 North Park Avenue, Sanford, Florida 32771, and Florida Water Features, Inc., a Florida corporation, whose principal address is 1451 Seminola Boulevard, Casselberry, Florida 32707, (hereinafter referred to as "FWF"). The City and FWF may be collectively referenced herein as the "parties". WITNESSETH. - IN CONSIDERATION of the mutual covenants, promises, and representations contained herein and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the parties hereto agree as follows: Section 1. Recitals. The above statements are true and form a material part of this Agreement upon which the parties have relied. Section 2. Authority. Each party hereto represents to the other that it has undertaken all necessary actions to execute this Agreement, and that it has the legal authority to enter into this Agreement and to undertake all obligations imposed on it. The persons executing this Agreement for each party certify that they are authorized to bind the party fully to the terms of this Agreement. Section 3. Scope of Agreement; Direction of the Provision of Goods and Services. (a). This Agreement is for the provision of goods and services set forth in the attachments hereto and FWF agrees to accomplish the provision of goods and services specified in the attachments for the compensation set forth in those documents relating to the fountain inspection and cleaning goods and services and for such other goods and services as may be agreed upon by the parties as set forth in issued work/purchase orders.. (b). It is recognized that FWF shall provide goods and services as directed by the City. (c). The City's contact/project manager for all purposes under this Agreement shall be the following: Ms. Marisol Ordohez Purchasing Manager Finance -Purchasing Division 11 P a g e City of Sanford Post Office Box 1788 Sanford, Florida 32772 Phone: 407.688.5028 Section 4. Effective Date and Term of Agreement. This Agreement shall take effect on the date that this Agreement is fully executed by the parties hereto. This Agreement shall be in effect for a term of I year with the opportunity for additional I year renewal periods when in the best interest of the City. However, the total Agreement length, including all renewals, shall not exceed 5 years. The decision to renew or extend this Agreement shall be at the discretion of the City. FWF shall review the quality and status of the fountain inspection and cleaning goods and services delivered to the City with the City on a semi-annual basis. In any event, this Agreement shall remain in effect until the goods and services to be provided by FWF to the City under each work order have been fully provided in accordance with the requirements of the City; provided, however, that, the indemnification provisions and insurance provisions of the standard contractual terms and conditions referenced herein shall not terminate and the protections afforded to the City shall continue in effect subsequent to such goods and services being provided by FWF. No goods, services or actions have been provided prior to the execution of this Agreement that would entitle FWF for any compensation therefor. Section 5. Compensation. The parties agree to compensation as set forth in the attachments hereto, with the initial purchase of goods and services being in the amounts set forth in the attachments hereto and, subsequently, as may be agreed upon by the parties as set forth in issued work/purchase orders. Section 6. Standard Contractual Terms and Conditions. All "Standard Contractual Terms and Conditions", as provided on the City's website, apply to this Agreement. Such Terms and Conditions may be found at the City's website; which can be reached at: (hftps://www.sanfordfl.gov/departments/fiinance/purchasing/contract- terms-and conditions or www.SanfordFL.gov). The parties shall also be bound by the purchasing policies and procedures of the City as well as the controlling provisions of Florida law. Work orders shall be used, in accordance therewith, in the implementation of this Agreement to the extent deemed necessary by the City in its sole and absolute discretion. Section 7. FWF's Mandatory Compliance with Chapter 119, Florida Statutes, and Public Records Requests. (a). In order to comply with Section 119.0701, Florida Statutes, public records laws, FWF must: (1). Keep and maintain public records that ordinarily and necessarily would be required by the City in order to provide goods or perform services. 2 1 P o , ,, (2). Provide the public with access to public records on the same terms and conditions that the City would provide the records and at a cost that does not exceed the cost provided in Chapter 119, Florida Statutes, or as otherwise provided by law. - (3). Ensure that public records that are exempt or confidential and exempt from public records disclosure requirements are not disclosed except as authorized by law. (4). Meet all requirements for retaining public records and transfer, at no cost, to the City all public records in possession of FWF upon termination of the contract and destroy any duplicate public records that are exempt or confidential and exempt from public records disclosure requirements. All records stored electronically must be provided to the City in a format that is compatible with the information technology systems of the City. (b). If FWF does not comply with a public records request, the City shall enforce the contract provisions in accordance with this Agreement. (c). Failure by FWF to grant such public access and comply with public records requests shall be grounds for immediate unilateral cancellation of this Agreement by the City. FWF shall promptly provide the City with a copy of any request to inspect or copy public records in possession of FWF and shall promptly provide the City with a copy of FWF's response to each such request. i '. •: A: ! y �. • + �. , 1. Section S. Time is of the Essence. Time is hereby declared of the essence as to the lawful performance of all duties and obligations set forth in this Agreement. Section 9. Entire Agreement/Modification. This Agreement, together with all "Standard Contractual Terms and Conditions", as provided on the City's website and the attachments hereto (the documents relative to the procurement activity of the City leading to the award of this Agreement) constitute the entire integrated agreement between the City and FWF and supersedes and controls over any and all prior - agreements, understandings, representations, correspondence and statements whether written or oral in connection therewith and all the terms and provisions contained herein constitute the full and complete agreement between the parties hereto to the date hereof. This Agreement may only be amended, supplemented or modified by a formal 3 1 P a «c written amendment of equal dignity herewith. In the event that FWF issues a purchase order, memorandum, letter, or any other instrument addressing the goods or services, work, and materials to be provided and performed pursuant to this Agreement, it is hereby specifically agreed and understood that any such purchase order, memorandum, letter, or other instrument shall have no effect on this Agreement unless agreed to by the City, specifically and in writing in a document of equal dignity herewith, and any and all terms, provisions, and conditions contained therein, whether printed or written or referenced on a Web site or otherwise, shall in no way modify the covenants, terms, and provisions of this Agreement and shall have no force or effect thereon. Section 10. Severability. If any term, provision or condition contained in this Agreement shall, to any extent, be held invalid or unenforceable, the remainder of this Agreement, or the application of such term, provision or condition to persons or circumstances other than those in respect of which it is invalid or unenforceable, shall not be affected thereby, and each term, provision and condition of this Agreement shall be valid and enforceable to the fullest extent permitted by law when consistent with equity and the public interest. Section 11. Waiver. The failure of the City to insist in any instance upon the strict performance of any provision of this Agreement, or to exercise any right or privilege granted to the City hereunder shall not constitute or be construed as a waiver of any such provision or right and the same shall continue in force. Section 12. Captions. The section headings and captions of this Agreement are for convenience and reference only and in no way define, limit, describe the scope or intent of this Agreement or any part thereof, or in any way affect this Agreement or construe any provision of this Agreement. Section 13. Counterparts. This Agreement may be executed in any number of counterparts, each of which shall be deemed an original, but all of which, taken together, shall constitute one and the same document. Section 14. Binding Effect. This Agreement shall be binding upon and inure to the benefit of the successors in interest, transferees and assigns of the parties. Each party hereto represents to the other that it has undertaken all necessary actions to execute this Agreement, and that it has the legal authority to enter into this Agreement and to undertake all -obligations imposed on it. The signatories hereof represent that they have the requisite and legal authority to execute this Agreement and bind the respective parties herein. Section 15. Remedies. The rights and remedies of the parties, provided for under this Agreement, are in addition to any other rights and remedies provided by law or otherwise necessary in the public interest. Section 16. Governing law, Venue and Interpretation. This Agreement is to be governed by the laws of the State of Florida. Venue for any legal proceeding 4 1 Ila ge related to this Agreement shall be in the Eighteenth Judicial Circuit Court in and for Seminole County, Florida. This Agreement is the result of bona fide arms length negotiations between the City and FWF, and all parties have contributed substantially and materially to the preparation of the Agreement. Accordingly, this Agreement shall not be construed or interpreted more strictly against any one party. than against any other party and all provisions shall be applied to fulfill the public interest. IN WITNESS WHEREOF, the City and FWF have executed this instrument for the purpose herein expressed and FWF represents and affirms that the signatories below have full and lawful authority to bind FWF in every respect. A TTES T. Traci Houchin, CMC, FCRM City Clerk Approved as to form and legal sufficiency. William L. Colbert, City Attorney ATTESTIWITNESS: John P. Anderson Vice President, Director CITY OF SANFORD By: Jeff Triplett Mayor Date: FLORIDA WATER FEATURES, INC., a Florida corporation. By: Pamela Anderson President, Director Dated: 5 111 a g e State of Florida Department of State I certify from the records of this office that E. W. SIVER AND ASSOCIATES, INC. is a corporation organized under the laws of the State of Florida, filed on January 28, 1977. The document number of this corporation is 524647. I further certify that said corporation has paid all fees due this office through December 31, 2019, that its most recent annual report/uniform business report was filed on May 10, 2019, and that its status is active. I further certify that said corporation has not filed Articles of Dissolution. Given under my hand and the Great Seal of the State of Florida at Tallahassee, the Capital, this the Fourteenth day of January, 2020 Tracking Number: 5079134024CU **W1ejV- Secret(ay of State To authenticate this certificate,visit the following site,enter this number, and then follow the instructions displayed. https: //services.s u n b iz.o rg/Filings/CertificateOfStatu s/CertificateAuth en ticatio n - 1/14/2020 Detail by Entity Name )f Stpte / Division of Corp a S / Search Betc r / Detail B Document Nurnber Detail by Entity Name Florida Profit Corporation E.W.SNERAND ASSOCIATES, INC. tjRWgInformation Document Number 524647 FEf/E8N Number 59-1712226 Date Filed 01/28/1077 State FL Status ACTIVE Last Event REINSTATEMENT Event Date Filed 10/12/2001 Principal Address 8U1Q4thAvenue North #202 ST. PETERSBURG, FL337O2 Changed: O5/ 0/2019 Mailing Address PO.Box 21343 ST. PETERSBURG, FL 33742 Changed: U5/ 0/2019 Registered gent Name & Address ER|CKSON.GEORGE VV _ 8O184thAvenue North #2O2 � STPETERSBURG, FL33702 Name Changed: 10/12/2O01 Address Changed: O5/ 0/2019 Officer/Director Detail Name & Address [_ MARSHALL, JAMES JR � | PO.Box 21343 | �- aeaoh.aunbizong/|nquiryKCoqpnouionSearchXSaanhReau0]etoi|?inquirytypo=EnhtyNoma&dimctionType=|nitiaI&suorchNamoOode=EVVG|VEFASSO— 1/3 1/14/2020 I J I. F'C I CKJC5UKt7, rL 33/4G Title VTSD ERICKSON, GEORGE W P.O. Box 21343 ST. PETERSBURG, FL 33742 Title V GORDON, KATHLEEN P.O. Box 21343 ST. PETERSBURG, FL 33742 Annual Reports View image in PDF format Report Year Filed Date 2017 04/19/2017 2018 04/23/2018 2019 05/10/2019 Document Images 05/10/2019 -w ANNUAI- REPORT View image in PDF format 04/2.312018 -- ANNUM- RFP(Jf2T View image in PDF format 04/19/2017 -- ANNUAL REPORT �_- View image in PDF format � 03/06/2016 -- ANNUAI..REPOR f View image in PDF format 04/07/:LO15 --ANNUAL REPORT View image in PDF format 04/29/2014 -:- ANNUAL REPORT View irnage in PDF format 04/16/2013 -- ANN,UAI,REPQIT_ View image in PDF format 04/25/2012 -- ANN UAL REPORT View image in PDF format 04/19/2011 --ANNUAL- REPORT View image in PDF format 06/17/2010 --ANNUAL REPORT View image in PDF format Cis/05/2003,w-„ANNUAL _REPORT View image in PDF format 04/28/2008 -- ANNUAL REPORT View image in PDF format 04/26/2007 -- ANNUAL REPORT- View image in PDF format 04/23/2006 - ANNUAL REPORT View image in PDF farrnat 05/02/2005 --ANNUAL REPORT View image in PUP format 02/12/2004 ANNUAL REPORT View image in PDF format 04/28/2003_,ANNUAL vREPORT View image in PDF format 05/27/2002 -- ANNUAL REPORT View irnage in PDF format 10/12/2001 --REINSTATEMENT i View image in PDF forn°iat 02/29/2000—ANNUAL REPORT View image in PDF format 0.3/03/1.999 --ANNUAL REPORT View image in PDF format 02/04/1998 _ANNjQL1 L_ EELQ ! View image in PDF format 03/03/19977- ANNUAL.REPORT View image in PDF format 01/29/1996 ANNUAL..REPORT View image in PDF format 01/1„3/1_995 ANNUAL REPORT View irnage in PDF format Detail by Entity Name ' search.sunbiz.org/Inquiry/CorporationSeareh/SearchResultDetail?inquirytype=EntityName&directionType=Initial&searchNameOrder—EWSIVERASSO... 213 - 1/14/2020 Detail by Entity Name search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=EntityName&directionType=lnitial&searchNameOrder=EWSIVERASSO... 3/3 City of Sanford I Finance Department I Purchasing Division 0 300 N. Park Avenue Suite 243 2°a Floor, Sanford Florida 32771 "rX �" Phone: 407-688-5028, or 5030 ( Fax: 407-688-5021 FINANCE p£.PAKFME47 REQUEST FOR PROPOSALS (RFP) TERM CONTRACT Attachment "I"I Organizational Information The Bidder must include a copy of their State Certificate of Good Standing/Articles of Incorporation, which lists the corporate officers. In addition to the aforementioned documents the Bidder/Bidder must include necessary information to verify the individual signing this proposal/bid and or any contract document has been authorized to bind the corporation. Examples include: A. A copy of the Articles of Incorporation listing the approved signatories of the corporation. B. A copy of a resolution listing the members of staff as authorized signatories for the company. C. A letter from a corporate officer listing the members of staff that are authorized signatories for the company. TYPE OF ORGANIZATION (Please place a check mark (f) next to applicable t ]e) X Corporation Partnership Non -Profit Joint Venture Sole Proprietorship Other (Please specify) State of Incorporation Florida Principal Place of Business 801 94th Avenue North, Suite 202, St. Petersburg, FL 33702 (Enter Address) Federal I.D. or Social Security 59-1712226 Number By the signature(s) below, Uwe, the undersigned, as authorized signatory to commit the firm, certify that the information as provided in Attachment "P", Organizational Information, is truthful and correct at the time of submission. Bidder/Contractor Name: E. W. Siver & Associates, Inc. dba Siver Insurance Consultants Mailing Address: „ „v __ __P.O. Box 21343, St. Petersburg, FL 33742-1343_ Tele`o�i Numbe(7 7 .. 0 Fax Number:. n/a E-mail Address: k'ordon(i .c siverom r K.athv Gordon _ -.___.._. ........_.. FEIN: 59-._.1712226 ._ ...__.-- Autl orized Sig atory Printed Name Vice President 1- K-- 2-02 D Title Date PLEASE COMPLETE AND SUBMIT WITH YOUR. RFP RESPONSE m'Failure to submit this form may be grounds for disqualification of your submittal'a Insurance Consultants SWER 801 94h Avenue North, Ste. 202 St. Petersburg, Florida 33702-2479 Post Office Box 21343 St. Petersburg, Florida 33742-1343 Telephone: (727) 577-2780 Email: gerickson@siver.com January 22, 2020 City of Sanford Purchasing Division ATTN: Marisol Ordofiez, Purchasing Manager 300 N. Park Avenue, Suite 243, 2nd Floor Sanford, FL 32771 RE: RFP 19/20-47 — Health Insurance & Wellness Program Study Authorized Signatories Dear Ms. Ordofiez: The individuals below are Authorized Signatories on behalf of E. W. Siver & Associates, Inc. dba Siver Insurance Consultants (Siver) and are authorized on behalf of Siver to sign proposals, negotiate and sign contracts, agreements, amendments and related documents. James (Jim) Marshall, Jr. President George Erickson Executive Vice President Kathy Gordon Vice President Very truly yours, SIVR INSYRA CE CONSULTANTS G6orge)W. Erickson, JD, CPCU, LLM Executive Vice President and Senior Consultant City of Sanford I Finance Department I Purchasing D 300 N. Park Avenue Suite 243 2"d Floor, Sanford Florida 32 CITY or Phone: 407-688-5028, or 50301 Fax: 407-688-5021 S,k1qF0RD - r[NAWEMPARTMENT REQUEST FOR (RFP) P) TERM CONTRACT 71E a , ll Attachment "R" Proposed Schedule of Subcontractor Participation 19 No Subcontracting (of any kind) will be utilized on this project. Solicitation Number: RFP 19/2047 Title: Health Insurance & Wellness Program Study Total Project Amount: $ Subcontractor Minority Code (if applicable) Company Name Address Phone, Fax, Email Trade, Services or Materials portion to be subcontracted Percent (%) of Scol;)e/Contract Federal D) Dollar Value W No subcontracting (of any kind) will be utilized on this projeci. 1-fispanic SDVBE Service Disabled Veteran PERCENTAGE TOTALS FOR SUBCONTRACTOR PARTICIPATION PERCENTAGE TOTALS FOR MINORITY SUBCONTRACTOR PARTICIPATION Minority Code Code Description Minoritv Code Code Description AA African American NA Native American A Asian/Pacific Islander W Woman H 1-fispanic SDVBE Service Disabled Veteran When applicable, the Bidder, will enter into a formal agreement with the subcontractors identified herein for work listed in this schedule conditioned upon execution of a contract with the City. By the signature(s) below, Uwe, the undersigned, as authorized signatory to commit the firm, certify that the information as provided in Attachment "ll", Proposed Schedule of Subcontractor Participation, is truthful and correct at the time of submission, Bidder/Contractor Name: E. W. Siver & Associates. Inc. dba Siver Insurance Consultants Mailing Address: P.O. Box 21343, St. Petersburg, FL 33742-1343 Tel `phone Numben, 727 577-2780 Fax Number: n/a E-mail Address: kgor pn(i)siver.com.. Kathy Gordon Authorized Sig a ory Printed Name FEIN: 59-1712226 ( I I � Vice President -I - -2 Title Date PLEASE COMPLETE AND SUBMIT WITH YOUR RFP RESPONSE 'F'Failure to submit this form may be grounds for disqualification of your submittal*w 51 dd City of Sanford I FTmance Department I Purchasing Division OS 300 N. Park Avenue Suite 243 2nd Floor, Sanford Florida 32771 ORD Phone: 407-688-5028, or 50301 Fax: 407-688-5021 NNANCE DEPARTMEW REQUEST FOR PROPOSALS (RFP) TERM CONTRACT TITLE: HEALTH INSURANCE & WELLNESS PROGRAM STUDY I. It is noted that Professional Liability, builder's risk, garage keepers and garage liability is not required unless applicable conditions exist. If clarification is needed the CONTRACTOR must request clarification from the City of Sanford Purchasing Office. H. Vendor, Contractor, bidder shall provide, to the City of Sanford "City," prior to commencing any work, a Certificate of Insurance which verifies coverage in compliance with the requirements outlined below. Any work initiated without completion of this requirement shall be unauthorized and the City will not be responsible. M. The City reserves the right, as conditions warrant, to modify or increase insurance requirements outlined below as may be determined by the project, conditions and exposure > Certification Terms and Conditions IV. It is noted that the City has a contractual relationship with the named vendor, contractor or provider (collectively referred hereinafter as Contractor) applicable to a purchase order, work order, contract or other form of commitment by the City of Sanford, whether in writing or not and has no such contractual relationship with the Contractor's insurance carrier. Therefore, the onus is on the Contractor to insure that they have the insurance coverage specified by the City to meet all contractual obligations and expectations of the City. Further, as the Contractor's insurance coverage is a matter between the vendor and its insurance carrier, the City will turn to the Contractor for relief as a result of any damages or alleged damages for which the Contractor is responsible to indemnify and hold the City harmless. It is understood that the Contractor may satisfy relief to the City for such damages either directly or through its insurance coverage; exclusions by the insurance carrier notwithstanding, the City will expect relief from the Contractor. a. The insurance limits indicated above and otherwise referenced are minimum limits acceptable to the City. Also, all contractor policies shall to be considered primary to City coverage and shall not contain co-insurance provisions. b. All policies, except for professional liability policies and workers compensation policies shall name the City of Sanford as Additional Insured. c. Professional Liability Coverage, when applicable, will be defined on a case by case basis. d. In the event that the insurance coverage expires prior to the completion of the project, a renewal certificate shall be issued 30 days prior to said expiration date. e. All limits are per occurrence and must include Bodily Injury and Property Damage. f All policies must be written on occurrence form, not on claims made Form, except for Professional Liability. g. Self -Insured retentions shall be allowed on = liability coverage. h. In the notification of cancellation: The City of Sanford shall be endorsed onto the policy as a cancellation notice recipient. Should any of the above described policies of Sanford in accordance with the policy provisions. i. All insurers must have an A.M. rating of at least A -VII. j. It is the responsibility of the Prime CONTRACTOR to ensure that all sub -contractors retained by the Prime CONTRACTOR shall provide coverage as defined here -in before and after and are the responsibility of said Prime CONTRACTOR in all respects. k. Any changes to the coverage requirements indicated above shall be approved by the City of a City of Sanford I Finance Department I Purchasing Division OS300 N. Park Avenue Suite 243 2"a Floor, Sanford Florida 32771 CITY OF ORD Phone: 407-688-5028, or 5030 1 Fax: 407-688-5021 FINANCE DEPARTMENT REQUEST FOR PROPOSALS (RFP) TERM CONTRACT TITLE: HEALTH INSURANCE & WELLNESS PROGRAM STUDY Sanford, Risk Manager. 1. Address of "Certificate Holder" is City of Sanford; P 0 Box 1788 (300 N. Park Avenue); Sanford, Florida 32771; Attention Purchasing Manager. m. All certificates of insurance, notices etc. must be provided to the above address. n. In the description of the certificate of insurance please also add the solicitation number and project name. Kathv Gordon Typed Name of AFFIANT Vice President Title COUNTY OF PMLLAS STATE OF FLORIDA On day Januar.), 2020 this before me, the undersigned Notary Public of the State of Florida "ily persona appeared K at by G5�don whose name(s) is/are subscribed to the within instrument, and he/she/they acknowledge that he/she/they executed it WITNESS my hand and official seal, HShe is personally kn ownlo-m e or has vroduced . as identification. THERESA M. CONLEY (Notary Public in an(I'for the County and State -Aforementionecr)-, Notary Public - State of Florida 'I,r I eCommission # GG 909481 11 MY Comm. Expires Sep 2, 2023 SEAL My commission expires: Bonded through National Notary Assn. The City reserves the unilateral tight to modify the insurance requirements set forth at any time during the process of solicitation or subsequent thereto. PLEASE COMPLETE AND SUBMIT WITH YOUR RFP RESPONSE M'Failure to submit this form may be grounds for disqualification of your submittal 0 SkORD FINANCE M PARTFALNt City of Sanford I Finance Department I Purchasing Division 300 N. Park Avenue Suite 243 2nd Floor, Sanford Florida 32771 Phone: 407-688-5028, or 5030 1 Fax: 407-688-5021 REQUEST FOR PROPOSALS (RFP) TERM CONTRACT is TITLE: HEALTH INSURANCE & WELLNESS PROGRAM STUDY Attachment "O" References Bidder shall submit as a part of their bid response, a minimum of five (5) of the most significant projects similar in size and scope which were performed within the last three (3) years. The contact person shall be someone who has personal knowledge of the Bidder's performance for the specific requirements listed and is aware the City may be contacting them. Project #1: Project Name: Employee Benefits Insurance Consulting Type of Project/Service: Surveys, Ongoing Consulting,Medical Audits RFP Projects Renewals Address: 451 Third Street NW Winter Haven FL 33883-2277 Contracting Agency/Client: Ci of Winter Haven Contact Name and Phone #: Michele Stayner (863) 291-5600 Cal Bowen (863) 291-5667 Contact Email Address and Fax #: msta ner a m winterhaven.com cbowen rn winterhaven.com Contract Amount: varies depending on project Start Date: 1 1983 End Date: present Project #2: Project Name: Employee Benefits Insurance Consulting Type of Project/Service: Developed RFPs and Analyzed Proposals for Medical Services, Dental, Life Employee Health Clinic Address: 201 Highland Ave. NE Largo, FL 33779-0296 Contracting Agency/Client: Ci of Largo Contact Name and Phone #: Susan Sinz 727 587-6716 Contact Email Address and Fax #: ssinz lar o.com Fax: (727) 587-6782 Contract Amount: varies depending on project I Start Date: 1 1981 End Date: present Project #3: Project Name: Employee Benefits Insurance Consulting Type of Project/Service: Developed RFPs for Disability Products, Life, Long Term Care Insurance and Claims Administration Serve s Address: 3501 Johnson St. Hollywood, FL 33021 Contracting Agency/Client: South Broward Hospital District Contact Name and Phone #: Ed Werner 954 265-5467 Contact Email Address and Fax #: EWerner@MHS.net Contract Amount: varies depending on project I Start Date: 1998 End Date: present Project #4: Project Name: Employee Benefits Insurance Consulting Type of Project/Service: Developed RFPs for Medical (fiffly insured and ASO Stop Loss. Prescription. Vision. Dental. Flexible Benefits Address: 426 School Street Sebring,FL 33870 Administration Services and Em to ee Health Clinic Contracting Agency/Client: School Board of Highlands County Contact Name and Phone #: Richard "Bo" Birt (863) 471-5664 Contact Email Address and Fax #: birtr hi hlands.kl2.fl.us Contract Amount: varies depending on project Start Date: 1999 1 End Date: resent Project #5: Project Name: Employee Benefits Insurance Consulting Type of Project/Service: Developed RFPs for Medical, Dental, Life, Disability and Vision Address: 1105 SW 7th Road Ocala FL 34471 Contracting Agency/Client: School District of Marion County Contact Name and Phone #: Lori Lively (352) 671-6910 Contact Email Address and Fax #: lori.livel marion.k12.f[.us Fax: 352 671-4100 Contract Amount: varies depending on prqject I Start Date: 1 2012 1 End Date: present PLEASE COMPLETE AND SUBMIT WITH YOUR. RFP RESPONSE `-Failure to submit this form may be grounds for disqualification of your submittal"m State of Florida Department of State I certify from the records of this office that E. W. SIVER AND ASSOCIATES, INC. is a corporation organized under the laws of the State of Florida, filed on January 28, 1977. The document number of this corporation is 524647. I further certify that said corporation has paid all fees due this office through December 31, 2019, that its most recent annual report/uniform business report was filed on May 10, 2019, and that its status is active. I further certify that said corporation has not filed Articles of Dissolution. Given under my Band and the Great Seal of the State of Florida at Tallahassee, the Capital, this the Fourteenth day of January, 2020 Tracking Number: 5079134024CU *W1e)0V-- Secreany of 'State To authenticate this certificate,visit the following site,enter this number, and then follow the instructions displayed. https:/lservices.sunbiz.org/Filings/CertificateOfStatusICertificateAuthentication Licensee Search Licensee Detail License #: Issue Date A101004 AUTO -OWNERS LIFE INSURANCE COMPANY 9/21/2007 Full Name: GENERAL LINES (PROP & CAS) (0220) GORDON, KATHLEEN MARY Business Address: Issue Date 801 94TH AVENUE N, SUITE 202 AUTO -OWNERS INSURANCE COMPANY SAINT PETERSBURG, FL 33702 12/31/2021 Mailing Address: Copyright @ Florida Department of Financial Services 2018 PO BOX 21343 SAINT PETERSBURG, FL 337421343 Email: KGORDON@SIVER.COM Phone: (727)577-2780 County: Pinellas NPN #: 330731 Continuing Education Statistics CE Due Date: 12/31/2019 Continuing Education Status: Compliant Number of Hours Required: 20 Number of Hours Completed: 20 Valid Licenses Type Issue Date Qualifying Appointment LIFE INCL VAR ANNUITY & HEALTH (0215) 3/25/1989 YES GENERAL LINES (PROP & CAS) (0220) 4/22/1989 YES Active Appointments LIFE & HEALTH (0218) Company Name Issue Date Exp Date AUTO -OWNERS LIFE INSURANCE COMPANY 9/21/2007 12/31/2021 GENERAL LINES (PROP & CAS) (0220) Company Name Issue Date Exp Date AUTO -OWNERS INSURANCE COMPANY 9/21/2007 12/31/2021 Copyright @ Florida Department of Financial Services 2018 Invalid Licenses Type Issue Date Status LIFE (0216) 3/25/1989 INVALID LIFE & HEALTH (0218) 3/25/1989 INVALID Inactive Appointments LIFE (0216) Company Name Issue Date Exp Date Status Date SUN LIFE ASSURANCE COMPANY OF CANADA 1/9/1998 12/31/2002 12/31/2002 LIFE & HEALTH (0218) Company Name Issue Date Exp Date Status Date COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY 2/27/2003 12/31/2009 12/31/2007 GOLDEN RULE INSURANCE COMPANY 4/10/1990 3/31/1994 3/1/1994 FIDELITY SECURITY LIFE INSURANCE COMPANY 4/12/1990 3/31/1994 3/1/1994 BRIGHTHOUSE LIFE INSURANCE COMPANY 7/24/1992 12/31/2000 12/31/2000 UNITED PRESIDENTIAL LIFE INSURANCE COMPANY 4/12/1990 4/1/1992 UNITEDHEALTHCARE LIFE INSURANCE COMPANY 1/30/1992 12/31/1996 4/8/1996 AUTO -OWNERS LIFE INSURANCE COMPANY 3/25/1989 3/31/1994 3/5/1993 PARK AVENUE LIFE INSURANCE COMPANY 4/13/1990 4/1/1992 AMERICAN FAMILY LIFE ASSURANCE COMPANY OF COLUMBUS 7/17/1992 12/31/1996 12/1/1996 AUTO -OWNERS LIFE INSURANCE COMPANY 2/3/1998 12/31/2002 12/31/2002 CELTIC INSURANCE COMPANY 8/28/1992 12/31/1994 12/1/1994 PRINCIPAL LIFE INSURANCE COMPANY 3/31/2006 12/31/2010 6/30/2009 GENERAL LINES (PROP & CAS) (0220) Company Name Issue Date Exp Date Status Date ACE PROPERTY AND CASUALTY INSURANCE COMPANY 7/20/1989 12/31/1995 10/23/1995 ACE FIRE UNDERWRITERS INSURANCE COMPANY 7/20/1989 12/31/1995 10/23/1995 ACE FIRE UNDERWRITERS INSURANCE COMPANY 8/17/1998 12/31/2004 1/22/2003 GREAT AMERICAN ASSURANCE COMPANY 8/13/1998 12/31/2004 8/5/2004 GREAT AMERICAN ALLIANCE INSURANCE COMPANY 8/13/1998 12/31/2004 8/5/2004 AMERICAN INSURANCE COMPANY (THE) 6/21/1989 12/31/1995 3/15/1993 GREAT AMERICAN INSURANCE COMPANY OF NEW YORK 8/13/1998 12/31/2004 8/5/2004 ASSURANCE COMPANY OF AMERICA 6/11/1998 12/31/2002 5/24/2001 BANKERS INSURANCE COMPANY 6/1/1998 12/31/2000 12/31/2000 CONTINENTAL INSURANCE COMPANY 6/13/1998 12/31/2000 12/31/2000 "i. FIREMAN'S FUND INSURANCE COMPANY 6/21/1989 12/31/1995 3/15/1993 AXIS INSURANCE COMPANY 6/3/1992 6/3/1994 3/15/1993 AMERICAN HOME ASSURANCE COMPANY 9/23/1992 12/31/1998 12/31/1998 HANOVER INSURANCE COMPANY (THE) 4/1/2001 12/31/2005 5/14/2004 INA INSURANCE COMPANY 7/20/1989 12/31/1995 10/23/1995 INSURANCE COMPANY OF NORTH AMERICA 7/21/1989 12/31/1995 10/23/1995 INSURANCE COMPANY OF NORTH AMERICA 8/17/1998 12/31/2004 1/22/2003 ST. PAUL FIRE & MARINE INSURANCE COMPANY 11/21/2000 12/31/2006 11/2/2006 -- NATIONAL FIRE INSURANCE COMPANY OF HARTFORD 6/13/1998 12/31/2004 3/30/2004 NATIONAL UNION FIRE INSURANCE CO. OF PITTSBURGH, PA 9/23/1992 12/31/1998 12/31/1998 NORTHERN INSURANCE COMPANY OF NEW YORK 6/11/1998 12/31/2002 5/24/2001 STARR INDEMNITY & LIABILITY COMPANY 11/18/1991 11/18/1993 9/1/1992 TRANSCONTINENTAL INSURANCE COMPANY 6/13/1998 12/31/2004 3/30/2004 CENTURY INDEMNITY COMPANY 7/20/1989 12/31/1995 10/23/1995 ASSOCIATED INDEMNITY CORPORATION 6/21/1989 12/31/1995 3/15/1993 BANKERS STANDARD INSURANCE COMPANY 3/6/1995 12/31/1995 10/23/1995 BANKERS STANDARD INSURANCE COMPANY 8/17/1998 12/31/2004 1/22/2003 CONTINENTAL CASUALTY COMPANY 6/13/1998 12/31/2004 3/30/2004 FIDELITY AND CASUALTY COMPANY OF NEW YORK 6/13/1998 12/31/2000 12/31/2000 FIDELITY AND DEPOSIT COMPANY OF MARYLAND 2/27/1991 12/31/1997 12/31/1997 FIDELITY AND DEPOSIT COMPANY OF MARYLAND 6/9/1998 12/31/2000 12/31/2000 GREAT AMERICAN INSURANCE COMPANY 8/13/1998 12/31/2004 8/5/2004 ACE AMERICAN INSURANCE COMPANY 7/21/1989 12/31/1995 10/23/1995 ACE AMERICAN INSURANCE COMPANY 8/17/1998 12/31/2004 1/22/2003 MARYLAND CASUALTY COMPANY 6/11/1998 12/31/2002 5/24/2001 MASSACHUSETTS BAY INSURANCE COMPANY 4/1/2001 12/31/2005 5/14/2004 NATIONAL BEN FRANKLIN INSURANCE CO. OF ILLINOIS 6/13/1998 12/31/2000 12/31/2000 NATIONAL SURETY CORPORATION 6/21/1989 12/31/1995 3/15/1993 OWNERS INSURANCE COMPANY 6/26/1989 12/31/1995 3/5/1993 OWNERS INSURANCE COMPANY 2/3/1998 12/31/2002 3/9/2001 PACIFIC EMPLOYERS INSURANCE COMPANY 7/21/1989 12/31/1995 10/23/1995 ATLANTIC MUTUAL INSURANCE COMPANY 6/3/1998 12/31/2000 12/31/2000 TRANSPORTATION INSURANCE COMPANY 6/13/1998 12/31/2004 3/30/2004 VALLEY FORGE INSURANCE COMPANY 6/13/1998 12/31/2004 3/30/2004 INDEMNITY INSURANCE COMPANY OF NORTH AMERICA 3/6/1995 12/31/1995 10/23/1995 AMERISURE MUTUAL INSURANCE COMPANY 6/1/1998 12/31/2004 7/1/2004 PENNSYLVANIA LUMBERMENS MUTUAL INSURANCE COMPANY 8/24/1998 12/31/2004 10/25/2004 RISCORP PROPERTY & CASUALTY INSURANCE COMPANY 5/24/1995 12/31/1999 3/31/1998 RISCORP INSURANCE COMPANY 5/26/1992 12/31/1998 3/31/1998 HANOVER AMERICAN INSURANCE COMPANY (THE) 4/1/2001 12/31/2005 5/14/2004 PROGRESSIVE EXPRESS INSURANCE COMPANY 6/5/1998 12/31/2006 12/30/2004 AMERICAN CASUALTY COMPANY OF READING, PENNSYLVANIA 6/13/1998 12/31/2004 3/30/2004 AMERICAN GUARANTEE AND LIABILITY INSURANCE COMPANY 6/8/1998 12/31/2002 5/24/2001 AMERICAN ZURICH INSURANCE COMPANY 6/8/1998 12/31/2002 5/24/2001 AMERISURE INSURANCE COMPANY 6/1/1998 12/31/2004 7/1/2004 BLACKBOARD INSURANCE COMPANY 6/11/1998 12/31/2002 5/24/2001 PACIFIC EMPLOYERS INSURANCE COMPANY 8/17/1998 12/31/2004 1/22/2003 PROGRESSIVE SOUTHEASTERN INSURANCE COMPANY 2/8/1999 12/31/2005 12/30/2004 PROGRESSIVE AMERICAN INSURANCE COMPANY 6/5/1998 12/31/2006 12/30/2004 XL INSURANCE AMERICA, INC. 11/18/1991 11/18/1993 9/1/1992 ZURICH AMERICAN INSURANCE COMPANY 6/8/1998 12/31/2002 5/24/2001 AUTO -OWNERS INSURANCE COMPANY 4/22/1989 3/31/1993 3/5/1993 AUTO -OWNERS INSURANCE COMPANY 2/3/1998 12/31/2002 3/9/2001 Licensee Search Licensee Detail License #: E138743 Full Name: CONLEYTHEREGA Business Address: 801 94TH AVE. N.. SUITE 202 ST. PETERSBURG, FL337O2 Mailing Address: PDBOX 13OV R|VERV|EVKFL355O8 Email: TCDNLEY@SNER.COM Phone: (727)577-278O County: Pinellas NPN #: 8245368 Continuing Education Statistics CEDue Date: 181/200 / Continuing Education Status: CnmpUoru Number ufHours Required: 20 Number ofHours Completed: 20 Type LIFE INCL VAR ANNUITY & HEALTH (021s) Valid Licenses Issue Date 2/3/2005 Active Appointments Qualifying Appointment YES Copyright @ Florida Department ufFinancial Services 2O18 LIFE & HEALTH (0218) Company Name Issue Date Exp Date AUTO -OWNERS LIFE INSURANCE COMPANY 9/21/2007 1/31/2022 Invalid Licenses No invalid licenses found. Inactive Appointments LIFE INCL VAR ANNUITY & HEALTH (0215) Company Name Issue Date Exp Date Status Date PRINCIPAL LIFE INSURANCE COMPANY 10/27/2008 1/31/2013 9/14/2011 Licensee Search o v Licensee Detail License #: A078494 Full Name: ERICKSON, GEORGE WOODS Business Address: SIVER INSURANCE CONSULTANTS 801 94TH AVENUE N., #202 ST PETERSBURG, FL 33702 Mailing Address: SIVER INSURANCE CONSULTANTS 801 94TH AVENUE N., #202 ST PETERSBURG, FL 33702 Email: GERICKSON@SIVER.COM Phone: (727) 577-2780 County: Pinellas NPN #: 418487 Continuing Education Statistics CE Due Date: 4/30/2021 Continuing Education Status: In Progress Number of Hours Required: 20 Number of Hours Completed: 0 Valid Licenses Type Issue Date Qualifying Appointment GENERAL LINES (PROP & CAS) (0220) 7/13/2007 YES Active Appointments Copyright © Florida Department of Financial Services 2018 GENERAL LINES (PROP & CAS) (0220) Company Name Issue Date Exp Date AUTO -OWNERS INSURANCE COMPANY 9/21/2007 4/30/2020 Invalid Licenses Type Issue Date Status LIFE & HEALTH (0218) 11/18/1989 INVALID GENERAL LINES (PROP & CAS) (0220) 5/9/2002 INVALID Inactive Appointments LIFE & HEALTH (0218) Company Name Issue Date Exp Date Status Date AUTO -OWNERS LIFE INSURANCE COMPANY 11/18/1989 3/31/1994 10/22/1992 Jimmy Pa-pnis Licensee Search Licensee Detail License #: W189495 Full Name: RYBKA, LAURA M Business Address: 801 94TH AVENUE N. SUITE 202 ST. PETERSBURG, FL 33702 Mailing Address: _ PO BOX 21343 ST PETERSBURG, FL 33742 Email: LRYBKA@AOL.COM Phone: (727)577-2780 County: Pinellas NPN #: _ 17252914 Continuing Education Statistics CE Due Date: 10/31/2020 Continuing Education Status: In Progress Number of Hours Required: 24 Number of Hours Completed: 5 Valid Licenses Type Issue Date Qualifying Appointment LIFE INCL VAR ANNUITY & HEALTH (0215) 4/24/2014 YES GENERAL LINES (PROP & CAS) (0220) 9/26/2014 YES Active Appointments LIFE INCL VAR ANNUITY & HEALTH (0215) Company Name Issue Date Exp Date AUTO-OWNERS LIFE INSURANCE COMPANY 1/25/2019 10/31/2021 GENERAL LINES (PROP & CAS) (0220) Company Name Issue Date Exp Date AUTO-OWNERS INSURANCE COMPANY 1/25/2019 10/31/2021 Copyright © Florida Department of Financial Services 2018 Invalid Licenses No invalid licenses found. .__ Inactive Appointments LIFE INCL VAR ANNUITY & HEALTH (0215) Company Name Issue Date Exp Date Status Date AUTO -OWNERS LIFE INSURANCE COMPANY 10/13/2014 10/31/2018 11/1/2018 LIFE & HEALTH (0218) Company Name Issue Date Exp Date Status Date AUTO -OWNERS LIFE INSURANCE COMPANY 10/13/2014 10/31/2018 11/1/2018 GENERAL LINES (PROP & CAS) (0220) Company Name Issue Date Exp Date Status Date AUTO -OWNERS INSURANCE COMPANY 10/13/2014 10/31/2018 11/1/2018 W-9 Requestfor Taxpayer Give Form to the Form (Rev. October 2018) Identification Number and Certification requester. Do not impartment Treasury send to the IRS. Int, to- Go to wwwJrs.gov1FbrmW9 for instructions and the latest Information. 1 Name (as shown on your Income tax retum). Name Is required on this line; do not leave this line blank. E. W. Siver and Associates, Inc. 2 Business name/disregarded entity name, if different from above SiverInsuranec Consultants 3 Check appropriate box for federal tax classification of the person whose name Is entered on line 1. Check only one of the 4 Exemptions (codes apply only to following seven boxes. certain entities, not individuals; see CL El Individual/sole proprietor or 21 C Corporation 0 S Corporation ❑ Partnership ❑ Trustlestate instructions on page 3): 0r_ r. U) single -member LLC Exempt payee code (d any) 5 2 ❑ Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnershlp) Ib - 0 Note: Check the appropriate box in the line above for the tax classification of the single -member owner. Do not check Exemption from FATCA reporting V rnLLC if the LLC is classified as a single -member LLC that is disregarded from the owner unless the owner of the LLC Is LLC that Is disregarded from the for U.S. federal tax Otherwise, LLC that code(ffany) Z .9 116 .2 another not owner purposes. a single -member is disregarded from the owner should check the appropriate box for the tax classification of its owner. E] Other (see Instructions) IP- Mpp&s to accounts mabtahiad ovWda Me U.S.) 6 Address (number, street, and apt, or suite no.) See Instructions. Requester's name and address (optional) ar P.O. Box 21343 6 City, state, and ZIP code St. Peters burg, VL 33742 I 7 List account numbeqs) here (optional I= Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid Social security number backup withholding. For individuals, this is generally your social security number (SSM. However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part 1, later. For other _M entities, it is your employer Identification number (EIN). If you do not have a number, see How to got a _ C_ TIN, later. or Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and [_Ejjp1—.yar1'jh"�fl..t,.n Wn.-ber�� Number To Give the Requester for guidelines on whose number to enter. I—T-1 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. 1 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 3.1 am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. 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 for Part 11, later. 01911 Signature of Here I U.S. person is Section references are to the Internal Revenue Code unless otherwise noted. Future developments. For the latest information about developments related to Form W-9 and its Instructions, such as legislation enacted after they were published, go to wwwdirs.govIFormIN9. Purpose of Form An individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (171N) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of Information returns include, but are not limited to, the following. a Form 1099 -INT (interest earned or paid) Data P, January 22, 2020 a Form 1099 -DIV (dividends, Including those from stocks or mutual funds) * Form I D99-MISC (various types of Income, prizes, awards, or gross proceeds) * Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) • Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition) • Form 1099-C (canceled debt) • Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN. If you do not return Form W-9 to the requester with a 77N, you might be subject to backup withholding. See What Is backup withholding, later. Cat. No. 10231X Form W-9 (Rev. 10-2018) City of Sanford I Finance Department I Purchasing Division OS 300 N. Park Avenue Suite 243 2nd Floor, Sanford Florida 32771 ORD Phone: 407-688-5028, or 5030 1 Fax: 407-688-5021 FWANCE DEPARI MEW REQUEST FOR PROPOSALS (RFP) TERM CONTRACT Attachment "Ell Public Entity Crimes Statement SWORN STATEMENT UNDER SECTION 287.133(3) (a), FLORIDA STATUTES: THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICER AUTHORIZED TO ADMINISTER OATHS. A. This sworn statement is submitted with Bid, or Contract Number RFP 19/20-47 titled Health Insurance & Wellness Program Study E. W. Siver & Associates, Inc. dba B. This sworn statement is submitted by_5iver Insurance Consultants whose business address is submittirtsworn statement] 801 94th Avenue North, Suite 202, 9ta3=urg,,,.F 33702 and (if applicable) it's Federal Employer Identification Number (FEIN) is 59-1712226-- .1- __ (If the entity has no FEIN, include the Social Security Number of the individual signing this sworn statement: C. My name is _Kathy G�ordon__ - and my relationship to the above is Vice President [Please print name of individual signing] D. 1 understand that a "public entity crime" as defined in section 287.133(1)(g), Florida Statutes, means a violation of any state or federal law by a person with respect to and directly related to the transaction of business with any public entity in Florida or with an agency or political subdivision of any other state or with the United States, including, but not limited to, any bid or contract for goods or services to be provided to any public entity or an agency or political subdivision and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation. E. I understand that "convicted" or "conviction" as defined in section 287,133(1) (b), Florida Statutes, means a finding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in any federal or state trial court of record relating to charges brought by indictment or information after July 1, 1989, as a result of a jury verdict, non jury trial, or entry of a plea of guilty or nolo contenders. F. I understand that "affiliate" as defined in section 287.133(1) (a), Florida Statutes, means: 1. A predecessor or successor of a person convicted of a public entity crime; or 2. An entity under the control of any natural person who is active in the management of the entity and who has been convicted of a public entity crime. The term "affiliate" includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in the management of an affiliate. The ownership by one person of shares constituting a controlling interest in another person, or a pooling of equipment or income among persons when not for fair market value under an arm's length agreement, shall be a prima facie case that one person controls another person. A person who knowingly enters into a joint venture with a person who has been convicted of a public entity crime in Florida during the preceding thirty-six (36) months shall be considered an affiliate. G. I understand that a "person" as defined in section 287.133(l) (e), Florida Statutes, means any natural person or entity organized under the laws of any state or of the United States with the legal power to enter into a binding contract and which bids or applies to bid on contracts for the provision of goods or services let by a public entity, or which otherwise transacts or applies to transact business with a public entity. The term "person" includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in management of an entity. H. Based on information and belief, the statement, which I have marked below, is true in relation to the entity submitting this sworn statement. [Please indicate with a check mark (,/) which statement applies]. City of Sanford I Finance Department I Purchasing Division C)S 300 N. Park Avenue Suite 243 2 d Floor, Sanford Florida 32771 ORD Phone: 407-688-5028, or 5030 1 Fax: 407-688-5021 FKANCE EXPARTMENT REQUEST FOR PROPOSALS WFP) TERM CONTRACT TITLE: HEALTH INSURANCE & WELLNESS PROGRAM STUDY X Neither the entity submitting this sworn statement, nor any officers, directors, executives, partners, shareholders, employees, members, or agents who is active in the management of the entity, nor any affiliate of the entity have been convicted of a public entity crime subsequent to July 1, 1989. The entity submitting this sworn statement or one or more of the officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity; or an affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989, AND [Please indicate which additional statement applies]. There has been a proceeding concerning the conviction before a judge or hearing officer of the State of Florida, Division of Administrative Hearings, or a court of law having proper jurisdiction. The final order entered by the hearing officer or judge did not place the person or affiliate on the convicted contractor list. [Please attach a copy of the final order.] — The person or affiliate was placed on the convicted contractor list. There has been a subsequent proceeding before a court of law having proper jurisdiction or a judge or hearing officer of the State of Florida, Division of Administrative Hearings. The final order entered by the judge or hearing officer determined that is was in the public interest to remove the person or affiliate from the convicted contractor list, [Please attach a copy of the final order.] The person or affiliate has not been placed on any convicted vendor list. [Please describe any action taken by or pending with the State of Florida, Department of Management Services.] By the signature(s) below, I/we, the undersigned, as authorized signatory to commit the firm, certify that the information as provided in Attachment "E" Pblic Entity Crimes Statement, is truthful and correct at the time of submission. 6) AFFIANT SIGNATURE Kathy Gordon Typed Name of AFFIANT Vice President Title COUNTY OF PINELLAS STATE OF FLOR11DA On this dayof January 20 20 before me, the undersigned Notary Public of the State of Florida, personally appeared Ka ly ordon whose name(s) is/are subscribed to_tha.-within instrument, and he/she/they acknowledge that he/she/they executed it. WITNESS my hand and official seal. Hc7 ("known to me or has produced as identification. (Notary Public in and for the County and State Afore SEAL My commission expires: Failure to submit this form may be grounds for disqualification of your =ut)nu`Mta 'AA THERESA M. CONLEY Notary Public - State of Florida Commission # GG 909481 ESP@Nar`o`ug'h M C . Expires Sep 2, 2023 National Notary Assn, Failure to submit this form may be grounds for disqualification of your =ut)nu`Mta 'AA City of Sanford I Finance Department I Purchasing Division 300 N. Park Avenue Suite 243 2 d Floor, Sanford Florida 32771 Nor FORD Phone: 407-688-5028, or 5030 1 Fax: 407-688-5021 FINAMCE MPARTMENT REQUEST FOR PROPOSALS WP) TERM CONTRACT Attachment 'IF" COMPLIANCE WITH THE PUBLIC RECORDS LAW AFFIDAVJ I. If and when the City of Sanford transmits records to the ContractorNendor which are exempt from public disclosure, the ContractorNendor shall execute an "Acknowledgement of Receipt of Exempt Public Records and Agreement to Safeguard" which will be provided with the exempt records. A sample form is attached for the bidder/proposer's information. H. Upon award recommendation or 30 days after opening, it is understood that all submittals shall become "public records" and shall be subject to public disclosure consistent with Chapter 119, Florida Statutes, and Section 24(a), Article 1 of the Constitution of the State of Florida, and other controlling law (collectively the "Public Records Laws"). If the City of Sanford (City) rejects all replies submitted in response to a competitive solicitation and provides notice of its intent to reissue the solicitation, the replies remain exempt from disclosure until the City provides a notice of intent to award or withdraws the reissued solicitation. If no award is made, responses are not exempt for longer than 12 months after the initial notice rejecting all responses. Proposers/Bidders must invoke the exemptions to disclosure provided by law as applicable to the response to the solicitation, must identify the data or other materials to be protected, and must state the reasons why such exclusion from public disclosure is necessary. The submission of a proposal authorizes release of your firm's credit data to the City. If a Proposer/Bidder submits information exempt from public disclosure, the Proposer/Bidder must specifically and in detail identify with specificity which pages/paragraphs of their bid/proposal package are exempt from the Public Records Laws, identifying the specific exemption under the Public Records Laws that applies to each. The protected information must be submitted to the City in a separate envelope marked accordingly. By submitting a response to this solicitation, the Proposer/Bidder agrees to defend, indemnify and hold the City harmless in the event the City litigates the public records status of the Proposer's/Bidder's documents this provision including the obligation to pay the full legal costs of the City including, but not limited to, attorney's fees, court costs, and any and all other charges, regardless of what level of trial or appeal. E. W. Siver & Associates, Inc. dba Siver Insurance Consultants Proposer/Bidder, . - h-1-- 1-15-2-0-26 Signature of Authorized I , gepresentative (Affiant) Date Kathy Gordon, Vice President Printed or Typed Name and Title of Authorized Representative (Affiant) 35 City of Sanford I Finance Department I Purchasing Division OS 300 N. Park Avenue Suite 243 2nd Floor, Sanford Florida 32771 ORD Phone: 407-688-5028, or 50301 Fax: 407-688-5021 FNANCE DEPAUMENT REQUEST FOR PROPOSALS (RFP) TERM CONTRACT I a I 191 om so I By.0% 910 is a 1,11i ; i � i 111� 1� ii, ;� i v 0111001 wi;; COUNTY OF PMLLAS STATE OF FLORIDA On this ly-11"�" day of January 20 2O before me, the undersigned Notary Public of the State of Florida,�_ersomlly appeared Kathy Gorl�n —whose name(s) is/are subscrftd_ to the within instrument, and he/she/they acknowledge that he/shelthey executed it WITNESS my hand and official seal. H(%� a is personally Iknown to ' nor has produced as identification, 4 . ............. — (Notary Public in and for the County and State Afbr�ltrentioned) Y P "' ff6W&%W(A4 -, t. THERESA M. CONLEY Notary Public - State of Florida SEAL My commission expires: Commission # GG 909481 My Comm. Expires Sep 2, 2023 Bonded through National Notary Assn. PLEASE COMPLETE AND SUBMrr WITH YOUR RFP RESPONSE *-Failure to submit this form may be grounds for disqualification of your submiffal"v 16 City of Sanford I Finance Department J Purchasing Division CIT300 N. Park Avenue Suite 243 2nd Floor, Sanford Florida 32771 Y 4 Phone: 407-688-5028, or 50301 Fax: 407-688-5021 0 FINANCE bEV'FNIh9F.MT REQUEST FOR PROPOSALS (RFP) TERM CONTRACT logo 11,111111i D1 N "01 W. 1 1 _ 1 11141 Attachment "G" CERTIFICATION OF NON -SEGREGATED FACILITIES FORM The Bidder certifies that no segregated facilities are maintained and will not be maintained during the execution of this contract at any of its establishments. The Bidder further certifies that none of its employees are permitted to perform their services at any location under the Bidder's control during the life of this contract where segregated facilities are maintained. The Bidder certifies further that it will not maintain or provide for its employees any segregated facilities at any of its establishments, and that he will not permit his employees to perform their services at any location, under his control, where segregated facilities are maintained. As used in this certification, the term "segregated facilities" means any waiting rooms, work area, rest rooms and wash rooms, restaurants and other eating areas, time clocks, locker rooms and other storage or dressing areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, and housing facilities provided for employees which are segregated by explicit directive or are in fact segregated on the basis of race, creed, color or national origin, because of habit, local custom, or otherwise. The Bidder agrees that (except where it has obtained identical certification from proposed subcontractors for specific time periods) it will obtain identical certifications from proposed subcontractors prior to the award of subcontract exceeding $10,000 and that it will retain such certifications in its files. E. W. Siver & Associates, Inc. dba Siver Insurance Consultants Name of Bidder f .. lis 1.) 02-0 Signature of AutWGrized Representative Kathy Gordon, Vice President Printed or Typed Name and Title of Authorized Representative PLEASE COMPLETE AND SUBMIT WITH YOUR RFP RESPONSE 13"Failure to submit this form may be grounds for disqualification of your submittal'w 37 City of Sanford I Finance Department I Purchasing Division S.KgFORI) 300 N. Park Avenue Sulte 243 2nd Floor, Sanford Florida 32771 Phone: 407-688-5028, or 5030 1 Fax: 407-688-5021 FINAKE MA(MMIr REQUEST FOR PROPOSALS (RFP) TERM CONTRACT Attachment "H" DISPUTES DISCLOSURE FORM Answer the following questions by answering "YES" or "NO". If you answer "YES", please explain in the space provided, please add a page(s) if additional space is needed. Has your firm, or any of its officers, received a reprimand of any nature or been suspended by the Department of Professional Regulation or any other regulatory agency or professional association within the last five (5) years? No _ (Y/N) 2. Has your firm, or any member of your firm, been declared in default, terminated or removed from a contract or job related to the services your firm provides in the regular course of business within the last five (5) years? No - (Y/N) 3. Has your firm had filed against it or filed any requests for equitable adjustment, contract claims or litigation in the past five (5) years that is related to the services your firm provides in the regular course of business? No (Y/N) Note: If yes, the explanation must state the nature of the request for equitable adjustment, contract claim or litigation, a brief description of the case, the outcome or status of suit and the monetary amounts or extended contract time involved. I hereby certify that all statements made are true and agree and understand that any misstatement or misrepresentation or falsification of facts shall be cause for forfeiture of rights for further consideration of the project identified. E. W. Siver & Associates, Inc. dba Siver Insurance Consultants Firm e, Signatureb'f Authorized Representative Gordon, Vice President Printed or Typed Name and Title of Authorized Representative ffe PLEASE COMPLETE AND SUBMrr WITH YOUR RFP RESPONSE M'Failure to submit this form may be grounds for disqualification of your submittal "61 W City of Sanford I Finance Department I Purchasing Division O'S300 N. Park Avenue Suite 243 2nd Floor, Sanford Florida 32771 'W..N`Phone: 407-688-5028, or 5030 Fax: 407-688-5021 FMNCE DEPARtMENr REQUEST FOR PROPOSALS (RFP) TERM CONTRACT Attachment "J" Unauthorized (Illegal) Alien Workers The CITY will not intentionally award publicly -funded contracts to any contractor who knowingly employs unauthorized alien workers, constituting a violation of the employment provisions contained in 8 U.S.C. Section 1324a(e) Section 274A(e) of the Immigration and Nationally Act (INA). The CITY shall consider the employment by the CONTRACTOR of unauthorized aliens, a violation of Section 274A(e) of the INA. Such violation by the CONTRACTOR of the employment provisions contained in Section 274A(e) of the INA shall be grounds for immediate termination of this Agreement by the CITY. 1. By executing this certification, the CONTRACTOR certifies that E. W. Siver & Associates, Inc. dba _.._ Siver Insurance Consultants (name of company) does not and will not during the performance of any contract resulting from the solicitation identified below employ illegal alien workers or otherwise violate the provisions of the federal Immigration Reform and Control Act of 1986. 2. The Undersigned agrees to, upon request of the City, provide copies of Immigration Form I-9 for each person associated with the above named company who has been or is present at the designated jobsite associated with any work or project resulting from this solicitation. CONTRACTOR: E. W. Siver & Associates, Inc. dba Siver Insurance Consultants Signature: Printed Name: Kathy Gordon Title: Vice President, _ Date: Affix Corporate Seal . I0 . 1M IMIN STATE OF FLORIDA On this � day of Janes' , 2020 , before me, the undersigned Notary Public of the State of Florida, personally appeared a or on cubed to the instrument,within and he/she/they acknowledge that he/she/they executed it. WITNESS my hand and official seal. Ike /Sh is personally P Y PP whose names is/are subs e known to rhas produced , as identification. SEAL (Notary Public in and for the County and State My commission expires: THERESA M. CONLEY Notary Public • State of Florida Commission p GG 909481 My Comm. Expires Sep 2.2023 �d through National Notary Assn. PLEASE COMPLETE AND SUBMIT WITH YOUR .RFP RESPONSE w -Failure to submit this form may be grounds for disqualification of your submittal'w City of Sanford I Finance Department I Purchasing Division 300 N. Park Avenue Suite 243 2°d Floor, Sanford Florida 32771 0�zOF Phone: 407-688-5028, or 5030 1 Fax: 407-688-5021 NFORD MANCE DEPARVAENT REQUEST FOR PROPOSALS (RFP) TERM CONTRACT I I IN NOM so IDEN pigeon 1114 i� 111111 1 1� 11 1141''1 i 11111 11516) 9101 111 ill i Attachment "10 E -VERIFY COMPLIANCE AFFIDAVIT The Affiant identified below attests to the following: That the Contractor is currently in compliance with and throughout the term of the above identified project and will remain in compliance with Executive Order 11-02, issued by the Office of the Governor, State of Florida, requiring the use of the Department of Homeland Security's Status Verification (E -Verify) System to ensure that all employees of the Contract and the Contractor's subcontractors performing work under the above -listed Contract are legally permitted to work in the United States. 2. Each Contractor that performs work under the Project referenced above shall provide the City of Sanford, Florida, a copy of the "Edit Company Profile" screen indicating enrollment in the E -Verify Program. 3. The Contractor will register and participate in the work status verification for all newly hired employees of the contractor and for all subcontractors performing work on the above -listed Contract. 4. The Contractor agrees to maintain records of its compliance with the verification requirements as outlined in this Affidavit and, upon request of the any Authority having jurisdiction over the Project, including, but not limited to, the State of Florida, agrees to provide a copy of each such verification to that Authority. 5. That all persons assigned by the Contractor or its subcontractors to perform work under the above identified project will meet the employment eligibility requirements as established by the Federal Government and the government of the State of Florida. 6. That the Contractor understands and agrees that its failure to comply with the verification requirements as set forth herein or its failure to ensure that all employees and subcontracts performing work under the above identified project are legally authorized to work in the United States and the State of Florida constitute a breach of contract for which the City of Sanford may immediately terminate the Contract without notice and without penalty. Contractor further understands and agrees that in the event of such termination, the Contractor shall be liable to the City for any costs incurred by the City as a result of the Contractor's breach. 7. That for the purposes of this Affidavit, the following definitions apply. "Employee" — Any person who is hired to perform work in the State of Florida. "Status Verification System" — the procedures developed under the Illegal Immigration Reform and Immigration Responsibility Act of 1996, operated by the Department of Homeland Security and known as the 'T -Verify Program", or any successor electronic verification system that may replace the E -Ver* Program. E. W. Siver & Associates. Inc. dbaSiver Insurance Consultants Contractor I - V1 Signature of Authorized Kathy Gordon, Vice President Printed or Typed Name and Title of Authorized Representative (Affiant) Date -16-202-0 City of Sanford I Finance Department I Purchasing Division OSXRFORD 300 N. Park Avenue Suite 243 2°d Floor, Sanford Florida 32771 Phone: 407-688-5028, or 50301 Fax: 407-688-5021 rVAINCE UVAUMEW REQUEST FOR PROPOSALS (RFP) TERM CONTRACT TITLE: HEALTH INSURANCE & WELLNESS PROGRAM STUDY COUNTY OF PINELLAS STATE OF FLORIDA On this -/l day of January 2()20 before me, the undersigned Notary Public of the State of Florida, personally appeared Kathv Gordon — whose name(s) is/are suI12.5cribed-tp the within instrument and he/she/they acknowledge that he/she/they executed it WITNESS my hand and official seal. kliown to 'me Vr has produced as identification. U--. .. . ...... (Notary Public in and for the County and State Afore(nentioned) THERESA AL CONLEY Notary Public - State of Florida SEAL My commission expires: 7 Commission # GG 909481 My Comm. Expires Sep 2, 2023 Sonded through National Notary Assn. PLEASE COMPLETE AND SUBMIT WITH YOUR RFP RESPONSE *"Failure to submit this form may be grounds for disqualification of your submittaPw 47 City of Sanford J Finance Department I Purchasing Division (D 300 N. Park Avenue Suite 243 2aa Floor, Sanford Florida 32771 CITY °F (" Phone: 407-688-5028, or 5030 1 Fag: 407-688-5021 MPARTM€W1 REQUEST FOR PROPOSALS (RFP) TERM CONTRACT TITLE: HEALTH INSURANCE & WELLNESS PROGRAM STUDY Attachment "L" Americans With Disabilities Act Affidavit By executing this Certification, the undersigned CONTRACTOR certifies that the information herein contained is true and correct and that none of the information supplied was for the purpose of defrauding the City of Sanford (CITY). The CONTRACTOR will not discriminate against any employee or applicant for employment because ofphysical or mental handicap in regard to any position for which the employee or applicant for employment is qualified. The CONTRACTOR agrees to comply with the rules, regulations and relevant orders issued pursuant to the Americans with Disabilities Act (AFA), 42 USC s. 12101 et seq. It is understood that in no event shall the CITY be held liable for the actions or omissions of the CONTRACTOR or any other party or parties to the Agreement for failure to comply with the ADA. The CONTRACTOR agrees to hold harmless and indemnify the CITY, its agents, officers or employees from any and all claims, demands, debts, liabilities or causes of action of every kind or character, whether in law or equity, resulting from the CONTRACTOR's acts or omissions in connection with the ADA. E. W. Siver & Associates. Inc. dba Siver Insurance Consultants Contractor Signature of Authoriz�,Representative (Affiant) Date Kathy Gordon. Vice President Printed or Typed Name and Title of Authorized Representative (Affiant) COUNTY OF PINELLAS STATE OF FLORIDA On this /, w. ` day of January , 20 20 . before me, the undersigned Notary Public of the State of Florida, personally appeared Kathy Gordon whose name(s) is/are subscribed to the within instrument, and he/shelthey acknowledge that he/she/they executed it. WITNESS my hand and official seal. HqSSh e.;.s� ;persorialy"B'-- tome tr has produced . as identification. (Notary Public in and for the County and State Aforemen SEAL My commission expires:` 10 .. ° `* 14i �'RERESA M. CONLEY Notary Public - State of Florida Commission # GG 909461 ` My Comm, Expires Sep 2, 2023 Bonded through National Notary Assn. PLEASE COMPLETE AND SUBMIT WITH YOUR. RFP RESPONSE M" Failure to submit this form may be grounds for disqualification of your submittal A2 City of Sanford I Finance Department I Purchasing Division 300 N. Park Avenue Suite 243 2nd Floor, Sanford Florida 32771 0 ISCITY OF ORD Phone: 407-688-5028, or 50301 Fax: 407-688-5021 FINANCE CEPARIMENT REQUEST FOR PROPOSALS (RFP) TERM CONTRACT Attachment 'IQ" Contractor Certification Regarding Scrutinized Companies (Contracts of $1,000,000.00 or more) Section 287,135, Florida Statutes, prohibits local governments from contracting with companies, for goods or services of One Million and 00/100 Dollars ($1,000,000.00) or more that are on either the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List. Both lists are created pursuant to section 215.473, Florida Statutes. As the person authorized to sign on behalf of the Bidder, I hereby certify that the company identified below in the section entitled "Bidder/Contractor Name" is not listed on either the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List. I understand that pursuant to section 287.135, Florida Statutes, the submission of a false certification may subject the successful Bidder to termination ofthe awarded Agreement, civil penalties, attorney's fees, and/or costs. By the signature(s) below, I/we, the undersigned, as authorized signatory to commit the firm, certify that the information as provided in Attachment "Q", Contractor Certification Regarding Scrutinized Companies, is truthful and correct at the time of submission, Bidder/Contractor Name: E. W. Siver & Associates, Inc. dba Siver Insurance Consultants Mailing Address: ___.,,P.0._l3ox,,,21343. St. Petersburg. FL 33742-1343 Telephone Number: (727) 577-2780 Fax Number: . _n/a —E-mail Address: kgordon(t�siver.com Kathy Gordon Authorized Signat Printed Name Vice President I I I 15 � Title Date FEIN: 59-1712226 PLEASE COMPLETE AND SUBMIT WITH YOUR RFP RESPONSE (when applicable) '�Failure to submit this form may be grounds for disqualification of your submittal`' 50 TAB E FEESCHEDULE Per the RFP instructions, Attachment "B" — Price Proposal and Acceptance of Bid Terms and Conditions, has been included in Tab D — Forms. Kathy Gordon, who is an authorized signatory, has signed page 30 attesting to knowledge of the scope of services, committing to the prices as offered, and acceptance of the terms and conditions. The form has been notarized in accordance with the RFP. Siver is proposing a flat fee of $25,000 for the Health Insurance and Wellness Program Study. This flat fee excludes Section 2.05 III (future annual reviews) and Section 2.05 XIII (on-call support for all matters relevant to this study for a period of five (5) consecutive years following the final deliverable). Siver will negotiate pricing with the City on future annual reviews based on our hourly rates and the scope of the future reviews. On-call support and follow up after the final deliverable will be at our hourly rates, which are as follows: Senior Consultants $240 per hour Consultants $180 per hour Note: For services performed after the final deliverable, typical business expenses (i.e., mileage, lodging, meals, etc.) will be billed in addition on a pass-through basis. TAB F ADDITIONAL INFORMATION We are attaching the 2016 Health Insurance Plan Review for the City of Hallandale Beach, Florida. This project was not included in our response as a current project because it is older than three -years. However, the scope of the report is relevant to the scope of the City's RFP. We offer this as an example of our work product for a similar project. CITY OF HALLANDALE BEACH, FLORIDA HEALTH INSURANCE PLAN REVIEW 2016 ISSUES REPORT Prepared by Siver Insurance Consultants March 25, 2016 TABLE OF CONTENTS Executive Summary 1 Health Insurance Plan Review 2 Historical Health Insurance Review 2 Health Insurance Contribution Strategies 4 Cost of Coverage for Retirees 9 Wellness Initiatives 11 Comparison of Other Entity's Benefits 13 2015-2016 Benchmark Study 13 Other Survey Information 19 Health Plan Funding 23 Fully Insured — Advantages, Disadvantages & Description 23 Self -Insurance —Advantages, Disadvantages & Description 24 Pooling Arrangement —Advantages, Disadvantages & Description 25 Health Plan Options 29 High Deductible Health Plan (HDHP) Options 29 Cafeteria Plans & Employer Based Exchanges 30 Defined Contribution Plans 31 Direct Contracting Models 33 Use of Onsite Employee Health Clinics 34 Improving Access to Primary Care 38 Medicare Advantage Options 38 Annual Benefit Statements & Employee Communications 39 Healthcare Reform 40 Historical Timeline 40 Cadillac Excise Tax 41 Employer Shared Responsibility Mandate — Pay or Play 45 W-2 Reporting 49 Wellness Benefits 50 I ii TABLE OF CONTENTS (cont'd) Exhibits Exhibit 1 2013-2014 Cigna Rates and Plan Documents 2014-2015 Cigna Rates and Plan Documents 2015-2016 Cigna Rates and Plan Documents Exhibit 2 Cigna Experience Reports Exhibit 3 Cigna Wellness Documents Exhibit 4 2015-2016 Benchmark Study of Local Government Entities Exhibit 5 Sample Wage and Benefits Statement Appendix Plan Designs and Rates of all entities from Benchmark Study ii EXECUTIVE SUMMARY Our overall review of the health insurance plan offered to the employees of the City of Hallandale Beach (the City) found that: • The plan benefits, such as the deductible, maximum out-of-pocket and copays, are consistent with what other public entities, both local and across the state, are offering to their employees. The premium rates for the plan are also consistent with what other public entities, both local and across the state, are offering to their employees. • It is not typical that only one (1) plan option be offered. Most of the local and Florida governmental entities reviewed offer their employees more than one (1) plan option and when only one (1) plan option is provided, it is a PPO type plan, not an HMO type plan. • The City is contributing more towards the cost of health coverage than most of the local and Florida governmental entities, particularly for the cost of coverage for dependents. The City pays 100% of the employee cost and a minimum of 70% of the dependent cost. • The City's current health insurer, Cigna, is paying out more for claims than it is collecting in premium. The City's plan has had poor claim experience for the last 29+ months and may need to consider other plan offerings, plan designs and contribution structures for the October 1, 2016 renewal. Based upon premium and claims data for the first five (5) months of the 2015-2016 plan year, the October 1, 2016 renewal will include an approximate 30%+ increase in premium. • We recommend that the City consider an RFP process for the October 1, 2016 renewal. The review of other governmental entities in the City's geographic area indicated that there are a number of viable proposers. The RFP should request fully insured proposals, self-insured proposals and proposals from consortiums within the state. The RFP should request plan design options and other services designed to control future costs. • Florida Statute 112.08 requires Florida governments to competitively procure contracts to provide employee benefits, like health insurance. However, it is our understanding that the statute also allows governments to participate in a pooling arrangement without the competitive procurement process. If the City's procurement/legal staff agree with this interpretation, an option to the October 1, 2016 renewal could include negotiating with Cigna and also requesting and considering proposals from consortiums/pools. • In consideration of the Cadillac provision of Affordable Care Act (ACA), if the City were to make no changes to the plan until the effective date of October 1, 2020, the City could potentially be taxed millions of dollars. • As outlined in our report, in order to control future claims costs, we are recommending a multi -pronged approach that includes consideration of plan design changes, changes in contributions for dependent coverage, increased emphasis on wellness, a dependent eligibility process/audit, etc. We do not believe there will be a single solution to the problem, and we anticipate a few years of difficult decisions and work involved. Page 1 HEALTH INSURANCE PLAN REVIEW The City currently offers employees one (1) health plan option, an HMO, through Cigna. In addition, the City offers employees the ability to contribute to a Flexible Spending Account and Dependent Care Account through Wageworks. Historical Health Insurance Review The City's health insurance is provided by Cigna as a fully insured arrangement. The health plan runs on an October 1 — September 30 plan year. For the 2013-2014 renewal, the City received competitive bids for the health insurance and the coverage moved from Coventry to Cigna effective October 1, 2013. The City offered three (3) plans at that time: the two (2) HMO plans were offered to both active employees and retirees and the PPO plan was only offered to retirees who lived outside of the Tri -County area. For the 2013-2014 plan year, there was a significant combined claims loss ratio of 150.06%. Appropriately, the City was given a significant renewal for the 2014-2015 plan year, which the City had to negotiate. The City reduced the plan offering to one (1) HMO plan with some minimal plan changes and negotiated a renewal under 15%. For the 2014-2015 plan year, again there was a significant combined claims loss ratio of 147.52%. Appropriately, the City was given a significant renewal for the 2015-2016 plan year, which again, the City had to negotiate. The City added a $1,000 deductible to the one (1) HMO plan with minimal other changes and negotiated a renewal of 14.9%. Historical rates, open enrollment communication, plan summaries and Cigna plan year settlement documents are shown as Exhibit 1 of this report. High Claimant and Historical Experience Review We believe that Cigna has worked with the City for the renewals of the plan(s). The City has incurred both high claims and high utilization of the plan for the last two (2) plan years, a trend that is ongoing in the current 2015-2016 plan year. The City's plan(s) with Cigna include a pooling premium charge for claims which hit a threshold of $175,000 or higher called their Experience Protection Benefit. This threshold has not changed since the inception date of October 1, 2013. When a claimant's claims go over the dollar threshold of $175,000, the claims experience above $175,000 is removed from the claims to premium loss ratio and does not count against the City during renewal negotiations. For the 2013-2014 plan year, there were four (4) claimants whose claims totaled approximately $633,500 over the $175,000 threshold. These four (4) claimants had approximately $1.33M in claims, which equals 22% of the total claim dollars for the plan year. Page 2 For the 2014-2015 plan year, there were four (4) claimants whose claims .totaled approximately $876,500 over the $175,000 threshold. These four (4) claimants had approximately $1.58M in claims, which equals 23% of the total claim dollars for the plan year. To date, the 2015-2016 plan year is already fairly active five (5) months in with multiple additional claimants already piercing or close to piercing the $175,000 threshold. Taking into consideration the most recent twelve (12) months of claims and high claimant activity, we expect that the 2016-2017 renewal will also be challenging. Roughly based on the October 1, 2015 renewal document prepared by Cigna for the City, the following is our estimated projection of the 2016-2017 renewal: Page 3 October 1, 2016 Renewal Proiection 1 Total Paid Claims (Medical and Rx) (March 15 - February 16) (trended 10%) $6,932,700.50 2 Minus Large Claims over $175k (March 15 - February 16) ($1,829,007.00) 3 $5,103,693.50 4 Plus Capitation Claims $262,293.00 5 $5,365,986.50 6 7 Annual Inforce Employee 5,796 8 Per Employee Per Month Claim Costs $925.81 9 Projected Trend 12% 10 Projected # Employees 484 11 $6,022,347.75 12 Large Claims to Proposed Pooling $1,050,000.00 13 (6 x $175,000) 14 Total Trended Claims $7,072,347.75 15 16 Projected Total Expenses 17 (includes ACA fees, expense and pooling fees) 15.00% 18 Total Expenses $1,060,852.16 19 Estimated Access Fees $140,000.00 20 21 Total Premium Need $8,273,199.91 22 Total Current Premium $6,281,148.00 23 Total Annual Premium Increase 31.71% Page 3 As the last competitive process was completed in 2013, the City should strongly consider bidding out the health insurance. As we will discuss below, the surveyed entities in the immediate local area are using other insurers and therefore, there are other available networks in the Tri -County area that may be competitive. However, with the City continuing to see higher than desired claims ratios but lower than expected renewal rate increases, Cigna remains a viable option to negotiate with. We would recommend that the City request plan design options, including a lower cost, lower benefit plan (preferably a PPO or HDHP type plan), whether a decision is made to competitively bid or not. Cigna has worked with the City to make benefit changes when needed to curb rate increases and has additional plan offerings to review. If a decision is made to competitively bid out the health insurance, we would recommend the RFP request fully insured proposals, self-insured proposals and proposals from consortiums within the state, along with plan design options designed to lower premium costs. Historical experience reports are shown in Exhibit 2 of this report. Health Insurance Contribution Strategies Historically, the City has provided employees with "free" health insurance for the employee coverage and pays 70% or more (depending on Job Level) for the dependent cost share. We would consider this a great benefit to employees, as we have seen some entities unable to continue doing so. Public entities have endured challenging financial environments for the last decade and costs have had to be shifted to employees. Being able to offer a "free" health plan to employees is not only a great benefit for attracting quality employees and retention, but also assists the City with the "Pay or Play" Employer Shared Responsibility Mandate discussed in the healthcare reform section of this report. Of the nine (9) additional local governments surveyed (see section later in report), only four (4) provide a no premium plan option to employees. Due to the additional ACA provisions put into place for an affordable health care plan option, discussed further in the report, we have seen some entities offer a low-cost, low benefit option (still able to meet minimum value criteria) to satisfy the ACA requirement. These plans may offer generic -only drug coverage and have higher deductible and out-of-pocket costs. We would encourage the City to continue offering an affordable or "free" plan option with the best benefits available as long as it is financially feasible to do so. Page 4 Current Tier Structure 2015-2016 (All Employees and Retirees) The current contributions for employees and retirees are summarized in the below chart: 2015-2016 Current Costs Retiree Premium Per Mmployee onth (15/16) E Monthly Cost $0.00 City Monthly Cost Estimated Enrollment Cigna OAP HMO Plan - $1,000 Ded $1,151.43 $0.00 Employee $563.65 $0.00 $563.65 181 Emp+ 1 $1,151.43 $176.33 $975.10 88 Family $1,678.60 $334.49 $1,344.11 165 Retiree $563.65 $563.65 $0.00 33 Ret + 1 $1,151.43 $1,151.43 $0.00 14 Family $1,678.60 $1,678.60 $0.00 5 Total Cost / % Paid by City $4,915,291 78.25% Total Cost / % Paid by Employees $848,495 13.51% Total Cost / % Paid by Retirees $517,362 8.24% Total Cost / % by All $6,281,148 100.00% For this HMO plan, employees do not contribute towards the employee only coverage. For dependents, employees pay 30% of the dependent share of the premiums. It is our experience that the cost of dependent coverage for employees with smaller families is typically one of the most common complaints from employees when in a two or three tiered contribution structure. Cigna can provide the City with rates in any reasonable tier structure desired. Current Tier Structure For 2016-2017 Renewal (Active Employ) In our opinion, due to the continued poor claims experience that the City is experiencing, as estimated in the chart on page 3, we believe that the 2016-2017 renewal will be fairly substantial and over 30%. Page 5 The 2016-2017 current contribution structure for employees, including the estimated 30% increase, is summarized in the below chart: 2016-2017 Projected Costs - 30% Renewal Increase Retiree Premium Per Month (16/17) Employee Monthly Cost* $0.00 City Monthly Cost Estimated Enrollment Cigna OAP HMO Plan - $1,000 Ded $1,496.86 $0.00 Employee $732.75 $0.00 $732.75 181 Emp + 1 $1,496.86 $229.23 $1,267.62 88 Family $2,182.18 $434.83 $1,747.35 165 Retiree $732.75 $732.75 $0.00 33 Ret + 1 $1,496.86 $1,496.86 $0.00 14 Family $2,182.18 $2,182.18 $0.00 5 Total Cost / % Paid by City $6,389,886 78.25% Total Cost / % Paid by Employees $1,103,036 13.51% Total Cost / % Paid by Retirees $672,570 8.24% Total Cost / % by All $8,165,492 100.00% * Assumes cost share for dependent coverage is 30% of the dependent share of the premium. Contribution Tier Options The current rates allow for three coverage options for employees: to cover themselves only (Employee), cover themselves plus one dependent, either a wife or a child (employee + 1) or to pay for family coverage. Family coverage covers the employee, their spouse and all dependent children. An employee with one (1) child as a dependent pays the same premium as an employee with a spouse as a dependent, even though, on average, adult spouses generate significantly more claims costs than children. The most common tier structure to spread out the dependent cost share is to have a four (4) coverage tier option: Employee Employee plus Spouse Employee plus Child(ren) Family (includes Child(ren) and Spouse) Page 6 This tiering structure was used by four (4) of the ten (10) entities surveyed. The following is a projection of a four -tiered structure for the City, using the projected 2016- 2017 renewal rates: Estimated Four Tier Structure Retiree Premium Per Month (16/17) Employee Monthly Cost $0.00 33 City Monthly Cost Estimated Enrollment $1,245.67 Cigna OAP HMO Plan - $1,000 Ded Ret + Spouse $1,496.86 Employee $732.75 $0.00 $732.75 181 Emp + Child(ren) $1,245.67 $153.88 $1,091.79 44 Emp + Spouse $1,496.86 $229.23 $1,267.62 44 Full Family $2,249.00 $454.88 $1,794.12 165 Retiree $732.75 $732.75 $0.00 33 Ret + Child(ren) $1,245.67 $1,245.67 $0.00 12 Ret + Spouse $1,496.86 $1,496.86 $0.00 2 Family $2,249.00 $2,249.00 $0.00 5 Total Cost / % Paid by City $6,389,658 78.26% Total Cost / % Paid by Employees $1,102,938 13.51% Total Cost / % Paid by Retirees $672,570 8.24% Total Cost / % by All $8,165,166 100.00% * Assumes cost share for dependent coverage is 30% of the dependent share of the premium. We did not have any data indicating how many of the families had just children, how many had just spouses and how many had both. At this time, if the City were to consider amending their tier structure, we would recommend this four -tiered structure. Another common trend is to tie contributions to wellness initiatives. Many public and private entities are amending their contributions to be reduced if wellness goals are achieved and/or increasing contributions if wellness goals are ignored or not reached. This could be as simple as a smoker surcharge or a non-smoker discount or a complex system where contributions are amended if various wellness goals are met. Page 7 As an example, a Siver client wanted to improve employee health and chose to encourage annual physicals, including biometric screenings. The employer did not want to tell employees which physicians to use but wanted to encourage all employees to establish a relationship with a primary level physician and have the recommended preventative screenings. It was felt that this would, over time, lead to better controlled hypertension and diabetes via earlier intervention. (These were two (2) of the more costly diagnoses indicated in their health plan data.) Annual physicals were covered on their health plan with no copayment so this did not result in any cost to employees. To accomplish this goal, employees were required to demonstrate they had a physical via getting a simple form completed during the office visit. To be eligible for any buy -up plan options, this was required. Many entities are considering a requirement that all new employees be non-smokers. In addition to wellness program initiatives to support smoking cessation, many employers have implemented contribution strategies which encourage smoking cessation and/or penalize smoking. As an example, a no -cost base plan could only be available to demonstrated non-smokers or to smokers who had participated in one of the smoking cessation programs. Others would have to pay some sort of premium, such as $20 per week or per pay period. This type of structure may require bargaining and while currently upheld in Florida, to our knowledge, there have been legal challenges to some programs of this sort. Page 8 Cost of Coverage for Retirees The City does not contribute towards the cost of health coverage for retirees. For the 2015-2016 City, the retirees contributed approximately $517,000 towards the overall premium costs of the plan. The February 2016 census includes 49 pre -65 retirees (not Medicare eligible) plus their dependents and 2 post -65 (Medicare eligible) plus their dependents on the City's health plan. Current Tier Structure 2015-2016 (Retirees) The current contributions for retirees are summarized in the below chart: 2015-2016 Current Costs - Retirees Only Total Cost Paid by City Premium Per MonthEmployee (15/16) Monthly Cost City Monthly Cost Estimated Enrollment $517,362 Cigna OAP HMO Plan - $1,000 Ded 354.3% November 2015 Retiree $563.65 $563.65 $0.00 33 Ret+ 1 $1,151.43 $1,151.43 $0.00 14 Family $1,678.60 $1,678.60 $0.00 5 Total Cost Paid by City $0 Total Cost Paid by Retirees $517,362 Total Cost by Retirees & City $517,362 There are 49 pre -65 retirees and their dependents that are contributing heavily to the poor claim experience that the City is experiencing. Their premium dollars total approximately $517,000 annually but their claims experience is, on average, three (3) times the amount of premium they bring in. Per the most current five (5) months of claims data: Month Premium Billed Claims Loss Ratio October 2015 $34,659 $122,798 354.3% November 2015 $34,659 $85,661 247.2% December 2015 $34,659 $98,900 285.4% January 2016 $35,134 $78,690 224.0% February 2016 $33,708 $120,549 357.6% For the 2 post -65 retirees and their dependents, their claim experience is the opposite and is much lower than their pre -65 counterpart. Month Premium Billed Claims Loss Ratio October 2015 $1,437 $372 25.9% November 2015 $1,437 $458 31.9% December 2015 $1,437 $653 45.5% Januar 2016 $1,437 $677 47.1% February 2016 $1,437 $959 66.8% Page 9 Florida Statute 112.0801 requires that the City allow retirees to continue to participate in the health plan. The statute reads, in part: 112.0801 Group insurance; participation by retired employees.— (1)Any state agency, county, municipality, special district, community college, or district school board that provides life, health, accident, hospitalization, or annuity insurance, or all of any kinds of such insurance, for its officers and employees and their dependents upon a group insurance plan or self-insurance plan shall allow all former personnel who retired before October 1, 1987, as well as those who retire on or after such date, and their eligible dependents, the option of continuing to participate in the group insurance plan or self-insurance plan. Retirees and their eligible dependents shall be offered the same health and hospitalization insurance coverage as is offered to active employees at a premium cost of no more than the premium cost applicable to active employees. For retired employees and their eligible dependents, the cost of continued participation may be paid by the employer or by the retired employees. [Underlining added for emphasis.] The statute requires coverage be offered at "a premium cost of no more than the premium cost applicable to active employees," and it does not require that the City pay any share of the premium on behalf of the retiree. For the size of the City, there does seem to be a high population of retirees in the pre -65 tier. Since the City does not contribute to their premiums, there are few options to incentivize them to move onto other plans. Within the marketplace and exchanges, there may still be some uncertainty as to their permanence. One suggestion we recommend could be rolling out additional communication to this group of retirees and offering them a one-time (or more) option to come back onto the City's current active plan if needed. We feel that some of these retirees may be holding onto the City's plan due to the comfort level it provides, but if there is a "safety net" of sorts, perhaps they may consider other plan options, including the marketplace and exchanges. The City does not currently offer a Medicare Advantage plan for retirees who are post -65 and Medicare eligible. At this time, we agree that this makes sense due to the low enrollment in that tier. However, within the next 5 years, there will be more retirees who become eligible for Medicare and to incentivize them to move off the City's active plan, a Medicare Advantage offering, which typically includes lower premiums and equal or better benefits than the active plan, may be attractive. In addition, this moves any of their future poor claim experience off the active plan. Page 10 Wellness Initiatives The City currently receives $50,000 a year in wellness funds from Cigna. Since October 1, 2013, the City has mainly dedicated these funds to providing free gym memberships to 24 Hour Fitness and Premier Fitness to employees and their dependents on the health insurance plan who sign up. In addition, it is our understanding that there was $5,000 allocated from the City budget to use towards a health fair sometime in the 2015-2016 plan year. As part of a long-term strategy to take into account the consistent higher claims and high utilization being experienced by the plan, it may make sense to re -think the allocation of the wellness funds to use thein towards a larger portion of the City population versus the higher cost of the gym memberships. After reviewing options with Cigna, they provided additional details on the types of wellness services that are currently included with the City's plans and premium and also some additional programs that are available for an additional cost. Included in the Cigna Rates: • Mycigna.com • MyCigna.com Mobile App • Coach by Cigna • Mobile Apps & Activities • Health Assessment • 24 Hour Health Information Line • Healthy Rewards • Lifestyle Management Programs • My Health Assistant • The Well • Your Health First Available for an additional cost includes: • Biometrics • Flu Shots • Cigna Onsite Health Wellness Seminars • Cigna Onsite Health Hourly Coaching • Just Walk 10,000 Steps a Day • Onsite Lifestyle Management Courses Page 11 Specifically for the $50,000 wellness fund, Cigna provided a listing of services that qualify towards the use of the funds. Included on that list: • Rewards for wellness program participation (excluding cash) • Activity and challenge programs related to wellness • Onsite health and wellness classes • Health awareness communications • Wellness speakers • Onsite screenings like flu and biometrics Coupled with the additional $5,000 that the City has set aside for a health fair or similar - onsite service, the City may consider implementing a full wellness, Health Risk Assessment and fair/clinic to begin the steps towards implementing wellness criteria into the enrollment of the health plan(s). For example, we have a client that offers only a high deductible health plan (HDHP) tied to a Health Reimbursement Account (HRA) (which only the employer can contribute to) and the employees receive a portion of their HRA funds annually based on their participation in the annual Health Risk Assessment information gathering. Employees are "required" to either attend the wellness fair during open enrollment or go to their own primary care provider, have their updated bloodwork and other health assessment(s) completed, and have it reported back to the entity by either the onsite vendor or self- report on a form from the primary care provider. As part of a long-term strategy for reducing claims for the City, we strongly advise that a more stringent wellness program(s) be put into place which "requires" employee (and dependent) participation. Cigna wellness documents, flyers and City gym invoices are shown in Exhibit 3 of this report. Page 12 COMPARISON OF OTHER ENTITY'S BENEFITS 2015-2016 Benchmark Study At the request of the City, we conducted a benchmarking study of both local entiies within the Tri -County area and a couple that were outside of the Tri -County area to provide an insight to what other entities are offering in other parts of the state. Please see Exhibit 4 for the entire Benchmark Study. In addition, all the rates, plan designs and employee communication that was able to be used for the study is included as an Appendix to this report. The survey included: • City of Hallandale Beach, FL • Brevard Public Schools • Broward County Schools • City of Hialeah, FL • City of Hollywood, FL • City of Largo, FL — part of the Public Risk Management consortium/pool • City of Maitland, FL • City of Miramar, FL • Emerald Coast Utilities Authority — part of the Florida Municipal Insurance Trust • Town of Davie, FL The following were some of the conclusions we noted from the survey. Markets Used Of the ten (10) municipalities that were surveyed, and including the City, the insurers/administrators used were: Aetna used by 1 of the 10 Cigna used by 3 of the 10 Coventry used by 2 of the 10 (Hialeah will be counted twice) Florida Blue used by 2 of the 10 United Health Care used by 3 of the 10 (Hialeah will be counted twice) Based upon this data, it appears that Cigna has the a strong market presence in the City's geographic area but other insurers also are considered competitive by the City's neighbors. Page 13 Plan Comparisons Of the ten (10) municipalities surveyed: • Six (6) entities offered a total of eight (8) HMO Plans, which provide no coverage for out -of -network providers, except in emergency situations. Most of the plans had minimal deductibles and mainly copays applicable for benefits. • Nine (9) entities offered a total of fourteen (14) PPO plans which included deductible, coinsurance and copays applicable for benefits. • Five (5) entities offered an HDHP plan, some tied to an HSA or HRA. These plans typically have a deductible that has to be met prior to any benefits being paid from the plan, except for preventative care which is covered at 100%. Page 14 Fully Insured vs. Self -Insured Of the ten (10) municipalities surveyed: • Four (4) entities fully insured a total of seven (7) different plans, including the one (1) plan for the City of Hallandale Beach. • Four (4) entities self-insured a total of fourteen (14) different plans. • Included in the self-insured percentage below, two (2) of the entities use a consortium or pooling arrangement. • One (1) entity is unknown as to their type of funding. *Note that the City of Hialeah offers two (2) fully insured plans from Coventry and two (2) self-insured plans from United Healthcare. Fully Insured vs. Self -Insured Page 15 Types of Dependent Coverage Tiers Of the ten (10) municipalities surveyed, three (3) use multiple tiers for dependent coverage contributions. All three (3) used the following tiers: Employee Only Employee plus Spouse Employee plus Children Family Of the ten (10) municipalities surveyed, six (6) use an additional two (2) tiers for dependent coverage contributions. All six (6) used the following tier structure: Employee Only Employee plus one dependent (either a child or a spouse) Employee plus two or more dependents No entity offered only a two-tiered structure. Overall Premiums The employee only premium averaged at $610.94, taking into consideration all entities' premiums for all plans. All entities had at least one (1) plan close to this average premium number. The family premium averaged at $1,718.61 taking into consideration all entities' premiums for all plans. Again, all entities had at least one (1) plan close to this average. From the benchmark study, we saw premiums stay relatively close in relation to the type of plan being offered. $3,000.00_,._.___.__......__...._.__._____.__........_._._._...._._._.__ $2,500.00 ____.. ___._..__ _....___._.__.___.__.______..__._.._ __.._.___.___._..... $2,000.00 .. _.._._._.._ __....._....______...__......___.__.._...._____.__..___w...__....._.____..___..._......_...______...._.._._._ $1,500.00 . ___ .._..___..._....__._ _._. __._ _w_____...._..___ .._.______ $1,000.00 _ ._ . ___..__. _ ._......__.. ,.... ._- _ ___._ .__. _ .._ ._Ir--" ......__.. , _..__ _ . ... .- Emp Only Emp+Sp $500.00 _.__.. _.._. _._._ _...._. _ .. _. __ _-._. - Emp + Child(ren) $0.00. �. _-_r... ...w_.. r___-- T _ L .._._` T___ _. r . 1�& Family D rn —i 2 E3 _ O O N O N0 O( 0�) O i K O' ~_ ':3 `< n =1 9- v OV N S (D v •< O :E y` OaO = n r O ON vO { 0vO O S O fl C fOpD = co T �_ (D Employee Contributions From the benchmark study, there were four (4) entities that provided a "free" health plan or paid 100% of the employee only premium. These included: • The City of Hallandale Beach • Broward Schools • City of Maitland • Town of Davie Percentage of Contributions - Employee Tier Only 100.00% 80.00% 60.00 40.00%20.00%0.00% IT p. 7._ r r t r r -r '.r._ _... .� E3 fA O -s O E3 O i-' rr rr �-r :-r' e=r i -r eY rr K Z .� .0 � •G ^G K � �G �G �G •G �G L` rL O W0 0 0 0 0 0 0 0 0 0 Ory O O O O Q 00 00 0 S n fV V A N N O Uq QC dA N fU =r _r CU 0 0. °0 0 0 0 s 0 — � F. FD M O O O 03 N (A p fD Ln Ln 0- (D v ' n s Page 17 Employee Contribution 01 Employer Contribution From the benchmark study, there was a range of contributions that the entity paid towards family coverage. The most generous contribution structure was: • The City of Hallandale Beach which contributes 70% or more to the dependent cost share. • The City of Hialeah which contributes approximately 75% to the dependent cost share. • The Town of Davie which contributes between 70% - 90% to the dependent cost share depending on the plan chosen. Percentage of Contributions - Family Tier Only 100.00% 80.00% _._._.__..__.._._...___.____....__..___......_ .__.__._._.........__._._.._..._.___._.___......___._ ...._ . 60.00% ---_..___ ._ _.._ _.__ _. _ _.._.. _ __._......__..... 40.00% ..._ ._.. ....._ .... ...... __.._._ ._ ._._ ... ._ _.._ '..._..._.. .. 20.00% _.. __ _. _. _.. .... ,.. _. _.. .._ .... _._ .. Employee Contribution Employer Contribution 0.00% 7. r 1. T .r ..T.. .r., r 0o n aoa-�onrn'-r nr n7 n't t�rt n nrY nrt ni-i ,n,C-r rDo0 fD 0 hn-r -F 0 0 O `{ 0 :E 0 r{ O w 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 S v-�-�-„-ti-h-h-ham,-++-ti-h-hO CL a O O= S S S= r r rK K -h O -h-h O Ln to m n n nF FD04 0'Qr_r' 0) d N N d CL O 0 O. 00 0 M' = M' 0 0. FD H EM Q d ro a.z;0 W W ro W n S All entities require employees to share in some cost of the tiers which include dependents. For the family tier, this ranged from $144.00 per month up to $1,557.84 per month. We caution that comparisons of the family coverage costs can be deceptive when comparing different tiered entities because for two-tiered or three -tiered entities, the family rate is an average of what smaller families would cost and larger families would cost and for 4 -tiered entities, the family rate is the highest cost. Page 18 Other Survey Information Health Insurance Premiums and Contributions Continuing to be one of the most provided benefits from employers to employees and their families, health insurance is an important part of the overall benefits structure for many employers. The Kaiser Family Foundation (www.kff.org) is a non-partisan source for healthcare policy, facts, information and surveys on healthcare. The Kaiser Employer Health Benefits 2015 survey report compares entities' overall healthcare costs on an annual basis and makes comparisons to show the change in costs for premiums, contributions, etc. The portion of the report does not take into consideration the differences between public and private sector but do make practical and general comparisons for premiums and contributions. Per the Kaiser report, the 2005 average family premium was $10,880. The average premium for family coverage has risen 61 %, up to $17,545 in 2015. However, the growth in employees' wages only increased 1.9% and inflation declined by 0.2% over this same time period, continuing to make the cost of health insurance rise at a faster pace than finances, and therefore, employers and employees paying more and making and earning less. See their Exhibit A below.' Average ms anw or er on ri Lt ions for Family Coverage, 2005-2015 6t % Total $17,545 Premfurn %iii/ $10,880 83% Workei Contrlb=on Increase 205 2015 .9'C?RKER CONI"iRCt?MIONv MEMPLOYMCOMMUMON SOURCE � M:rLs�t'21PCt `'5irr�'P �9 f.r�{�IrryM=p.S�r:�o-rr«oPed I'�^.elllr pc it�i1 :0 N5_21715, 1 http://files.kff.org/attachment/report-2015-employer-health-benefits-survey I Page 19 The report also states, for employee contributions, the average annual premium contributions in 2015 are: • $1,071 for single coverage, and • $4,955 for family coverage. "An employee's average dollar contribution to family coverage has increased 83% since 2005 and 24% since 2010 (refer back to Exhibit A). Employees in small firms have lower average contributions for single coverage than employees in large firms ($899 vs. $1,146), but higher average contributions for family coverage ($5,904 vs. $4,549)." "Employers generally require that employees make a contribution towards the cost of the premium. Employees contribute on average 18% of the premium for single coverage and 29% of the premium for family coverage, the same percentages as 2014 and statistically similar to those reported in 2010. Employees in small firms contribute a lower average percentage for single coverage compared to employees in large firms (15% vs. 19%), but they contribute a higher average percentage for family coverage (36% vs. 26%)." IIMT Average Annual Firm and Worker Premium Contributions and Total Premiums for Cowered Workers for Single and Family Coverage, by Plan Type, 2015 HADD Ang� t PPO slIi100'�' LST+ j sGngB', HDHPISO ALL PLA14S S0 51S„' M a.°,inK S 1.XK; S+„ (ray..: SIR, VYK) S E O"$ Y3 ,t?,x, d'.;:s 1 i,Cl� sI6,04YJ 7 i 8,NX) 94'dUi„h41 �G d 6�UP°lei^V3yp.,k"�S'�P^� fi�.��"L4"b"�'�"�'a r`r,'aP�fi6dASbi.6141'��@ rr ar. by ar• wrxg o kj c iP .°r?,'r Page 20 Per the survey, in regards to plan enrollment, PPO plans remain the most common plan type, enrolling 52% of covered workers in 2015, although a smaller percentage than 2014. 24% of covered workers are enrolled in a high -deductible plan with a savings options (HDHP/SO), 14% in an HMO, 10% in a POS plan, and 1% in a conventional (also known as an indemnity) plan (Exhibit F). Enrollment distribution varies by firm size; for example, PPOs are relatively more popular for covered workers at large firms than small firms (56% vs. 41%) and POS plans are relatively more popular among small firms than large firms (19% vs. 6%). Percentage of Covered Workers Enrolled In an HDHPIHRA or HSA -Qualified HDHP, 2000-2015 170; 25k. ,SCM" DO X107 2005 2a(* 2010 2011 2'02 .1013 2014 :0115 HSA QUALIFIED ALIT If.C7 HDHP HDHPrHRA n u is s ,i,.1 calkµ a zrar x o2 from oginrt, thr W.rrreruu y« rr !,**ai p,:051 h�0 I roves, f W4' "6 '. 4"vc Wrwa! iizr HU 9'r+., w ,r n12 r wrt^rar' i �'Dr '-11 WA w x kS�' Qjllifnud i4FAP for tr'y "r,wfor nz-nm u,,W tiw Si,-wi Mc1*�r� Jr8vacY ?,o:tcrn TF,N p4 com,tgc, nWcrrwv4e w iTKcu, p rro'W a: '4r an B C.1FV,14,,) ray w7o ;F4 xur•fi c° r6Yt,0 and HSA C; un,itcd 117 P wm-, mr r^ .tirraw, tfw to y,^rur-d-q __.. ,C.ar,VC1.: Farr S` f Srur w y5pc,y @ Wwr,'th 1;rvhn"'CKX:J1 a. Annual Deductibles HMO plans may or may not have an annual deductible for single or family coverage that must be met before any costs are reimbursed by the plan. Among covered workers with a general annual deductible, the average deductible amount for single coverage is $1,318. The average annual deductible is similar to last year ($1,217), but has increased from $917 in 2010. Deductibles differ by firm size; for workers in plans with a deductible, the average deductible for single coverage is $1,836 in small firms, compared to $1,105 for workers in large firms. 63% of covered workers in small firms are in a plan with a deductible of at least $1,000 for single coverage compared to 39% in large firms; a similar pattern exists for those in plans with a deductible of at least $2,000 (36% for small firms vs. 12% for large firms). See their Exhibit G. The City currently has a $1,000/$3,000 (single/family) deductible on the HMO plan. Page 21 EXHIBIT G Perc4ntage of Covered Workers Enrolled in a Plan with a General Annual Deductible of S1,000 or More for Strig le Coverage, by Firm StZe, 2006-2015 61% 61% 58%* 50% 49% 46% 4646 40% 41% 34% Err* #0101111�1� 21%* 29% 201k� 16% 6% 194V*dry 26% 10% 17% 10% Sk 646 201M NK -7 2 0 AM 2004' 20101 20 11 20:1 20 13 2014 2015 AL I SMA L L f IR AAS '3 -144 WNDPKI', PSr x,14. 1 A RG U t I RMS 2 Cas'; IO MO Pf #`O 'fRS' A All, [IRM'" s' rmlk it iift'vwfrcm --amm. ffV +4 pwic'44' yzw tp,�.'O�i rf"'o'w Q -- *1x ndud; wcAzrt oUj �?, IMPSO wd rffl.4 p tyT"- - Akwzg.' ' - anm-eii d&lu &,ilbliv, fr-�f Ff'Oh R-5 p4ra 4rd B�p -M in no'w-'* 'Ka;W'4-447 Sunvy of tnkp,"` Rui't &M,0m, Page 22 Ul a." pig 612 9 W301"el Ulm Fully Insured — Advantages, Disadvantages & Description A fully -insured plan is the traditional form of financing a group health insurance plan. A conventional arrangement is when an employer purchases a group insurance contract from an insurance company and pays a monthly insurance premium in exchange for the insurance company agreeing to pay health insurance claims according to a master plan document. In addition, this insurance company has assumed the administrative responsibilities for the group's health insurance claims and will follow the appropriate state and federal filing and reporting procedures and fiduciary responsibilities. Also, when fully insured, the insurer assumes much of the responsibility for administration of healthcare reform. Many different factors come into play for a fully insured health insurance plan. Typically, the insurance company will rate the organization, depending on size, based on past claims experience incurred by the group based on health insurance claims. The most common types of arrangements include a traditional arrangement or various forms of participating arrangements. In a traditional arrangement, annually the insurer advises the employer of the premiums rates based upon historical loss experience and future projections. If the insurer over estimates claims, the insurer will collect more money than needed and if the insurer under estimates, the insurer will pay out more in claims than collected in premiums. The employer's costs are stable during the year and no adjustments are made until the following year. In a participating arrangement, the employer shares in the favorable or unfavorable claims experience, usually on a retrospective basis. For instance, if the estimated claims experience is less than expected during the policy year and there is a surplus of funds, the employer will receive those funds back (or, a percentage of these funds back). But if the estimated claims experience is more than expected during the policy year and there is a deficit of funds, the employer may have the deficit remain on their account until any future surplus amounts make up for the previous deficit(s). Advantages: • Known, fixed costs • Insurer responsible for the claims risk • Insurer responsible for most administrative duties including ACA fees • If claims experience is worse than originally estimated by insurer, insurer does not typically charge back deficit amount to organization Page 23 Disadvantages: • Employer pays the insurer additional money for their reserves, other claim charges for providing special benefit coverages such as extended liability coverage and conversion, administrative charges, commissions and premium taxes • If claims experience is better than originally estimated by insurer, insurer keeps the surplus funds Self -Insurance — Advantages, Disadvantages & Description Self-insurance is another funding method for paying health insurance claims. As the cost of healthcare continues to rise each year, many employers are looking at self-insurance as an alternative funding method compared to the traditional fully insured group insurance contract. Under a self-insured medical plan, the entity bears more of the financial risk due to taking on the cost for medical claims and some administrative duties. Most organizations will contract out the claims administration portion of the self- insurance program. When a claims administrator is chosen to administer the claims, an Administrative Only Services (ASO) agreement is agreed upon which will assist the entity with claim processing, financial and administrative reports, plan descriptions for employees, banking arrangements and administrative duties which can include the proper state and federal reporting and fiduciary responsibilities. In addition, many organizations will purchase reinsurance/stop-loss coverage to insure against higher dollar medical claims. This helps to minimize the financial risk to the employer by insuring against the potential high dollar costs of a claim or claims. By eliminating the extra costs found under a fully insured plan including costs for reserves, other claim charges for providing special benefit coverages such as extended liability coverage and conversion, administrative charges, commissions and premium taxes, an organization can pay only the costs of the actual claims, claims administration expenses and have the ability to capture any favorable loss experience. Advantages: • Potential cost savings if claims experience is favorable • Improved cash flow due to claims lag (only applies to first few months of being self-insured) • Paying only for the costs associated with claims, administration of claims and reinsurance/stop-loss Page 24 Disadvantages: • Takes on more of the financial responsibility • Cost savings may not be realized if claims experience is significantly worse than previous years' experience. For the past few years, the City's costs, if self- insured, would have been higher than premiums costs assuming no change in plan designs. • Inclusion in funding of ACA fees and direct payment to proper federal entities Other issues to take into consideration: • Must receive Florida Department of Financial Services approval • Must hire actuary to confirm actuarial soundness of plan • Must fund for current and future liabilities Florida Statute 112.08 requires government entity plans of group health (e.g., medical, dental) self-insurance to be actuarially sound and to provide sufficient revenues to pay current and future liabilities. Pooling Arrangement —Advantages, Disadvantages & Description There are a few self-insured pooling arrangements available in Florida for municipalities the size of the City. For example, both FMIT (Florida Municipal Insurance Trust) and - PRM (Public Risk Management) self -insure their health plan for all of their participating entities and to each participating entity in their consortium/pool, the plan works like a fully insured plan. In other words, the consortium/pool takes the risk of claim costs being worse than projected and the City does not. FMIT contracts with United Healthcare and PRM contracts with FloridaBlue to administer claims and provide the network of providers. Florida Statute 112.08 requires Florida governments to competitively procure contracts to provide employee benefits, like health insurance. However, it is understood that the statute also allows governments to participate in this type of pooling arrangement without the competitive procurement process. If the City's procurement/legal staff agree with this interpretation, an option to an RFP process for the October 1, 2016 renewal could include negotiating with Cigna and also requesting and considering proposals from one or both of these pooled arrangements. Cost Projections for a Self -Insured Plan The three major cost components for a self-insured health plan are: • Actual Claims, • Stop -Loss Insurance Premiums, and • Administration Fees. Page 25 Florida Statute 112.08 requires government entity plans of group health self-insurance to be actuarially sound and to provide sufficient revenues to pay current and future liabilities. When claims are projected, usually a figure is projected for "expected" claims for the time frame. Since actual claims will not be known until the coverage period is ended, funding rates are determined based upon projected expected claims. The following projections assume coverage between October 1, 2016 and September 30, 2017. We are assuming 15% annual trend based increases to historical claims data. For the period between October 1, 2014 and September 30, 2015, actual paid claims for the City's health plan through Cigna were $6,717,394. Effective October 1, 2015, the City enacted plan changes (eliminating some plan options and adding a deductible). During the first five (5) months of the 2015-2016 plan year, claims have been $2,633,000 which annualizes to $6,319,000. In our calculations, expected claims for the 2016-2017 term are $7,077,280 (assumes trend of 12% and no significant enrollment or plan changes). Stop -loss coverage usually provides two types of protection: • Specific — Specific stop -loss insurance provides protection when an individual plan participant's medical claims exceed the specific deductible. As an example, if an employee's covered child incurred paid medical costs of $300,000 and the specific deductible was $175,000, the stop -loss insurer would pay the City the difference or $125,000. • Aggregate — Aggregate coverage provides protection when all claims for the City minus any specific stop -loss claim payments exceed the expected claims times 125%. Expected claims times 125% is referred to as "maximum claims" because aggregate insurance pays for all claims when the maximum is exceeded. Since expected claims are projected to be $7,077,280, maximum claims are $8,846,600. When entities first become self-insured and have no funding reserves, most actuaries recommend first year funding be sufficient to support actual claims being higher than expected claims and many conservative actuaries will recommend funding levels which allow for actual claims to equal maximum claims. While not actuaries, we recommend first year funding allow for maximum claims. Administration (ASO) fees are usually provided on a "per employee per month" basis (PEPM). Within the last few years, we have seen the ASO fees become more competitive. We would expect ASO fees for the City's size to be in the range of $35.00/PEPM to $65.00/PEPM. Based on another client similar in size to the City, we have used an estimate of $60.00/PEPM. We have also included $15.00/PEPM extra to account for ACA fees including the Transitional Reinsurance Fee ($42.00/per member per year), the PCORI fee ($2.08/per member per year) and other fees, such as COBRA or HIPAA administration. Page 26 For stop -loss costs, rates are usually shown on a PEPM basis and either include two (2) rates, one for employee only coverage and another for family units or a composite rate is used. We are assuming that both specific and aggregate coverage will be purchased and that the specific deductible will be $175,000. We are assuming coverage will be purchased including "run -out" coverage to pay for claims incurred during the plan year but paid in the three months following conclusion of the plan year. Actual rates for the City will be based upon the most recent claims experience available. (Projected Claims are based upon actual data for the most recent 12 months of claims experience. We have further assumed that coverage will be available for a premium slightly higher than these claims. We caution, however, that this coverage may not be available on such favorable terms based upon the last few years of claims experience.) The estimated self-insured projection for the 2016-2017 plan year is summarized in the below chart: Cost Category PEPM Monthly Annual Expected Claims $1,221.06 $589,773 $7,077,280 Maximum Claim $1,526.33 $756,964 $8,846,600 Stop Loss Specific $140.00 $67,620 $811,440 Aggregate $14.00 $6,762 $81,144 Projected Stop Loss Claims - ($779,000) $175,000 Administration ASO Fee $60.00 $28,980 $347,760 Add'l Fees $15.00 $7,245 $86,940 Annual Cost at Total Employees 483 Expected Claims $7,625,564 Annual Cost at Maximum Claims $9,394,884 As shown on page 5 of the report, the fully insured premiums for the 2015-2016 (current year) are projected to be $6,281,148. As shown on page 6 of the report, the fully insured costs for the 2016-2017 plan year are projected to be $8,165,492. Based on the criteria explained in this section of the report, the City would need to fund somewhere between $7.625M and $9.394M for the 2016- 2017 plan year if switching to a self-insured plan. As stated previously, when entities first become self-insured and have no funding reserves, it is recommended that first year funding be sufficient to support actual claims being higher than expected claims, so the funding levels may need to be closer to the maximum claims projections. Page 27 At this time and with the historical claims experience that the City has experienced, we would find it difficult to recommend switching to a self-insured plan, assuming no plan design changes. The City's claim experience has been too volatile to warrant taking on additional risk with a plan design as is. If the City were to review additional plan offerings, such as a lower cost, lower benefit and potentially a high deductible health plan (potentially tied to an HRA or similar arrangement), going self-insured could make sense. However, we also caution that the money needed to set-up the required reserves can also be challenging and needs to be taken into consideration. Page 28 HEALTH PLAN OPTIONS High Deductible Health Plan WDHP�ptions A high deductible health plan (HDHP) is another type of medical plan (as compared to an HMO or PPO plan) where the monthly premiums are typically lower in return for higher out-of-pocket costs including higher deductibles and coinsurance. Typically, an HDHP has a high deductible that has to be met prior to any coinsurance or prescription copays applying to benefits. However, preventative services for both children and adults are covered at 100% without any deductible or cost-sharing component being applied. These types of plans usually are tied to a tax-deferred account which may include a Health Savings Account (HSA), Health Reimbursement Account (HRA) or a Flexible Savings Account (FSA) or a combination thereof per Internal Revenue Service (IRS) guidelines. These accounts allow members to set aside pre-tax dollars to pay for the medical services. Depending on the type of account chosen, both the employer and the employee can contribute funds to the account. HDHPs are intended to encourage members to be more aware of their health costs and become consumers of medical care. In most cases, the member has choices about where to receive medical care and can take a proactive approach to where medical care is received. The costs of services can be reduced depending on where care is received. For example, having an MRI done at an outpatient facility can be less costly than having one done at a hospital. However, these types of plans remain criticized for the high costs that they require a member to pay as there are no copays for office visits or hospital stays, etc. prior to the deductible being met, which can be financially burdensome for members and their families. We have seen this type of plan design rise in popularity for our clients in the last three (3) years or more. We typically see this type of plan offered in conjunction with another plan option, such as an HMO or PPO offering. This type of plan has been used as a "base" plan option for employees with dependents to reduce the cost of dependent coverage. Page 29 Cafeteria Plans & Employer Based Exchanges Technically, the current City benefits plan is a "cafeteria" plan as defined by the IRS. City employees have choices among a variety of options for benefits and are able to pay for benefits with pre-tax dollars through the Section 125 Plan and are able to contribute to the FSA and DCA to access these benefits on a pre-tax basis. However, the term "cafeteria" plan (or flex plan) often refers to plan offerings which provide more choices to employees to select the benefits that best fit their personal needs. As an example, in this type of more flexible program, employees would be given a fixed amount of "flex dollars" or "credits" that could be used to purchase benefits. If, as example, they did not need health insurance because they had coverage through a spouse, they could use the "flex dollars" for other benefits, to fund their FSA account or take as taxed income. In today's health insurance market, very rarely do employers offer employees options of health insurance through different insurers. A few decades ago, it was more common for employers to provide employees a choice of a few different health plans from different insurers. These insurers may have included a local HMO type plan with very narrow physician choices and very low out of pocket costs. Other options included more traditional indemnity or PPO plans that gave more physician choices but included higher premiums. Employer Based Exchanges are a new innovation in employee benefits that may change the trend for only one insurers plan(s) to be offered to employees. This type of structure first was seen for the retiree health market for large employers in the past few years. Retirees would be provided a fixed amount to be spent on healthcare and then would have access to a phone or internet based "connector" (a customer service representative/salesperson) who would help them decide what plans met their needs. Plan options included options from many different insurance companies. The connector would assist the retiree in completing all application and other documents needed to enroll in the selected plan and to authorize the premium payments for the selected plan. Most employers using this model were national or international firms with employees in different states. This model is now being promoted by a number of large U.S. insurance brokers (such as Aon Hewitt and Mercer). Employees are provided a fixed dollar amount to spend on benefits and, via the exchange, are able to select plans from different insurance companies. While there is a lot of interest in this type of arrangement, we are not aware of any Florida governments using this model. Over the next few years, this type of offering may become more commonly used and may become a viable option for the City to consider. Page 30 Defined Contribution Plans The environment of healthcare has continuously been characterized with rapidly increasing costs, employers' desires to control these costs and consumers' desires for more choice, quality care and information. These factors have led many employers to consider a shift from providing a specific health insurance benefit package (i.e., a "defined benefit" approach), to providing a specific contribution that employees can use to purchase the plan of their choice, perhaps from among a group of employer -selected options (i.e., a "defined contribution" approach).2 Historically, the City has provided a set of benefits to an employee that includes health, dental, vision, EAP, life and AD&D insurance, in addition to some other benefits, which the City either pays all or a vast majority of the cost (i.e., a defined benefit approach). Under a defined contribution approach, the City would give a specific dollar amount to employees to use annually towards the benefit package that they deem most beneficial to them. A defined contribution benefit plan is not a particular type of health plan. Rather, it is an alternative concept for financing and managing healthcare and other benefits for employees. These approaches can be arranged along a continuum of alternatives that realign responsibility, or choice, from the employer to the employee.3 Primary differences among these approaches reflect the degree to which responsibility and choice are shifted. A defined contribution approach provides a more predictable cost for employers, as the amount to be budgeted and given to employees is specific and does not change on a month-to-month basis and could even not change on an annual basis, if chosen. Defined contribution plans can work in many ways, however, the key components of a defined contribution plan are the same. This can be as narrow or broad that the City may choose. For example, it may be as narrow to include only healthcare, which to an extent, it already is as the City has a "base" plan which is paid at 100% for employees and then additional health plans that employees can "buy -up" into. Or, the City can make the fixed amount broader and include all the benefits offered such as health, dental, vision, life and AD&D, etc. Once that is decided, it is up to the employee to decide which plan(s) or coverages will best suit his or her needs. The employer pays a portion of the premium, their defined contribution, directly to the each insurer/provider/administrator, but, if the plan costs more than the employer's defined contribution, the employee must pay the difference. If it costs less, the employee sees the difference added to their paycheck or some other defined form including a tax- deferred health savings account or pension plan account, etc.4 2 (http://www.actuary.org/pdf/health/dc_june02.pdf) 3 (http://www.actuary.org/pdf/health/dc_june02.pdf) 4 (http://www.healthinsurance.info/plans/Defined-Contribution-Health-Benefits.HTM) Page 31 For example, a local Florida City structured their benefit plan to take on more of a defined contribution plan structure. They structured the plan based on two classes, those who took the health insurance and those who did not take the health insurance. For those who took the health insurance, they were given a monthly allowance of approximately $600.00 and they were able to disperse it to the different benefits being offered including health, dental, vision, life, disability and their pension plan offerings. This is an annual amount of approximately $7,200.00. For those who did not take the health insurance, they were given a lower amount of approximately $300.00 monthly to disperse. This is an annual amount of approximately $3,600.00. For this same City, when the plan initially went into effect, those who opted out of medical coverage were given the same amount of money to spend as those who were opted into the medical coverage. However, due to budgetary constraints, this was an area that was amended and subsequently lowered, as shown above, to help cut costs. The choice for employees to be able to choose where their money goes is very attractive. This can leave employees feeling more satisfied with the benefits they have as they chose which benefits to participate in. For the employees who have additional family members, if the employee decided to use the majority or all of the benefit amount towards family health coverage so that they were paying less out of their paycheck towards family health costs, that would be the employee's decision. However, an issue that the City will have to be cognizant about is the employee only versus employee plus additional dependents factor. For those with family members, this could affect them dramatically if the dollar amount was lower than current. The City could implement a similar class structure as above but include a single only versus family class and include more dollars in the family class to use. There is a fairness factor that becomes more obvious under this type of structure. The differences in cost to employees, in our opinion, do become more obvious in a defined contribution plan. Single employees would fare better than those with additional family members. On the flip side, if families are given more, single employees may not appreciate that. In addition, this could also increase adverse selection to the health plans, as those who need to keep their family tier of health coverage for a sick child or spouse will as opposed to those who are healthier and could perhaps find coverage elsewhere. We would recommend that the City complete a cost analysis of a defined contribution plan and ask the insurers about the potential change to rates. Administratively, we believe there are pros and cons to this type of plan. Pros include more fixed costs to the City but cons include administrative difficulties in keeping track of the different choices. Again, the equality factor becomes more pronounced as well. If the City chose, an internal employee survey could assist with reviewing this topic. Page 32 Direct Contracting, Models In the 1990's, many of Siver's Florida governmental clients, particularly municipalities, entered into direct contracts with key medical providers in their communities and developed their own local provider networks. Often, they would access a network for services outside of the local area. Municipalities would often have close ties with a local health system/hospital and the associated physicians. These network arrangements would be used in a self-insured health plan administered by an independent claims administrator (not an insurer). These plans were often designed with three tiers of coverage - most generous coverage with lowest out of pocket for employees when the local health providers were used, a mid -coverage tier for out of area services accessed through a network and an out -of -network coverage tier with higher out of pocket costs to employees. In the past ten years, however, we have seen almost all of these types of networks/arrangements cease because the discount arrangements could not compete with the discount arrangement negotiated by the name brand insurers. Many of the larger insurers have network/discount arrangements with health systems/hospitals that have contractual terms which prohibit the providers to give better terms to others. As healthcare reform has become a more permanent fixture in the current insurance market, some of the "older" ideas, such as direct contracting models, may be making a comeback. We recently saw a private Florida -based hospital system's plan design that included a narrow scoped provider network plan design, utilizing their own providers, which included lower cost member cost -share benefits, in addition to the normal PPO network, which had higher member cost -share benefits, through one of the large Florida administrators. As the costs of insurance have continued to inflate every year, it makes sense that employers, both private and public, are trying to find ways to control the escalating claims costs. We reached out to a local hospital system within the Tri -County area to inquire about a narrow scoped direct contracting arrangement and the potential to contract with them. To date, we have not received any additional information on its potential from them. We would be happy to discuss and research this further with the City if requested. Page 33 Use of Onsite Employee Health Clinics Per a 2012 Towers Watson survey of employers who offer onsite health centers, they state that the number one reason companies establish an onsite health center is to enhance worker productivity. In addition, it states that "despite the high cost of opening a center and requiring a multiyear investment, most employers (62%) say a key reason they keep their centers open is improved employee productivity that comes from eliminating visits to offsite medical providers. They say another important reason for establishing a center is cost reduction, including lower cost per service performed, improved health outcomes, reversal of health risk, and fewer ER visits and hospitalizations." If the City is interested in additional wellness initiatives, for many entities, an onsite clinic can assist in focusing on wellness initiatives, among other issues. In relation to popularity, specifically in Florida, we know of a handful of public entities in the last five (5) years that have either reviewed the feasibility of costs of opening a clinic or clinics, have competitively bid out services to review clinic managers or have opened an onsite clinic(s). However, due to the economic times, we believe it is fair to say that many entities have not been able to move forward with a clinic due to the costs involved in opening and running a clinic. There are a number of issues that the City must consider when contemplating a clinic which include: • The location, number of sites, hours of operation • Staffing • Will the clinic be associated with health insurer or independent of health insurer? • Will the clinic report claims data to health insurer for claims payment and/or for data purposes? • Will the clinic be managed by a third party (outsourced) or will the City hire healthcare professionals as staff? • Will the clinic include a full pharmacy, limited pharmaceutical dispensing or no dispensing? • Will the clinic provide primary care services, occupational injury services, drug testing services, and/or wellness services? • Will the clinic provide services for employees only or can also include dependents and/or retirees? • What cost, if any, will be charged to employees for use of the clinic and how does this cost differ from comparable services through health plan? • Will healthcare reform affect the potential of an onsite clinic? 5 (http://www.towerswatson.com/assets/pdf/7705/Realizing-the-Potential-of-Onsite-Health-Centers.pdf) Page 34 Clinic Costs Brick & Mortar Start Up Costs The start- up costs for a clinic can vary. For the size of the City, we would assume that only one clinic site would be used. The City would need to find a centrally located site which would be convenient to the City's main employee population. Ideally, the site would have appropriate parking and space requiring no initial cost outlay. We would expect such a building to require some remodeling to meet the needs of the clinic. We estimate approximately $50,000 to $100,000 for the establishment of the facility. These will be one-time costs. When plans for the remodeling are done, consideration should be given to possibility of future expansion, if necessary. Other Start -Up Costs After a location is selected and the site is remodeled, there will be other start-up costs to consider. These costs include the purchase of initial supplies including necessary medical equipment, medical supplies, pharmaceuticals, computers and software, etc. Based our experience reviewing clinic proposals, an estimate of $15,000 to $20,000 would be a reasonable projection of these costs. Operating costs The most significant operating cost of the clinic will be the costs associated with staffing. It is possible to set up the clinic so that staff are independent contractors or employees of the clinic provider. If the staff are independent contractors, no employee benefit costs are included. If the staff are employees of the clinic provider, the costs passed onto the City would also include the costs of benefits for the staff. We have seen hourly estimates range from: - M.D. $125 - $170 per hour Nurse practitioner $80 - $102 per hour Licensed Practical Nurse (LPN) $35 - $40 per hour Medical Assistant $20 - $25 per hour It is common for clinics to staff nurse practitioners instead of medical doctors. A 2009 study found that only 5% of on-site employer sponsored clinics have doctors on premises.6 We believe this continues to be true. Another common staffing set-up would include a full-time nurse practitioner with a medical doctor part-time or only for oversight. We have assisted a number of entities in either reviewing the feasibility of a clinic and/or their competitive bidding process for a clinic manager and nurse practitioners are commonly proposed to save costs. Consideration of the population is an important factor in choosing the staff. 6 Managed Care Magazine, June 2009, "Employers Move Into Primary Care," Maureen Glabman. (http://www.managedcaremag. com/archives/0906/0906.companydoc.html) Page 35 Appropriate selection of staff is very important to the financial success of the clinic. In many instances, the savings projections for the clinic are based upon the clinic staff having a more cost conscious attitude than traditional medical providers towards the following: -- • Ordering of expensive diagnostic tests, like MRIs and CAT scans, • Referring to specialists, and - • Prescribing of cost effective drugs. Total Costs We would estimate the cost range to be in the range between $400,000 (including no drug costs) and $450,000 (including dispensing of some pharmaceuticals, mostly generics). If no medical doctor time was involved, estimated costs could drop by approximately $40,000. The City may be able to open a clinic for 30-35 hours a week with a medical doctor at 5-10 hours a week and a nurse practitioner for the full amount of hours per week. Other staff may include an LPN, a medical assistant and if warranted, an office assistant. From a BenefitNews article, "about one in 10 participants (11%) share their clinic with another employer, and 13% would consider such a partnership. Small employers (200- 999 employees) were the most likely to share a clinic (65%), the survey notes. None of the employers with 10,000 or more employees shared a clinic." This information is based on a survey of 345 employers with 100 having an onsite clinic.7 Clinic Savinjzs Clinics have been considered by many employers because the long term health plan cost savings are promised to greatly exceed the start-up and ongoing costs. Savings are usually measured by comparing the prior year's health plan claims costs adjusted by inflationary trend increases to actual claims costs in the first year after implementation of the clinic. However, per the Towers Watson 2012 Onsite health clinic survey, "Employers sponsoring onsite health centers continue to struggle with quantifying return -on - investment (ROI) or are not even trying to track return. More than half either don't know (39%) or don't track (14%) ROI..."8 We believe reporting is an area that continues to be challenging for employers. The clinic and medical reporting have to work together to capture all the relevant data and we continue to hear this is a challenge from our clients. Clinic savings are attributable to: The cost of an average clinic visit is less expensive than the cost of a primary care level visit with a traditional medical provider when paid for through the health plan. (http://ebn.benefitnews.com/news/all-together-one-ecomonic-woes-unite-worksite-health-clinics- 2671909-1.html) 8 (http://www.towerswatson.com/assets/pdf/7705/Realizing-the-Potential-of-Onsite-Health-Centers.pdf) Page 36 • There will be fewer non -clinic primary care office visits. • There will be fewer referrals for expensive diagnostic tests. • There will be fewer self -referrals to specialty providers. • Clinic staff will prescribe pharmaceuticals in a more cost-conscious manner leading to reduced pharmacy costs. • Combined with an effective wellness program, there will be reduced emergency room visits and other disease escalation costs. • There will be a reduction in sick time increasing productivity on the job. Other savings may be realized if the clinic can be used for occupational injuries or for drug testing. Clinic Issues The same issues regarding a clinic are relevant today as they were in 2009-2010. From an article from BenefitsNews, it outlines some of the issues including: • The trusted clinician model of wellness/primary care delivery hinges on having the right staff. Through longer, more frequent face-to-face encounters, this approach emphasizes holistic rather than acute, episodic care but depends on finding and retaining clinic staff with the right skills and qualities. • Sustained employer engagement is critical to success. Most employers outsource clinics to vendors, but experts noted that no successful clinic is completely a turnkey operation. ` • Gaining employee trust is key to clinic acceptance. When clinics are first introduced, employees may be mistrustful of employer motivations, concerned about personal data confidentiality and skeptical about quality of care. Employers need to expect these concerns, communicate clearly and honestly about how the clinic fits into the company's core business strategies and demonstrate convincing evidence of patient privacy protections. • Investing in the appropriate scope and scale of clinic services is challenging but essential. At startup, some employers take such a cautious and incremental approach that the clinic makes little impact on care delivery or cost containment. • Other employers take a no -expenses -spared approach, building state-of-the-art facilities with comprehensive ancillary services - an approach that might pay off in reputation and brand but makes it difficult to recoup direct medical costs. • Employers should be realistic about return on investment and recognize that measurement poses challenges. Employers should not expect clinics to be a quick fix for high health costs, because savings from population health improvement take time, even in the most effective programs.9 9 (http://ebn.benefitnews.com/news/employers-adjust-workplace-clinic-models-goals-2710650-1.html) Page 37 Improving Access to Primary Care For some entities like the City, the expenses of a clinic are not feasible at this time because of budget and fiscal restraints and/or because the claims savings may not be realized if fully insured. We do have a Florida government client that has negotiated reduced fees with a popular primary care physician practice which has a few local offices and provides both urgent care type appointments and provides general primary care services to allow their employees, and their dependents covered on the health plan, to access this provider with no copay. The reduced fees negotiated with the provider allowed the employer to offer access to this provider with no copayment. In this specific case, when first negotiated, the physician was paid by the employer directly. Later, the employer (who is self-insured through FloridaBlue) negotiated with FloridaBlue to pay the provider the negotiated rate through the health plan. This is an example of limited direct contracting. If, in the future, the City were to, as example, amend their base plan offering to be less generous and/or to not include low cost copayments for physician visits, negotiation of this type of arrangement could allow employees and their dependents access to low cost or no cost primary care treatment. Medicare Advantage Options As discussed above in the Insurance Plan Review section, Cigna, and other insurers, offer many Medicare Advantage plan designs for retirees who are Medicare eligible with lower deductibles and prescription costs and reduced monthly premiums. Monthly premiums, depending upon the plan design and part of the state of Florida, usually range from $0 to $300. These plans are available on both an individual and a group basis. We have found in the past that some retirees are reluctant to consider this type of plan because, in some cases, the election of an optional plan prohibits the retiree from ever re-electing to be on the active health plan and the retirees value the knowledge that they will always have access to the City's plan. Some of our Florida government clients who are obligated to provide coverage options for their retirees have chosen to offer Medicare Advantage options to retirees and to allow retirees the right to come back onto the entity's health plan in the future if the retiree changes their mind. In these cases, the Medicare Advantage premiums are collected similar to the current retiree premiums and list billed to the entity. This provides the retirees with reduced costs now and the stability of being able to re-elect the City's plan. While this option would not save the City premium costs, it may be beneficial to retirees over age 65 and it moves any of their future poor claim experience off the active plan. Page 38 Annual Benefit Statements & Employee Communications In our opinion, it is very common for employees to not fully realize the amount that employers contribute towards their benefits. Specifically, we would not be surprised if many employees at the City purchasing family coverage considered their cost share to represent the full cost of coverage for their dependents when in fact the City is contributing more than half of the cost. It is particularly important to communicate these costs to employees in an environment where salary increases are rare due to budget constraints. We acknowledge that the City provides an annual active employee and retiree memo that outlines the current benefits, any applicable changes to benefits and the timeline for open enrollment. However, we also recommend employers attempt to communicate the costs of benefits to employees a few times per year, recognizing that different types of communications are more effective for some employees than others. One technique to communicate to employees the cost of their coverage is an annual wage and benefits statement which typically shows their salary and the cost of their benefits. See Exhibit 5 for an example of a wage and benefits statement. This type of statement might be used at enrollment time or annually. In addition to the annual statement, occasional payroll stuffers and/or employee posters throughout the year can be used to communicate information to employees. Page 39 . 4. With the passage of healthcare reform through the Affordable Care Act (ACA) in March of 2010, many to most of the provisions of the ACA have already gone into effect today. A summary of those that affected employer plans most notably include: 2011 2011 Dependents Covered to Age 26 2011 No Lifetime Dollar Limits 2011 No Pre -Existing Condition Exclusions 2011 Insurers Subject to Medical Loss Ratios 2012 2012 Women's Preventative Services Mandate 2012 Summary of Benefits and Coverage (SBC) 2012 60 -Day Advance Notice of Material Modifications 2013 2013 Patient Centered Outcomes Research Fee 2013 $2,500 FSA Limit Cap 2014 2014 Transitional Reinsurance Fee 2014 Individual Health Exchanges and The Marketplace 2014 Individual Coverage Mandate 2014 Employer Shared Responsibility Mandate — 70% threshold 2014 Employer Reporting and Disclosure (delayed until 2015) 2015 2015 Employer Shared Responsibility Mandate — 95% threshold 2020 2020 Cadillac Tax (Delayed from 2018 implementation) Healthcare Reform has dramatically changed the insurance industry and marketplace for purchasing health insurance. Employers have become even more responsible for providing quality and affordable care for their employees. Our comments are based upon our current understanding of the published guidance to date. As additional guidance is released on outstanding provisions, such as the Cadillac Tax, some the information in this report may change. Page 40 Cadillac Excise Tax City Effective Date: October 1, 2020 One of the last provisions of the ACA is the excise tax on "Cadillac plans." Originally expected to go into effect around January 1, 2018, this provision has been delayed until plan year 2020. Cadillac plans are typically defined by the total cost of premiums versus what the insurance plan actually covers or offers. Premiums on Cadillac plans can be high for either being a generous health plan or because of high claims costs related to the pooling of the claims experience. The provision levies a 40% deductible tax (this was originally slated to be a non- deductible tax but was amended with the delay) on the annual value of health plan costs for employees that exceed $10,200 for single coverage or $27,500 for family coverage in 2020. For retirees and employees in high-risk professions, such as firefighters and longshoremen, the bill would set higher thresholds of $11,850 for an individual plan and $30,950 for a family plan. The thresholds would increase as the nation's overall rate of inflation goes up. 10 Annual costs for the current City's Cigna HMO plan are about $6,800 single and $20,000 for a family. When these figures are projected out to 2020 with reasonable estimates of future healthcare inflation, the excise tax is often triggered. We reviewed the City's current premiums for the HMO plan and projected them forward into plan year 2020 based on both a 15% annual increase and 30% annual increase. 10 (http://www.kaiserhealthnews.org /Stories/2010/March/18/Cadillac-Tax-Explainer-Update.aspx) Page 41 The 15% annual increase is suminarized in the below chart: Annualized % Increase 15.00% 15.00% 15.00% Cadillac Tax Thresholds $10,200 $27,500 $27,500 $40,515.17 Under/Over $3,404.42 $291.24 Tier Employee Only Emp +1 Family 2015-2016 Monthly $563.65 $1,151.43 $1,678.60 Annual Premium Cost $6,763.80 $13,817.16 $20,143.20 Under/Over ($3,436.20) ($13,682.84) ($7,356.80) 40% penalty $0.00 $0.00 $0.00 2016-2017 Monthly $648.20 $1,324.14 $1,930.39 Annual Premium Cost $7,778.37 $15,889.73 $23,164.68 Under/Over ($2,421.63) ($11,,610.27) ($4,335,32) 40% penalty $0.00 $0.00 $0.00 2017-2018 Monthly $745.43 $1,522.77 $2,219.95 Annual Premium Cost $8,945.13 $18,273.19 $26,639.38 Under/Over ($1,254.87) ($9,226.81) ($860.62) 40% penalty $0.00 $0.00 $0.00 2018-2019 Monthly $857.24 $1,751.18 $2,552.94 Annual Premium Cost $10,286.89 $21,014.17 $30,635.29 Under/Over $86.89 ($6,485.83) $3,135.29 40% penalty/person $34.76 $0.00 $1,254.12 40% penalty total $6,291.1.5 $0.00 $206,929.09 2019-2020 Monthly $985.83 $2,013.86 $2,935.88 Annual Premium Cost $11,829.93 $24,166.30 $35,230.58 Under/Over $1,629.93 ($3,333.70) $7,730.58 40% penalty/person $651.97 $0.00 $3,092.23 40% penalty total $118,006.82 $0.00 $510,218.46 Cadillac Excise Tax Projection - Current Effective Date -10/1/2020 10/1/2020 Monthly - Implementation $1,133.70 $2,315.94 $3,376.26 Annual Premium Cost $13,604.42 $27,791.24 $40,515.17 Under/Over $3,404.42 $291.24 $13,015.17 40% penalty/person $1,361.77 $116.50 $5,206.07 40% penalty/total $246,479.84 $10,251.79 $859,001.23 Combined Penalty $1,115,732.86 Page 42 The 30% annual increase is summarized in the below chart: Annualized % Increase 30.00% 30.00% 30.00% Cadillac Tax Thresholds $10,200 $27,500 $27,500 $74,790.29 Under/Over $14,913.52 $23,802.15 Tier Employee Only Emp +1 Family 2015-2016 Monthly $563.65 $1,151.43 $1,678.60 Annual Premium Cost $6,763.80 $13,817.16 $20,143.20 Under/Over ($3,43620) ($13,682.84) ($7,356.80) 40% penalty $0.00 $0.00 $0.00 2016-2017 Monthly $732.75 $1,496.86 $2,182.18 Annual Premium Cost $8,792.94 $17,962.31 $26,186.16 Under/Over ($1,407.06) ($9,53T69) ($1,313.84) 40% penalty $0.00 $0.00 $0.00 2017-2018 Monthly $952.57 $1,945.92 $2,836.83 Annual Premium Cost $11,430.82 $23,351.00 $34,042.01 Under/Over $1,230.82 ($4,14.9.00) $6,542.01 40% penalty $492.33 $0.00 $2,616.80 40% penalty total $89,111.51 $0.00 $431,772.53 2018-2019 Monthly $1,238.34 $2,529.69 $3,687.88 Annual Premium Cost $14,860.07 $30,356.30 $44,254.61 Under/Over $4,660.07 $2,856.30 $16,754.61 40% penalty/person $1,864.03 $1,142.52 $6,701.84 40% penalty total $337,388.97 $100,541.78 $1,105,804.29 2019-2020 Monthly $1,609.84 $3,288.60 $4,794.25 Annual Premium Cost $19,318.09 $39,463.19 $57,530.99 Under/Over $9,118.09 $11,963.19 $30,030.99 40% penalty/person $3,647.24 $4,785.28 $12,012.40 40% penalty total $660,149.66 $421,104.31 $1,982,045.57 Cadillac Excise Tax Projection - Current Effective Date - 10/1/2020 10/1/2020 Monthly - Implementation $2,092.79 $4,275.18 $6,232.52 Annual Premium Cost $25,113.52 $51,302.15 $74,790.29 Under/Over $14,913.52 $23,802.15 $47,290.29 40% penalty/person $5,965.41 $9,520.86 $18,916.12 40% penalty/person $1,079,738.55 $837,835.61 $3,121,159.24 Combined Penalty $5,038,733.40 Page 43 Note: For both the charts: 1. Based on 2015-2016 Cigna HMO OAP In -Network only plan 2. No plan changes 3. Based on February 2016 employee count 4. Based on current dollar thresholds of Cadillac tax as of date of report 5. Assumes 30% annual increase in premium rates. 6. Based on active employees only Based on the two (2) charts, with a 15% increase annually, the City would potentially hit the Cadillac thresholds in plan year 2018-2019 and have a potential penalty of $1,115,733 by the implementation date in 2020. With a 30% increase annually, the City would potentially hit the threshold in the 2017- 2018 plan year and have a potential penalty of $5,038,733 by the implementation date in 2020. Even though this provision is set to take place in 2020, employers need to be cognizant of the potential penalty it could create. A recent Mercer article states "that when most employers are asked about the excise tax, about a fourth of employers with 50 or more employees (23%) say: `We will do whatever is necessary to bring cost below the threshold amounts.' An additional 37% of employers say they will attempt to bring the cost below the threshold amounts, but acknowledged that `it may not be possible.' Only 3% say they will take no special steps to bring cost below the threshold amounts, and the rest (37%) predict their plans won't ever hit the cost threshold, which will be tied to CPI and increase each year."r 1 We continue to recommend that the City take measures to control these escalating annual costs and will have to strongly consider different plan offerings. The City will also want to continue monitoring this provision of the ACA. We expect that additional guidance will be released in the upcoming year or so which may take into consideration further indexing of these thresholds but to date, they have not been amended. 11 (http://www.mercer.com/press-releases/1399495) Page 44 Employer Shared Responsibility Mandate — Pay or Play This portion of the PPACA is applicable to large employers, which are defined as employers who have at least 50 full-time employees, including full-time equivalent employees during the preceding calendar year. A large employer must offer 95% of full- time employees (and their dependents up to age 26, not including spouses) affordable coverage and provide minimum value of coverage. For applicable employers that do not adhere to the guidelines either by choice or by accident, an Employer Shared Responsibility payment may be applicable. Definition of a Full -Time Employee A full-time employee, with respect to any month, is an employee who is employed on average at least 30 hours of service per week. Guidance released from the IRS gives the needed information on how to calculate a full- time employee. An employer can use a look -back period of up to 12 months to determine whether an on-going employee (i.e., one employed for at least the length of the look -back measurement period selected) is a full-time employee. If an employer uses a look- back/stability period for its on-going employees, it also can use the look-back/stability period for new and seasonal employees. The regulations include additional special rules for variable -hour employees and seasonal employees, whose status changes during the look -back measurement period, for rehired employees and employees returning from unpaid leaves of absence, for employees of temporary agencies, and for other special circumstances. When calculating "hours of service" for a non -hourly worker, an employer can choose between (a) counting actual hours of service, (b) using a days -equivalency method, or (c) using a weeks worked equivalency method, unless either (b) or (c) would substantially understate the hours worked and cause an employee otherwise considered full-time to not be classified as a full-time employee. Employers are able to establish testing periods ranging from three months to a full twelve months to measure whether an employee whose schedule causes him or her to be a "variable hours" employee qualifies as a full-time employee. To compute the hours for a part-time employee, for a given month, add the number of hours for all part-time employees (counting no more than 120 hours for any one employee) and divide by 120. Count all hours worked and all hours for which payment is made or due for vacation, illness, holiday, incapacity, layoff, jury duty, military duty, or leave of absence. Page 45 Affordable Coverage If an employee's share of the premium for employer-provided coverage would cost the employee more than 9.5% of that employee's annual household income, the coverage is not considered affordable for that employee. If an employer offers multiple healthcare coverage options, the affordability test applies to the lowest -cost option available to the employee that also meets the minimum value requirement. Because employers generally will not know their employees' household incomes, an employer can use one of three different safe harbors to determine affordable coverage including: The employee's IRS Form W- 2 The employee's rate of pay Federal poverty line These safe harbors can apply to all employees or to a specific category of employees. Minimum Value Employer coverage meets the minimum value test if it covers at least 60% of the total allowed cost of benefits that are expected to be incurred under the plan. Offer of Coverage In addition, to be in compliance with this provision, employers must also offer coverage to a full-time employee once during a plan year. This offer would be considered an open enrollment and full time employees can either enroll or decline to enroll in the plan but must have the option to do so once a year. Shared Responsibility Payment No penalty is triggered unless at least one full-time employee obtains subsidized Exchange coverage and it is important to know whether a full-time employee can obtain subsidized Exchange coverage. An employee can obtain subsidized Exchange coverage only if his or her household income is between 100 percent and 400 percent of the federal poverty line, he or she enrolls in Exchange coverage and is not eligible for Medicaid (or other government coverage), and either no employer coverage is offered or the employer coverage offered fails to meet either a minimum value test or an affordability test. An employer would potentially be liable for an Employer Shared Responsibility payment under the following circumstances: 1. If the City does not offer health coverage to any employees or offers coverage to less than 95% of the full-time employees (and dependents), and at least one of the full-time employees receives a premium tax credit to help pay for coverage on an Exchange; Page 46 2. The City offers health coverage to at least 95% of its full-time employees (and dependents), but at least one full-time employee receives a premium tax credit to help pay for coverage on an Exchange, which may occur because the employer did not offer coverage to that employee or because the coverage the employer offered that employee was either unaffordable or the coverage offered did not meet the minimum value criteria. We assume that option #1 above is not relevant and that the City offers coverage to more than 95% of their full time employees. For the second circumstance above, the fee is computed separately for each month. The amount of the fee for the month equals the number of full-time employees who receive a premium tax credit for that month multiplied by 1/12 of $3,240 (for 2016, adjusted annually). The amount of the payment for any calendar month is capped at the number of the employer's full-time employees for the month (minus up to 30) multiplied by 1/12 of $2,000. (The cap ensures that the payment for an employer that offers coverage can never exceed the payment that employer would owe if it did not offer coverage). This assessment is on an employee by employee basis versus the whole employee population. If the City offered coverage to 95% of the employees but for one or more employees coverage is not offered AND the employee meets the guidelines for receiving a premium tax credit from an Exchange, the City would pay on that employee only, not the entire population of employees. The monthly payment would be $270 a month (which is 1/12 of $3,240). Some employers are weighing the option of eliminating their healthcare coverage altogether and instead paying the penalty on their full-time employees. An Insurance Broadcasting article states, that while the "pay" option might be worth considering, there are strong reasons why employers should look carefully at all of their options and do their best to calculate the actual outcomes of each. Employers should consider the following in their decision-making process: 1. There may be lost tax advantages. Employers that eliminate healthcare coverage or opt not to offer it to full-time employees will be missing out on tax breaks (as will their employees). Employer contributions for healthcare coverage are not considered taxable income to the employee (and are deductible by the employer). Employee premiums that are paid through a Section 125 plan reduce the employee's taxable income, which reduces both the employer's and the employee's FICA tax. Page 47 2. The reporting burden. Employers that do not offer healthcare coverage will still face federal reporting requirements, in part so the penalty amount can be determined. In addition, employees who are not offered coverage are likely to go to the exchanges for coverage. These exchanges will require a variety of employee data from employers, particularly for employees who may be eligible for the premium tax credit, which means employers may have to deal with a significant number of inquiries from exchanges (staff time, effort, costs). 3. There may be recruitment and retention challenges. Employers who opt not to offer healthcare coverage could be doing long-term damage to their employment brands, making it difficult to attract top talent in the future. Even worse, they could lose current employees to organizations that do provide coverage. The damage to the brand could be even greater for employers that once offered coverage but elect to eliminate it in favor of paying penalties. In addition, employees who are forced to use exchanges, especially untested or insufficiently staffed exchanges, could feel undervalued or abandoned by their employers. 4. Rethinking the cost of coverage. While employers may have to cover more people, they do have options for reducing the costs of this coverage. For example, employers could reduce their lowest -cost coverage to stay just above the 60 percent minimum value threshold; they could reduce employees' hours below the "full-time employee" level; and they could consider paying targeted penalties (e.g., not providing "affordable coverage" to certain segments of their workforce). 5. There may be other financial implications such as employees demanding additional compensation from employers that elect to drop coverage to cover the cost of healthcare they must now purchase with their own, after-tax dollars. 12 12 (http://www.insurancebroadcasting.com/ news/United-Benefit-Advisors-2730177-1.html) Page 48 W-2 Reporting The ACA requires employers that will issue more than 250 W-2 forms to report the total cost of employer sponsored coverage on the employee's W-2 form. Initially, this provision was to take effect on January 1, 2012 for the 2011 calendar year. However, the IRS continued to delay the provision until January 1, 2016 for the 2015 calendar year to allow for employers to have more time to prepare. Reporting the cost of healthcare coverage on the W-2 form is not taxable income. The value of the healthcare coverage is reported in Box 12 of the W-2 form with code DD to identify the amount. The amount reported includes both the employer and employee portions. An employer is not required to issue a W-2 form solely to report the value of healthcare coverage for retirees or other employees if the employer would not have had to otherwise provide a Form W-2. The following chart represents the benefits offered to employees by the City and if the benefit is reportable on the W-2 form. Benefit Include or Not Include Medical Insurance Include — Employer and Employee costs Dental Insurance Optional Vision Insurance Optional Basic Life and AD&D Insurance Not Include Employee Assistance Program (EAP) Required if employer includes cost in COBRA premium On -Site Medical Clinic Optional if employer does not include costs in COBRA premium Wellness Programs Optional if employer does not include costs in COBRA premium Health FSA funded solely by salary- reduction amounts Not Include Cancer Policy (on a re -tax basis) Include Retiree coverage If W-2 being completed for other reason, then yes. Domestic Partner Coverage included in Gross Income Include Page 49 Wellness Benefits Effective for group health plans on or after January 1, 2014, the ACA expands and builds on the current wellness program policies in place to promote employer wellness programs and encourage opportunities to support healthier workplaces. The regulations divided the wellness programs into two categories: "participatory wellness programs" and "health -contingent wellness programs." Participatory wellness programs are generally available to all similarly situated individuals and either do not provide a reward or do not include any conditions for obtaining a reward that are based on an individual satisfying a standard that is related to a health factor. Examples include programs that reimburse for the cost of membership in a fitness center, rewards for attending a monthly, no -cost health education seminar or a reward to employees who complete a health risk assessment without requiring thein to take further action. Participatory programs are not required to meet the requirements (listed below) applicable to health -contingent wellness programs. Health contingent wellness programs require individuals to meet a specific standard related to their health to obtain a reward. Examples include programs that provide a reward to those who do not use, or decrease their use of, tobacco, or programs that provide a reward to those who achieve a specified cholesterol level or weight as well as to those who fail to meet biometric targets but take certain additional required actions. Health -contingent wellness programs require an individual to satisfy a standard related to a health factor to obtain a reward (or require an individual to do more than a similarly situated individual based on a health factor in order to obtain the same reward). The regulations continue to permit rewards to be in the following forms: • Discount or rebate of a premium or contribution, • Waiver of all or part of a cost-sharing mechanism (such as deductibles, copayments, or coinsurance), • The absence of a surcharge, • The value of a benefit that otherwise would not be provided under the plan, or • Other financial or nonfinancial incentives or disincentives. Health -contingent programs are permissible only if they comply with the following requirements: 1. Programs must be reasonably designed to promote health or prevent disease. To be considered reasonably designed to promote health or prevent disease, a program would have to offer a different, reasonable means of qualifying for the reward to any individual who does not meet the standard based on the measurement, test or screening. Programs must have a reasonable chance of improving health or preventing disease and not be overly burdensome for individuals. Page 50 2. Programs must be reasonably designed to be available to all similarly situated individuals. Reasonable alternative means of qualifying for the reward have to be offered to individuals whose medical conditions make it unreasonably difficult, or for whom it is medically inadvisable, to meet the specified health- related standard. 3. Individuals must be given notice of the opportunity to qualify for the same reward through other means. These rules provide sample language intended to increase the likelihood that those who qualify for a different means of obtaining a reward will contact the plan or issuer to request it. 4. The rules allow an increase in the maximum permissible reward under a health - contingent wellness program of 30% of the cost of health coverage, and increases the maximum reward to as much as 50% for programs designed to prevent or reduce tobacco use. As discussed above in the Health Insurance Plan review section for wellness, the City mainly offers free gym memberships at this time. These memberships are able to be reimbursed from the wellness dollars allocated by Cigna to the City. This would be considered a participatory wellness program. If the City were to consider adding a health -contingent wellness program, based on the 2015-2016 HMO plan employee rate, the cost could equal up to $169.10 (30%). The City would want to work with their current insurer/administrator to assure they meet the non-discriminatory wellness parameters. The regulations do not require plans and issuers to establish a particular alternative standard in advance of an individual's specific request for one. However, a reasonable alternative standard would have to be provided by the plan or issuer (or the condition for obtaining the reward would be required to be waived) upon an individual's request. 13 13 (http://healthcare-legislation.blogspot.com/2012/11/departments-issue-proposed-regulations.html) Page 51