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844-John Eastern Ins & CompPURCHASING DEPARTMENT TRANSMITTAL MEMORANDUM To: City Clerk RE: Work Order for John Eastern Insurance & Compensation Services The item(s) noted below is /are attached and forwarded to your office for the following action(s): ❑ Development Order ❑ Mayor's signature ❑ Final Plat (original mylars) ❑ Recording ❑ Letter of Credit ❑ Rendering ❑ Maintenance Bond ® Safe keeping (Vault) ❑ Ordinance ❑ ❑ Performance Bond ❑ Payment Bond ❑ Resolution ❑ City Manager Signature ® Work order ❑ City Clerk Signature Once completed, please: ❑ Return original ❑ Return copy El Special Instructions: Safe Keeping Please advise if you have any questions regarding the above. Thank you! From TADept_ forms \City Clerk Transmittal Memo - 2009.doc to-x--10 Date C::, �M r0 �I - re� m'e-1877- DOCUMENT APPROVAL "c7i ,rA C> C"I Contract/Agreement Name: John Eastem Company Inc Work Order Approval: I-'L7 Department Director k V Finance Director lolt M o Date 1C)IIalic) Date PURCHASING DEPARTMENT TRANSMITTAL MEMORANDUM To: Mayor Office and City Clerk RE: John Eastern Company Inc., Work Order The item(s) noted below is /are attached and forwarded to your office for the following action(s): Development Order Final Plat (original mylars) Letter of Credit Maintenance Bond Ordinance Performance Bond Resolution Once completed, please: ® Return original ❑ Return copy Special Instructions: For executed signature from both parties. 1 01 Mayor's signature Recording Rendering Safe keeping (Vault) Payment Bond City Manager Signature City Clerk Signature Please advise if you have any questions regarding the above. Thank you! From TADept_ forms \City Clerk Transmittal Memo - 2009.doe V P�©. ate EXHIBIT A WORK ORDER FORM Work Order Number NIA CITY OF SANFORD FLORIDA Master Agreement/Contract Number: NIA Dated: NIA Contract/Project Title Insurance and Workers Compensation Services per Attached Scope Solicitation No: - ISanford Project No. -- Purchase Order No. - Consultant/Contractor: Johns Eastern Company, Inc. Consultant/Contractor's Business Address, Phone Number, Fax Number and E -mail Address Special Account Services; 6015 Resource Lane; Lakewood Ranch, FL 34202; Attention Laura K. Lowe, Director of TPA Operations Tel: 941.527.3100 Fax: 941.527.4040 email: Laura Lowe (LLowe @JohnsEastern.comj X SCOPE OF SERVICES TIME BASIS -NOT TO EXCEED AMOUNT SPECIAL CONDITIONS I ITIME BASIS - LIMITATION OF FUNDS W I 0D1e%1 ur 11A1Gr1RRAAT1r1N I I UNIT PRICE BASIS -NOT TO EXCEED AMOUNT TIME FOR COMPLETION: Continuing Level of Effort Until September 30, 2011 Effective date- this Work Order: 1- Oct -10 Time for completion: The services to be provided by the Consultant/Contractor shall commence upon execution of this Work Order by the parties and shall be completed within the time frame indicated above. Failure to meet the stated completion requirement may be grounds for termination for default. Work Order Amount: Dollars Expressed in Numbers: $ See Attached Dollar Amount Written Out: See Attached In Witness Whereof, the parties hereto have made and executed this Work Order on the respective dates under each signature: The City through its City Manager and the Consultant/Contractor by and through its duly authorized corporate officer having the full and complete authority to execute same. ATTESZ; CONSULTANTICONTRACTOR r tip- s re Signature, Corporate President o name and title) Corporate President, Printed Name Date: /( ZD l y TTEST: CITY OF SANFORD . 4_0 Janet Dough , City CI k & Tom George, Interim City Manger Date: (-Y - /) . A (page Z) WORK ORDER TERMS AND CONDITIONS Execution of this Work Order by the CITY and the issuance of a notice to proceed, shall serve as authorl- zation for the CONSULTANT /CONTRACTOR to provide goods and /or services for the above project as set out in the Scope of Services which is attached as Exhibit "A,' as well as all other exhibits attached to that certain Agreement cited on the face of this Work Omer all of which are incorporated herein by reference as if they had been set out in its entirety and as further delineated in the specifications, conditions and requirements stated in the listed documents which are attached hereto and made a part hereof. The CONSULTANT /CONTRACTOR shall provide said goods and /or services pursuant to this Work Order, its attachments and the above - referenced Agreement and its exhibits. If this Work Order conflicts with said Agreement or exhibits, the Agreement and exhibits shall prevail: provided however, that the CONSULTANT /CONTRACTOR shall not proceed with work until directed to do so by the CITY. TERM: This Work Order shall take effect on the date of its execution by the CITY and expires upon final delivery, inspection, acceptance and payment unless terminated earlier in accordance with the Termination provisions herein provided, however, that the CONSULTANT /CONTRACTOR shall not proceed with work until directed to do so by the CITY. METHOD OF COMPENSATION: 0) FIXED FEE BASIS. If the compensation is based on a "Fixed Fee Basis," then the CONSULTANT /CONTRACTOR shall perform all work required by this Work Order for the Fixed Fee Amount indicated as the Work Order Amount. The fixed feel is an all- inclusive Firm Fixed Price binding the CONSULTANT /CONTRACTOR to complete the work for the Fixed Fee Amount regardless of the costs of performance. In no event shall the CONSULTANT /CONTRACTOR be paid more than the Fixed Fee Amount. (ii) TIME BASIS WITH A NOT TO EXCEED AMOUNT. If the compensation is based on a "Time Basis Method" with a Not -to- Exceed Amount, then the CONSULTANT /CONTRACTOR shall perform all work required by this Work Order for a sum not exceeding the amount indicated as the Work Order Amount. In no event is the CONSULTANT /CONTRACTOR authorized to incur expenses exceeding the Not -To- Exceed Amount without the express written consent of the CITY. Such consent will normally be in the form of an amendment to this Work Order. The CONSULTANT /CONTRACTOR's compensation shall be based on the actual work required by this Work Order and the Labor Hour Rates established in the Master Agreement. (iii) TIME BASIS WITH A LIMITATION OF FUNDS AMOUNT. If the compensation is based on a "Time Basis Method" with a Limitation of Funds Amount, then the amount identified as the Work Order Amount becomes the Limitation of Funds amount which shall not be exceeded without prior written approval of the CITY. Such approval, if given by the CITY, will indicate a new Limitation of Funds amount. The CONSULTANT /CONTRACTOR shall advise the CITY whenever the CONSULTANT /CONTRACTOR has incurred expenses on this Work Order that equals or exceeds eighty percent (80 %) of the Limitation of Funds amount. The CONSULTANTICONTRACTOR's compensation shall be based on the actual work required by this Work Order and the Labor Hour Rates established in the Master Agreement. (iv) UNIT PRICE BASIS WITH A NOT TO EXCEED AMOUNT. If the compensation is based on a "Unit Price Basis," then the CONSULTANT /CONTRACTOR shall perform all work required by this Work Order for the amount resulting from computing the quantity(ies) of defined units and agreed upon unit pricing to establish amount of CONTRACTOR'S compensation. All adjustments to quantities shall be approved by the Project Manager. Prior written approval by the City is required to adjust the not to exceed amount. The CITY shall make payment to the CONSULTANT /CONTRACTOR in strict accordance with the payment terms of the above - referenced Agreement. It is expressly understood by the CONSULTANT /CONTRACTOR that this Work Order, until executed by the CITY, does not authorize the performance of any services by the CONSULTANT /CONTRACTOR and that the CITY, prior to its execution of the Work Order, reserves the right to authorize a party other than the CONSULTANT /CONTRACTOR to perform the services called for under this Work Order if it is determined that to do so is in the best interest of the CITY. The CONSULTANTICONTRACTOR shall execute this Work Order first and the CITY second. This Work Order becomes effective and binding upon execution by the CITY and not until then. A copy of this executed Work Order along with a Purchase Order will be forwarded to the CONSULTANT /CONTRACTOR at the completion of that action. It is noted that the Purchase Order Number must be indicated on all invoices germane to the Work Order. SCOPE OF SERVICES — City of Sanford Johns Eastern Company Inc. Services provided on these programs Include, but are not limited to: Workers' Compensation Medical Management Services Cost Containment/ BIII Review SERVICE CENTERS The Workers' Compensation claims services are from the following office: SPECIAL ACCOUNT SERVICES 6015 Resource Lane Lakewood Ranch, FL 34202 Tel: (941) 907 -3100 Fax: (941) 527 -4040 Toll Free: 977326-JECO Beverly Adkins, AIC, AIM, Executive Vice President Laura K. Lowe, Director of TPA Operations Alice Bane, CWCL, Claims Manager Nancy Riley, AIC, Manager, Claims Development MANAGEMNf AND ADmu4m*RATION Coordination with the Department of Self- Insurance, AHCA or other regulatory departments Filing of Unit State Statistical Reports Analysis and verification of state assessments Assistance In certification of safety and drug free work place programs Assistance with compliance of security requirements Assistance in filing required self-insured reports le: SI -S payroll report Coordinate and respond on the Clty's behalf to state audits or excess carrier audits Assistance In Interpreting self- Insurance statute and rules In order to maintain self - Insured status • Claims funding and checking account reconciliation INFORMATION SERVICES • Monthly reports - standard and /or customized • On -line services, Including E-mall capabllities • Ad Hoc Reporting (optional) • Electronic transmission of First Report via online entry or fax • OSHA Reports (optional) • Electronic access to claims system • Annual 1099 reporting • Supply of necessary state forms • Assistance In program analysis CLAQNS MANAGEMENT, ADJUSTING AND INVESTIGATION • Three point contact • Investigate, accept, defend and /or settle all reportable cases • Application of appropriate reserving techniques • Necessary field investigations • Field offices staffed wfth experienced adjusters • Case file analysis of all claims • Investigation of claims involving questionable compensability • Investigation of claims Involving serious disability or unique medical problems • Investigation of claims Involving subrogation • Special Investigations requested by client • Field adjusters available seven days a week, 24 hours a day • Legal management SERVICES PROVIDED (CONTINUED) • Special Disability Trust fund recognition and collection • indexing injured employees for fraud detection • Subrogation recognition and collection • Analysis and application of special defenses such as sovereign immunity • Reporting to excess carriers or reinsurance carriers • Collection of excess and /or reinsurance payments • Management of vendors Defense attorneys Surveillance Rehabilitation, on -site or vocational case management • Claims management meetings • Establishment and education regarding fraud awareness • Attendance at mediations and hearings MEDICAL MANAGEMENT SERVICES • Education and training • Preferred provider network access and referrals • Telephonic case management (assigned with client approval only) • Utflizallon management • Management meetings • Management of vendors • on-site case management (assigned with client approval only) • Vocational case management (assigned with client approval only) • PPO networks • Development of specialized network COST CONTAE MENT/BUL REVIEW Review all provider bills and make appropriate reductions In the following areas: • State fee schedule • PPO network discounts • Utilization review • Usual and customary • Specially negotiated rates • Provider utilization reports • Savings by category reports Page 1 of 2 Compensation Schedule Allocated Claims Expenses. Charges for services below are billed at negotiated rates for vendors selected by CLIENT /SERVICE AGENT unless otherwise outlined below. "Allocated Claims Expenses" shall be defined as expenses arising in connection with the settlement of claims, which shall be defined as expenses directly allocated to a particular claim to be discharged from the accounts funded by the CLIENT specified in Paragraph 3, including, but not limited to: a. Attorneys' and legal assistants' fees for claim and any lawsuits, before and at trial, on appeal, or otherwise; b. Court and other litigation and settlement expenses, including, without limitation: (i) Medical examinations to determine extent of liability; (ii) Expert medical and other testimony; (iii) Laboratory, X -ray and other diagnostic tests; (iv) Autopsy, surgical reviews, and other pathology services; (v) Physician and related fees and expenses in reading, interpreting, or performing any of the foregoing tests or services; (vi) Stenographer, process server, and other related trial preparation, trial, settlement, and court costs; (vii) Witnesses fees and expenses before and at trial, deposition, settlement discussions, or otherwise; and C. Fees and expenses for surveillance, private investigators, or otherwise, d. Fees for the indexing of injured claimants, e. Fees for any work done outside the office, including, but not limited to, field investigations necessary to determine compensability, liability, Special Disability Trust Fund or subrogation recoverability, claimant control, attendance at mediations, hearings and depositions, attendance at management meetings, attendance at medical consultations or hearings, appraisals, case management, recorded statements, f. Fees for overnight or special mail service for various documents, g. Fees for examining and reducing hospital and medical bills as appropriate, $5.95 per bill and 30% of all savings over and above Fee Schedule reductions. h. Photocopying and /or CD -ROM copies, review of relevant documentation. i. Pre- Certification of Hospital Admissions, On -Site Case Management, Peer Review, Medical Care Audits, and Hospital Bill Audits. j. Medicare Set -Aside (MSA) services to include; recommendation for MSA submission, MSA cost projection, MSA submission, liability MSA services, comprehensive drug utilization review, lien search, conditional lien dispute, projection update. Page 2 of 2 Compensation Schedule Claims Handling. Fees for claims handling for the Client for exposures whose dates of loss fall between October 1, 2010 and September 30, 2011 will be a minimum and deposit of $16,000.00. This fee will be billed annually. The above fee contemplates handling 55 workers' compensation exposures. If the number of exposures exceeds 55, then the fees will be $320.00 per lost time or medical only exposure. The minimum and deposits covers all claims management /administration and data processing services. All years are subject to audit. Information Services — Optional programs available. If selected by Client, Service Agent will bill accordingly. • Online NOI (Pre -fill) $1,000.00 (per year) • Ad Hoc Report Library $1,000.00 Setup Fee (one time charge) $250.00 per login & password (per year) • Ad Hoc Report Library $1,500.00 Setup Fee (one time charge) $400.00 per login & password (per year) All other terms of the original contract and Addendums remain unchanged.