RES 2011-0218 - Agmt with Alternate Risk Services for self insured workers' compensation program •
1a°4:741`,� � RECEIVED Human Resources. Department
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a`a')� rr `a Omaha/Douglas Civic Center
_ 1819 Farnam Street,Suite 506
o�rC 'ry Omaha,Nebraska 68143- 06
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(402)444-535300
CITY CLERKFAX(402)444-5314
4TFo FEBR�City of Omaha (MAFIA, NE dRASKA FAX(402)444-$317
Jim Suttle,Mayor •
•
•
Honorable President
and Members of the City Council,
The purpose of the attached Resolution is to approve a Service Agreement with Alternative Risk
Services for the provision of third party administration services for the City's self insured
workers' compensation program for the period March 1, 2011 through December 31, 2011. The
$87,920 cost thereof will be paid from General Fund 11111, Organization 105011.
Your f orable consideration is requested. Referred to City Council for Consideration
A l7 l) - / 2k261'i
Richard O' ara, Director Date M or s Office Date
Human Re ources Department
•
Approved as to Funding: Approved:
•
Z
Pam Spaccarotella, Director Date Thomas C. Marfisi, Director Date
Finance Department Human Rights and Relations Dep ent
•
p:\law-city council documents\2011\10044dae.doc
RESOLVED:
THAT,approval is subject to continued compliance with the law,the Lottery Operator's
Agreement,as amended,the keno location criteria,and the terms,conditions and representations in the
application for approval of this location.
APPRO. 'ED A: FQ'� :
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Truck Chassis.Cab-(35K OVW) Page 7 of 9
temperature,engine hour meter and R.P.M.gauges.
E. To have oil change indicator light.
F. All gauges shall.be needle type located in dash panel.
Truck Chassis.Cab(35K GVW) Page 3 of 9
specifications,
9 pages)dated December 2010, Q wry p
30
Make&Model offered:..i-> iri'SP-t r:0v- ,.i1 7 0 42 !O,2t)Q '
BID/each: $ 4.43, x") $205,600--Err
(5%Be Bond Is to be based
upon lids amount)'
Questions regarding this bid should be directed to:
Steve Faris at(402)680-0827-OR-
Marc McCoy at(402)444-6191
REQUIREMENTS FOR BID BOND:The surety company issuing the bid bond or the performance bond should be licensed by the State of
Nebraska and listed on the current edition of Circular 570 of the United States Department of the Treasury. A certified check,an official
bark check,or cashiers.check drawn on a national bank or a bank chartered under the laws of the state,payable to the city,or lawful
money of the United States,or a United States Government Bond(negotiable)are acceptable substitutes for bond requirements.
All bidders awarded a contradt In the omen!of$5,000 or more must conicity with the Contract Compliance Ordinance and have on rile wilts the Human Rights&
Relations Department the Contract Compliance Report(Form CC.-1).This report shall be in affect for 24-months from the dale received by the Human Rights 6
Relations Department.Any questions regarding the Contract Compliance Ordinance should be directed to the Human Rights&Relations Department at(402)444-
5055.
(PLEASE PRINT LEGIBLY OR TYPE)
P t rc nS. Tom1 k' 1 Firm: , {1tis -vim 4.et'/Icr. t(1f1tA �r,tc n"i re.T�ruc{� Uncompleted In:
Delivery(a completion) Neme: C1 -2.X— _� ignature:
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' !0 calendar days following aware TTiie (_(go I l=ax 33i-6ec)2
Address: 46-02 Sic ,-4-k (i O I' 'Te + .Orn�.'4 N G 6• r 3 7
IS__tteeVP.O.Box City State Zip
Emal Address:tros1,ttc,n-e_ Ccicri"1t.tSkk!'trt4P 1.. COsy'\
A
ng Allowance,Unit Prices&
Alternates(If applicable). Refer any questions raga dine the Bid or Contract Documents directly to the Park Planning Division a 1,,402.44A-5900 or as noted In the
1 Contract Documents.
I All bidders awarded a contract In the amount of$5,000 or more must comply with the Contract Compliance Ordinance and have on the with the Human Relations Department the Contract
Compliance Report(Form CC-1).This report shalt be in effect for 24 months from the date received by the Human Relations Department Any questions regarding the Contract Compliance
Ordinance or PBEIDEB Listings should be directed to the Human Relations Department at 402.444-5055.
I
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'. SERVICE AGREEMENT
This Agreement is made and entered into this /$P day of /gineGI , 2011, by and between the City
of Omaha, a political subdivision organized and existing under the laws of the State of Nebraska ("CLIENT"),with
principal offices at 1819 Farnam Street, Ste. 506, Omaha, Nebraska 68183 and Alternative Risk Services, L.L.C.
("ARS"), a Missouri limited liability company; with principal offices at 10525 North Ambassador Drive, Kansas
City,MO 64153.
Whereas, CLIENT is a court approved self insured employer pursuant to Section 48-145 of the Nebraska
Workers' Compensation Act and has established a self-funded Workers' Compensation program ("Program").
Whereas, CLIENT desires that ARS provide coordinated Administration, Claims, and Risk Management
Information System Services in connection with said Program; and
Whereas,ARS desires to provide such services in connection with said Program,under the following terms and
conditions:
NOW,THEREFORE,THE PARTIES AGREE AS FOLLOWS:
SECTION I - SERVICES PROVIDED BY ARS
A.ADMINISTRATION SERVICES:
ARS will timely:
1. Provide assistance and information to legal, accounting and actuarial personnel as required. Including but not
limited to information required by the Nebraska Workers' Compensation Court.
2. Provide other services as reasonably requested by the CLIENT and agreed upon by ARS to ensure sound
management of the Program.
B. CLAIMS SERVICES:
ARS will:
1. Investigate, adjust, and otherwise administer claims, including the negotiation of settlements and assistance to
CLIENT in the defense of litigated claims, in accordance with applicable law, established claims handling
procedures, CLIENT's procedures, and ARS's best professional judgment. ARS may meet this obligation by
engaging the services of persons or firms outside of the ARS organization with CLIENT'S prior approval. All
fees and expenses of such approved third parties for these services shall be Allocated Loss Adjustment
Expenses.
2. Determine what claim payments, including settlement payments, should be made on behalf of the Program and
convey such recommendation to CLIENT; provided,ARS shall obtain CLIENT's approval before offering any
claim payment,including any settlement payment, and further provided that ARS's inability to settle a claim,will
not subject ARS to any liability whatsoever, including in the event of an adverse judgment against CLIENT for
any action based upon or related to the claim.
3. Assist in facilitating medical case management and rehabilitation with CLIENT's Managed Care Plan.
4. Determine,with the approval of CLIENT, any Allocated Loss Adjustment Expense to be incurred in
connection with a claim.
5. Establish reserves for all reported claims.
1
issuing the bid bond or the performance bond should be licensed by the State of
Nebraska and listed on the current edition of Circular 570 of the United States Department of the Treasury. A certified check,an official
bark check,or cashiers.check drawn on a national bank or a bank chartered under the laws of the state,payable to the city,or lawful
money of the United States,or a United States Government Bond(negotiable)are acceptable substitutes for bond requirements.
All bidders awarded a contradt In the omen!of$5,000 or more must conicity with the Contract Compliance Ordinance and have on rile wilts the Human Rights&
Relations Department the Contract Compliance Report(Form CC.-1).This report shall be in affect for 24-months from the dale received by the Human Rights 6
Relations Department.Any questions regarding the Contract Compliance Ordinance should be directed to the Human Rights&Relations Department at(402)444-
5055.
(PLEASE PRINT LEGIBLY OR TYPE)
P t rc nS. Tom1 k' 1 Firm: , {1tis -vim 4.et'/Icr. t(1f1tA �r,tc n"i re.T�ruc{� Uncompleted In:
Delivery(a completion) Neme: C1 -2.X— _� ignature:
-75c n f\act t1 S
' !0 calendar days following aware TTiie (_(go I l=ax 33i-6ec)2
Address: 46-02 Sic ,-4-k (i O I' 'Te + .Orn�.'4 N G 6• r 3 7
IS__tteeVP.O.Box City State Zip
Emal Address:tros1,ttc,n-e_ Ccicri"1t.tSkk!'trt4P 1.. COsy'\
A
ng Allowance,Unit Prices&
Alternates(If applicable). Refer any questions raga dine the Bid or Contract Documents directly to the Park Planning Division a 1,,402.44A-5900 or as noted In the
1 Contract Documents.
I All bidders awarded a contract In the amount of$5,000 or more must comply with the Contract Compliance Ordinance and have on the with the Human Relations Department the Contract
Compliance Report(Form CC-1).This report shalt be in effect for 24 months from the date received by the Human Relations Department Any questions regarding the Contract Compliance
Ordinance or PBEIDEB Listings should be directed to the Human Relations Department at 402.444-5055.
I
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'6. Review invoices relative to reported claims.
7. Advise CLIENT of claims in which subrogation may be warranted and assist CLIENT with same as requested.
8. Advise CLIENT of major developments in the administration of significant claims,including the provision of
narrative reports if reasonably requested by the CLIENT.
9. Provide claims forms and other appropriate forms.
10. Provide CLIENT with monthly reports on claims,payments,reserves and expenses.
11. Complete and file,with the cooperation and assistance of the CLIENT, all forms required by the Nebraska
Workers'Compensation Court,including but not limited to, electronic injury and payment reporting (FROI and
SROI, etc.).
12. Allocated Loss Adjustment Expenses as used in this Agreement means any cost or expenses incurred by
CLIENT or by ARS on behalf of CLIENT as a result of ARS's or CLIENT's engaging the services of a firm
or person outside the ARS organization, with CLIENT"S prior approval, for work in connection with the
investigation, adjustment, or settlement of a claim. Allocated Loss Adjustment Expenses include but are not
limited to the following: rehabilitation and retraining expenses; the cost of services for undercover operations
and detectives; fees and expenses of independent adjusters for the investigation or adjustment of claims in
areas removed from the reasonable access of ARS employees; the cost of employing experts for the purpose
of preparing photographs, and, or for expert advice or opinions; the cost of obtaining copies of any public
records, except CLIENT's public records; and the cost of recorded statements. Allocated Loss Adjustment
Expenses are not included within ARS fees.
13. MSEA Reporting: Alternative Risk Services, LLC agrees to provide reporting to the Centers for Medicare
and Medicaid Service (CMS) of all claims required to be reported to the CMS pursuant to the statutory
regulation of the Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA) or other CMS guideline,
whether independently by Alternative Risk Services, LLC or via a contractor. The terms of said reporting are
subject to the following:
A. CLIENT agrees to register, as required by CMS, as a Registered Reporting Entity (RRE) with the
CMS, maintain its RRE status with the CMS and abide by all requirements for good standing as an
RRE with the CMS as may be set forth from time to time by CMS. CLIENT further agrees to
designate Alternative Risk Services, LLC as its Designated Agent for purposes of reporting under
the MMSEA.
B. CLIENT agrees to supply Alternative Risk Services, LLC with any and all information or
documentation requested by Alternative Risk Services, LLC necessary for Alternative Risk
Services,LLC (or its contractor) to perform the mandatory reporting requirement or the MMSEA.
C. Alternative Risk Services, LLC agrees to defend and indemnify CLIENT against any action
initiated or instituted by the United States Government (including the CMS or other Federal
Agency) alleging a violation under the MMSEA for a failure on the part of Alternative Risk
Services,LLC (or its contractor) to report a qualified claim as required under the MMSEA, so long
as CLIENT is not in violation of the terms of paragraphs A and B of this Section nor has
undertaken any intentional or willful misconduct to disallow or harm Alternative Risk Services,
LLC (or its contractor) from fulfilling its reporting obligation pursuant to this Section.
14. Provide claims services through the persons specified in its Response to Request for Proposal or other
persons in its employ, subject to CLIENT's approval of such other persons.
15. Provide weekly, on the schedule established by CLIENT and in a format acceptable to CLIENT,
recommendations for payment of Injured on Duty and indemnity benefits.
2
In:
Delivery(a completion) Neme: C1 -2.X— _� ignature:
-75c n f\act t1 S
' !0 calendar days following aware TTiie (_(go I l=ax 33i-6ec)2
Address: 46-02 Sic ,-4-k (i O I' 'Te + .Orn�.'4 N G 6• r 3 7
IS__tteeVP.O.Box City State Zip
Emal Address:tros1,ttc,n-e_ Ccicri"1t.tSkk!'trt4P 1.. COsy'\
A
ng Allowance,Unit Prices&
Alternates(If applicable). Refer any questions raga dine the Bid or Contract Documents directly to the Park Planning Division a 1,,402.44A-5900 or as noted In the
1 Contract Documents.
I All bidders awarded a contract In the amount of$5,000 or more must comply with the Contract Compliance Ordinance and have on the with the Human Relations Department the Contract
Compliance Report(Form CC-1).This report shalt be in effect for 24 months from the date received by the Human Relations Department Any questions regarding the Contract Compliance
Ordinance or PBEIDEB Listings should be directed to the Human Relations Department at 402.444-5055.
I
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SECTION II - MAINTENANCE OF BOOKS AND RECORDS
A. In performing the services outlined in this Agreement ARS agrees to:
1. Maintain records of CLIENT business for at least five (5) years following the termination of this Agreement.
2. Maintain a claim file on each reported claim,which shall be available electronically to CLIENT at no cost.
3. Not disclose the contents of Program files and records to third parties, except as reasonably necessary for
ARS to carry out its obligations to CLIENT under this Agreement or to comply with any requirements
imposed by law.
B. Program files and records shall be considered the property of CLIENT and shall be available for inspection
by CLIENT upon reasonable notice. CLIENT may obtain copies of Program files and records. CLIENT
may, upon the termination of this Agreement and at its option and cost, require ARS to return Program files
and records to CLIENT, with the understanding that such action will terminate ARS's responsibilities for
maintenance of Program files and records required by paragraph A.1 and 2 of this section.
SECTION III - DUTIES OF CLIENT
CLIENT shall:
1. Promptly refer to ARS all claims, incidents, reports thereof and other matters relating to ARS's duties
hereunder.
2. Cooperate with ARS in the disposition of the matters referred under paragraph 1. of this section and in the
performance of this Agreement.
3. Promptly pay all ARS undisputed service fees and expenses.
3
or opinions; the cost of obtaining copies of any public
records, except CLIENT's public records; and the cost of recorded statements. Allocated Loss Adjustment
Expenses are not included within ARS fees.
13. MSEA Reporting: Alternative Risk Services, LLC agrees to provide reporting to the Centers for Medicare
and Medicaid Service (CMS) of all claims required to be reported to the CMS pursuant to the statutory
regulation of the Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA) or other CMS guideline,
whether independently by Alternative Risk Services, LLC or via a contractor. The terms of said reporting are
subject to the following:
A. CLIENT agrees to register, as required by CMS, as a Registered Reporting Entity (RRE) with the
CMS, maintain its RRE status with the CMS and abide by all requirements for good standing as an
RRE with the CMS as may be set forth from time to time by CMS. CLIENT further agrees to
designate Alternative Risk Services, LLC as its Designated Agent for purposes of reporting under
the MMSEA.
B. CLIENT agrees to supply Alternative Risk Services, LLC with any and all information or
documentation requested by Alternative Risk Services, LLC necessary for Alternative Risk
Services,LLC (or its contractor) to perform the mandatory reporting requirement or the MMSEA.
C. Alternative Risk Services, LLC agrees to defend and indemnify CLIENT against any action
initiated or instituted by the United States Government (including the CMS or other Federal
Agency) alleging a violation under the MMSEA for a failure on the part of Alternative Risk
Services,LLC (or its contractor) to report a qualified claim as required under the MMSEA, so long
as CLIENT is not in violation of the terms of paragraphs A and B of this Section nor has
undertaken any intentional or willful misconduct to disallow or harm Alternative Risk Services,
LLC (or its contractor) from fulfilling its reporting obligation pursuant to this Section.
14. Provide claims services through the persons specified in its Response to Request for Proposal or other
persons in its employ, subject to CLIENT's approval of such other persons.
15. Provide weekly, on the schedule established by CLIENT and in a format acceptable to CLIENT,
recommendations for payment of Injured on Duty and indemnity benefits.
2
In:
Delivery(a completion) Neme: C1 -2.X— _� ignature:
-75c n f\act t1 S
' !0 calendar days following aware TTiie (_(go I l=ax 33i-6ec)2
Address: 46-02 Sic ,-4-k (i O I' 'Te + .Orn�.'4 N G 6• r 3 7
IS__tteeVP.O.Box City State Zip
Emal Address:tros1,ttc,n-e_ Ccicri"1t.tSkk!'trt4P 1.. COsy'\
A
ng Allowance,Unit Prices&
Alternates(If applicable). Refer any questions raga dine the Bid or Contract Documents directly to the Park Planning Division a 1,,402.44A-5900 or as noted In the
1 Contract Documents.
I All bidders awarded a contract In the amount of$5,000 or more must comply with the Contract Compliance Ordinance and have on the with the Human Relations Department the Contract
Compliance Report(Form CC-1).This report shalt be in effect for 24 months from the date received by the Human Relations Department Any questions regarding the Contract Compliance
Ordinance or PBEIDEB Listings should be directed to the Human Relations Department at 402.444-5055.
I
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• SECTION IV-ARS SERVICE FEES
A. SERVICE FEES:
The Program shall pay ARS the following fees to provide the services as defined in Section I of this agreement and as
more specifically described on Exhibit "A" which is attached hereto and incorporated by this reference as if fully set
forth herein:
Claims Administration $80,000.00 3-1-11 to 12-31-2011
$96,000.00 annual 2012 extension at CLIENT's Option
$96,000.00 annual 2013 extension at CLIENT's Option
Program Administration $7,920 3-1-11 to 12-31-2011
$9,500.00 annual 2012 extension at CLIENT's Option
$9,500 annual 2013 extension at CLIENT's Option
The above fees are annual fees and are not subject to audit.
CLIENT shall have the right to change the fee method from a flat fee basis to a fee per claim basis at the
commencement of each extension year if CLIENT exercises its option for an extension year in 2012 or 2013.
B. PAYMENT OF FEES:
1. The Claims Administration fee shall be paid in monthly installments (each in the amount of$8,000) beginning the
effective date of this contract.
2. The Program Administration fee will be paid in equal monthly installments beginning the effective date of this
contract.
SECTION V- GENERAL PROVISIONS
A. This Agreement is for the sole benefit of the parties. ARS shall not be liable to any person not a party to this
Agreement for any loss, liability, damage or expense relating in any way to any services provided under this
Agreement.
B. ARS does not insure or underwrite the liability of CLIENT. CLIENT retains the ultimate responsibility for
payment of all claims made and all expenses associated with such claims.
C. CLIENT agrees to indemnify, defend and hold harmless ARS, its parents, subsidiaries, affiliates, and the
officers, agents and employees thereof, from and against any and all claims, actions, causes of action, liability,
loss, damage or expense, including punitive damages and attorney's fees and expenses, incurred in
connection with claims or demands for damages of any nature whatsoever, to the extent arising from or
caused by any real or alleged act or omission, tortious or otherwise, of CLIENT, its officers, agents,
employees or members.
D. ARS agrees to indemnify, defend and hold harmless CLIENT, its officers, agents and employees, from and
against any and all claims, actions, causes of action, liability, loss, damage or expense, including punitive
damages and attorney's fees and expenses, incurred in connection with claims or demands for damages of
any nature whatsoever, to the extent arising from or caused by any real or alleged act or omission, tortious or
otherwise, of ARS,its officers, agents, employees or members.
4
o perform the mandatory reporting requirement or the MMSEA.
C. Alternative Risk Services, LLC agrees to defend and indemnify CLIENT against any action
initiated or instituted by the United States Government (including the CMS or other Federal
Agency) alleging a violation under the MMSEA for a failure on the part of Alternative Risk
Services,LLC (or its contractor) to report a qualified claim as required under the MMSEA, so long
as CLIENT is not in violation of the terms of paragraphs A and B of this Section nor has
undertaken any intentional or willful misconduct to disallow or harm Alternative Risk Services,
LLC (or its contractor) from fulfilling its reporting obligation pursuant to this Section.
14. Provide claims services through the persons specified in its Response to Request for Proposal or other
persons in its employ, subject to CLIENT's approval of such other persons.
15. Provide weekly, on the schedule established by CLIENT and in a format acceptable to CLIENT,
recommendations for payment of Injured on Duty and indemnity benefits.
2
In:
Delivery(a completion) Neme: C1 -2.X— _� ignature:
-75c n f\act t1 S
' !0 calendar days following aware TTiie (_(go I l=ax 33i-6ec)2
Address: 46-02 Sic ,-4-k (i O I' 'Te + .Orn�.'4 N G 6• r 3 7
IS__tteeVP.O.Box City State Zip
Emal Address:tros1,ttc,n-e_ Ccicri"1t.tSkk!'trt4P 1.. COsy'\
A
ng Allowance,Unit Prices&
Alternates(If applicable). Refer any questions raga dine the Bid or Contract Documents directly to the Park Planning Division a 1,,402.44A-5900 or as noted In the
1 Contract Documents.
I All bidders awarded a contract In the amount of$5,000 or more must comply with the Contract Compliance Ordinance and have on the with the Human Relations Department the Contract
Compliance Report(Form CC-1).This report shalt be in effect for 24 months from the date received by the Human Relations Department Any questions regarding the Contract Compliance
Ordinance or PBEIDEB Listings should be directed to the Human Relations Department at 402.444-5055.
I
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•
'E. During the term of this Agreement and for five (5) years following its termination, without the prior written
consent of the other party, neither ARS nor CLIENT shall (i) communicate, divulge or use for its benefit or
that of any other person, firm or corporation, any trade secrets, business methods or other confidential
information of any type or description divulged to that party as a result of this Agreement, except as
expressly permitted herein or as required by law; or (ii) directly or indirectly, solicit for employment, employ
or retain any employee or agent of the other.
F. The term of the Agreement shall be for a period of approximately ten months commencing on the date of
execution and ending on December 31, 2011. CLIENT, at its sole option,may extend this Agreement for
two (2) additional one (1) year terns commencing, respectively,January 1, 2012 and January 1, 2013.
G. Either party may cancel this Agreement for cause upon written notice to the other party. For purposes of
this provision, "cause" shall be deemed to mean:
1. A material breach of this Agreement, by either party,which breach is not cured within thirty (30) days after
receipt of written notice from the other party; or
2. Either party becoming insolvent, making an assignment for the benefit of creditors, ceasing to do business,
filing a voluntary petition under any law having for its purpose the adjudication of that party as bankrupt,
being adjudged as bankrupt pursuant to any involuntary petition in bankruptcy, having a receiver appointed
for the property of that party by reason of the insolvency of that party, or having any department of the State
or Federal Government, or any officer thereof, duly authorized, take possession of the business or property
of that party by reason of the insolvency of that party.
H. ARS shall have the right to suspend its services under this Agreement upon ten (10) days' written notice to
the CLIENT in the case of non-payment of ARS's services fees by CLIENT. Upon early termination of the
Agreement for any reason,within sixty (60) days of such early termination date, an audit adjustment shall be
made based upon the rates shown in Section IV.A for those services actually performed on or before the
early termination date.
I. Upon the expiration of this Agreement or termination by either party of this Agreement, ARS shall have no
further duties under Section I hereof. The provisions of Paragraphs C. and D. of this Section 5 shall remain
in effect after any expiration or termination of this Agreement.
J. This Agreement is the entire Agreement between the parties with respect to the matters described herein and
may be modified only in writing signed by both parties.
K. This Agreement was entered into,is governed by, and shall be interpreted in accordance with the laws of the
state of Nebraska.Any action seeking to enforce any provision of this Agreement shall be brought only in
the courts of the State of Nebraska, or in the United States District Court, and the parties consent to the
exclusive jurisdiction of such courts and irrevocably waive objection to venue therein.
L. CLIENT and ARS represent that in the negotiation and drafting of this Agreement each has been represented
by or has had the opportunity to consult with counsel of its choosing. CLIENT and ARS represent that each
has had a substantial role in the drafting and negotiation of this Agreement, and the rule of construction to
the effect that any ambiguities are to be resolved against the drafting party shall not be employed in the
interpretation of this Agreement or any attachment.
M. Any notice, request, demand or other communication required or permitted hereunder shall be deemed
properly given when deposited in the mails,postage prepaid, or when deposited with any recognized national
delivery service for transmittal, charges prepaid, addressed to the parties at the addresses appearing in the
introductory paragraph to this Agreement.
N. CLIENT and ARS will execute and deliver such further instruments and take such further action as may be
deemed necessary to more effectively consummate the matters contemplated herein.
5
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A
ng Allowance,Unit Prices&
Alternates(If applicable). Refer any questions raga dine the Bid or Contract Documents directly to the Park Planning Division a 1,,402.44A-5900 or as noted In the
1 Contract Documents.
I All bidders awarded a contract In the amount of$5,000 or more must comply with the Contract Compliance Ordinance and have on the with the Human Relations Department the Contract
Compliance Report(Form CC-1).This report shalt be in effect for 24 months from the date received by the Human Relations Department Any questions regarding the Contract Compliance
Ordinance or PBEIDEB Listings should be directed to the Human Relations Department at 402.444-5055.
I
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: t • � s
•
•
0. This Agreement shall consist of CLIENT's Request for Proposal for Third Party Administration for Work
Related Injuries/Ilnesses — Claims Processing Only issued November 2010,ARS' Response to such Request
for Proposal dated December 15, 2010, which are attached hereto, respectively as Exhibit"B" and Exhibit"C",
and incorporated by this reference as if fully set forth herein,and this contract. This contract shall control with
regard to any conflict among them.
P. ARS shall not, in the performance of this Agreement, discriminate or permit discrimination in violation of
federal or state laws or local ordinances because of race, color, sex, age, disability as defined in the
Americans with Disability Act,political or religious opinions, affiliations or national origin.
Q. Pursuant to section 8.05 of the Home Rule Charter, no elected official or any officer or employee of the
City of Omaha shall have a financial interest, direct or indirect, in any City contract. Any violation of this
section with the knowledge of the person or corporation contracting with the City shall render the contract
voidable by the Mayor or Council.
R. ARS covenants that it presently has no interest and shall not acquire any interest, direct or indirect, which
would conflict with the performance of services required to be performed under this Agreement; it further
covenants that, in the performance of this Agreement, no person having any such interest shall be
employed.
S. The parties hereto acknowledge that, as of the date of the execution of this agreement, Section 10-142 of the
Omaha Municipal Code provides as follows:
"Any amendment to contracts or purchases which taken alone increases the original bid price as
awarded (a) by ten percent, if the original bid price is one hundred fifty thousand dollars($150,000)
or more, or (b) by seventy-five thousand dollars ($75,000) or more, shall be approved by the City
Council in advance of the acceptance of any purchase in excess of such limits or the authorization of
any additional work in excess of such limits. However, neither contract nor purchase amendments
will be split to avoid advance approval of the City Council.
"The originally approved scope and primary features of a contract or purchase will not be
significantly revised as a result of amendments not approved in advance by the City Council. The
provisions of this Section will be quoted in all future City contracts. Nothing in this Section is
intended to alter the authority of the Mayor under Section 5.16 of the City Charter to approve
immediate purchases."
T. Neither ARS nor CLIENT may assign its rights under this Agreement without the express prior written
consent of the other.
U. It is understood and agreed by and between ARS and CLIENT that any and all acts that ARS or its
personnel, employees, agents, contractors, or servants, perform pursuant to the terms of this Agreement
shall be undertaken as independent contractors and not as employees of CLIENT. CLIENT and ARS
shall each act in their individual capacities and not as agents, employees, partners, joint venturers or
associates of the other. An employee or agent of one shall not be deemed or construed to be the
employee or agent of the other for any purpose whatsoever. Neither ARS nor its personnel, employees,
agents, contractors, or servants shall be entitled to any City of Omaha benefits. CLIENT shall not
provide any insurance coverage to ARS or its employees including, but not limited to, workers'
compensation insurance. ARS shall pay all wages, salaries and other amounts due its employees and
shall be responsible for all reports, obligations, and payments pertaining to social security taxation,
income tax withholding, workers' compensation, unemployment compensation, group insurance
coverage, collective bargaining agreements or any other such similar matters. ARS shall have no
authority to bind CLIENT by or with any contract or agreement, nor to impose any liability upon
- 6
ts and take such further action as may be
deemed necessary to more effectively consummate the matters contemplated herein.
5
ttc,n-e_ Ccicri"1t.tSkk!'trt4P 1.. COsy'\
A
ng Allowance,Unit Prices&
Alternates(If applicable). Refer any questions raga dine the Bid or Contract Documents directly to the Park Planning Division a 1,,402.44A-5900 or as noted In the
1 Contract Documents.
I All bidders awarded a contract In the amount of$5,000 or more must comply with the Contract Compliance Ordinance and have on the with the Human Relations Department the Contract
Compliance Report(Form CC-1).This report shalt be in effect for 24 months from the date received by the Human Relations Department Any questions regarding the Contract Compliance
Ordinance or PBEIDEB Listings should be directed to the Human Relations Department at 402.444-5055.
I
�� n r 1�P) .Q,(1. t MC.
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FaxOloc2T)453 -a7S
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Address • city state Zap
t/P.O.Box
E-Mail Address
74
CLIENT. All acts and contracts of ARS shall be in its own name and not in the name of the City of
Omaha,unless otherwise provided herein.
V. Annexed hereto as Exhibit "B" and made a part thereof by reference are the equal employment
provisions of this Agreement. Refusal by ARS to comply with any portion of this program as therein
stated and described will subject the offending party to any or all of the following penalties:
A. Withholding of all future payments under the involved contracts to the contractor in violation
until it is determined that ARS is in compliance with the provisions of the contract;
B. Refusal of all future bids for any contracts with the City or any of its departments or divisions
until such time as ARS demonstrates that it has established and shall carry out the policies of the
program as herein outlined.
W. ARS is required and hereby agrees to use a federal immigration verification system to determine the
work eligibility status of new employees physically performing services within the State of Nebraska. A
federal immigration verification system means the electronic verification of the work authorization
program authorized by the Illegal Immigration Reform and Immigrant Responsibility Act of 1996, 8
U.S.C. 1324a, known as the E-Verify Program, or an equivalent federal program designated by the
United States Department of Homeland Security or other federal agency authorized to verify the work
eligibility status of a newly hired employee.
If ARS is an individual or sole proprietorship,the following applies:
1. ARS must complete the United States Citizenship Attestation Form, available on the Department
of Administrative Services website at www.das.state.ne.us.
2. If ARS indicates on such attestation form that he or she is a qualified alien, ARS agrees to
provide the US Citizenship and Immigration Services documentation required to verify ARS's lawful
presence in the United States using the Systematic Alien Verification for Entitlements (SAVE) Program.
3. ARS understands and agrees that lawful presence in the United States is required and ARS may
be disqualified or the contract terminated if such lawful presence cannot be verified as required by Neb.
Rev. Stat. §4-108
IN WITNESS WHEREOF, the signers below have entered this Agreement as of the day first above written.
Alternate Risk Services,L.L.C. City of Omaha,Nebraska
By: JA, , L By: Ng,
ATTEST:
Name: i j f- /1.214 r . Name: Suttle
Title: C25 Title: Mayor
.11 .4 /,„gdy
$ e town, City Clerk
p:\law-city council documents\2011\10046dae.doc
APPR .S TC pR
7 DEPUTY CITY ATTORNEY
S and CLIENT that any and all acts that ARS or its
personnel, employees, agents, contractors, or servants, perform pursuant to the terms of this Agreement
shall be undertaken as independent contractors and not as employees of CLIENT. CLIENT and ARS
shall each act in their individual capacities and not as agents, employees, partners, joint venturers or
associates of the other. An employee or agent of one shall not be deemed or construed to be the
employee or agent of the other for any purpose whatsoever. Neither ARS nor its personnel, employees,
agents, contractors, or servants shall be entitled to any City of Omaha benefits. CLIENT shall not
provide any insurance coverage to ARS or its employees including, but not limited to, workers'
compensation insurance. ARS shall pay all wages, salaries and other amounts due its employees and
shall be responsible for all reports, obligations, and payments pertaining to social security taxation,
income tax withholding, workers' compensation, unemployment compensation, group insurance
coverage, collective bargaining agreements or any other such similar matters. ARS shall have no
authority to bind CLIENT by or with any contract or agreement, nor to impose any liability upon
- 6
ts and take such further action as may be
deemed necessary to more effectively consummate the matters contemplated herein.
5
ttc,n-e_ Ccicri"1t.tSkk!'trt4P 1.. COsy'\
A
ng Allowance,Unit Prices&
Alternates(If applicable). Refer any questions raga dine the Bid or Contract Documents directly to the Park Planning Division a 1,,402.44A-5900 or as noted In the
1 Contract Documents.
I All bidders awarded a contract In the amount of$5,000 or more must comply with the Contract Compliance Ordinance and have on the with the Human Relations Department the Contract
Compliance Report(Form CC-1).This report shalt be in effect for 24 months from the date received by the Human Relations Department Any questions regarding the Contract Compliance
Ordinance or PBEIDEB Listings should be directed to the Human Relations Department at 402.444-5055.
I
�� n r 1�P) .Q,(1. t MC.
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FaxOloc2T)453 -a7S
Title I(,�}�(, � ��1
Address • city state Zap
t/P.O.Box
E-Mail Address
74
EXHIBIT A
Fee Proposal Sheet
March 1, 2011,through December 31, 2011
New cases (Injuries incurred on or after March 1,2011)
$800 per indemnity case
$160 per medical case
$ 30 per incident case
Old cases (Injuries incurred prior to March 1, 2011)
There is no charge to adjust claims reported and open prior to March 1, 2011. Claims occurring
prior to March 1, 2011 but not reported until after March 1, 2011 will fall within the new case
fee structure.
There is no fee to EDI FROI or SROI to NWCC. There is no charge to perform Section 111
quarterly queries or report filings.
January 1,2012,to December 31,2012
$825 per indemnity case
$170 per medical case
$ 30 per incident case
Alternate monthly flat fee that would include all administrative procedures to process and handle
old and new cases including electronic filing to NWCC for FROI and SROI and to Health and
Human Services (HHS) for Section 111 filings
$8,000.00/mo
January 1,2013,to December 31,2013
$825 per indemnity case
$170 per medical case
$ 30 per incident case
Alternate monthly flat fee that would include all administrative procedures to process and handle
old and new cases including electronic filing to NWCC for FROI and SROI and to Health and
Human Services (HHS) for Section 111 filings
$8,000.00/mo
1
United States Department of Homeland Security or other federal agency authorized to verify the work
eligibility status of a newly hired employee.
If ARS is an individual or sole proprietorship,the following applies:
1. ARS must complete the United States Citizenship Attestation Form, available on the Department
of Administrative Services website at www.das.state.ne.us.
2. If ARS indicates on such attestation form that he or she is a qualified alien, ARS agrees to
provide the US Citizenship and Immigration Services documentation required to verify ARS's lawful
presence in the United States using the Systematic Alien Verification for Entitlements (SAVE) Program.
3. ARS understands and agrees that lawful presence in the United States is required and ARS may
be disqualified or the contract terminated if such lawful presence cannot be verified as required by Neb.
Rev. Stat. §4-108
IN WITNESS WHEREOF, the signers below have entered this Agreement as of the day first above written.
Alternate Risk Services,L.L.C. City of Omaha,Nebraska
By: JA, , L By: Ng,
ATTEST:
Name: i j f- /1.214 r . Name: Suttle
Title: C25 Title: Mayor
.11 .4 /,„gdy
$ e town, City Clerk
p:\law-city council documents\2011\10046dae.doc
APPR .S TC pR
7 DEPUTY CITY ATTORNEY
S and CLIENT that any and all acts that ARS or its
personnel, employees, agents, contractors, or servants, perform pursuant to the terms of this Agreement
shall be undertaken as independent contractors and not as employees of CLIENT. CLIENT and ARS
shall each act in their individual capacities and not as agents, employees, partners, joint venturers or
associates of the other. An employee or agent of one shall not be deemed or construed to be the
employee or agent of the other for any purpose whatsoever. Neither ARS nor its personnel, employees,
agents, contractors, or servants shall be entitled to any City of Omaha benefits. CLIENT shall not
provide any insurance coverage to ARS or its employees including, but not limited to, workers'
compensation insurance. ARS shall pay all wages, salaries and other amounts due its employees and
shall be responsible for all reports, obligations, and payments pertaining to social security taxation,
income tax withholding, workers' compensation, unemployment compensation, group insurance
coverage, collective bargaining agreements or any other such similar matters. ARS shall have no
authority to bind CLIENT by or with any contract or agreement, nor to impose any liability upon
- 6
ts and take such further action as may be
deemed necessary to more effectively consummate the matters contemplated herein.
5
ttc,n-e_ Ccicri"1t.tSkk!'trt4P 1.. COsy'\
A
ng Allowance,Unit Prices&
Alternates(If applicable). Refer any questions raga dine the Bid or Contract Documents directly to the Park Planning Division a 1,,402.44A-5900 or as noted In the
1 Contract Documents.
I All bidders awarded a contract In the amount of$5,000 or more must comply with the Contract Compliance Ordinance and have on the with the Human Relations Department the Contract
Compliance Report(Form CC-1).This report shalt be in effect for 24 months from the date received by the Human Relations Department Any questions regarding the Contract Compliance
Ordinance or PBEIDEB Listings should be directed to the Human Relations Department at 402.444-5055.
I
�� n r 1�P) .Q,(1. t MC.
(Please Print Legibly or Type) Firm n.Gt�j1 r1u�Yn 11T y te)Incorporated in
Name 6lr i1._Y 1 1 ' 1 , SYYi r '`,, SignatureI -}- Phon )4 s 3-t`Qr wt:��n
FaxOloc2T)453 -a7S
Title I(,�}�(, � ��1
Address • city state Zap
t/P.O.Box
E-Mail Address
74
Terms:
Indemnity Case: any lost time, including permanent or loss of earning ratings
Medical Cases: only requiring medical attention but no lost reportable time
Incident Cases: cases that were reports but did not require any medical attention
There is only one additional fee associated with the workers' compensation program Alternative
Risk Services administers. This is an annual program administration fee of$9,500.00.
This fee covers services outside of the specific claims adjudication duties. This fee allows for a
variety of client services to be performed including:
• Quarterly on-site claim reviews
• On-line access to ARS risk management system, C3
• On-site training session for ARS risk management system, C3
• Required State filings to maintain self insurance capabilities
• Assistance with excess insurance placement
• Report customizations and report design as necessary
• Midwest Managed Case assessments on lost time file
• Annual loss analysis
• Quarterly trending of losses
p:\Iaw-city council documents\2011\10047dae.doc
•
incident case
Alternate monthly flat fee that would include all administrative procedures to process and handle
old and new cases including electronic filing to NWCC for FROI and SROI and to Health and
Human Services (HHS) for Section 111 filings
$8,000.00/mo
1
United States Department of Homeland Security or other federal agency authorized to verify the work
eligibility status of a newly hired employee.
If ARS is an individual or sole proprietorship,the following applies:
1. ARS must complete the United States Citizenship Attestation Form, available on the Department
of Administrative Services website at www.das.state.ne.us.
2. If ARS indicates on such attestation form that he or she is a qualified alien, ARS agrees to
provide the US Citizenship and Immigration Services documentation required to verify ARS's lawful
presence in the United States using the Systematic Alien Verification for Entitlements (SAVE) Program.
3. ARS understands and agrees that lawful presence in the United States is required and ARS may
be disqualified or the contract terminated if such lawful presence cannot be verified as required by Neb.
Rev. Stat. §4-108
IN WITNESS WHEREOF, the signers below have entered this Agreement as of the day first above written.
Alternate Risk Services,L.L.C. City of Omaha,Nebraska
By: JA, , L By: Ng,
ATTEST:
Name: i j f- /1.214 r . Name: Suttle
Title: C25 Title: Mayor
.11 .4 /,„gdy
$ e town, City Clerk
p:\law-city council documents\2011\10046dae.doc
APPR .S TC pR
7 DEPUTY CITY ATTORNEY
S and CLIENT that any and all acts that ARS or its
personnel, employees, agents, contractors, or servants, perform pursuant to the terms of this Agreement
shall be undertaken as independent contractors and not as employees of CLIENT. CLIENT and ARS
shall each act in their individual capacities and not as agents, employees, partners, joint venturers or
associates of the other. An employee or agent of one shall not be deemed or construed to be the
employee or agent of the other for any purpose whatsoever. Neither ARS nor its personnel, employees,
agents, contractors, or servants shall be entitled to any City of Omaha benefits. CLIENT shall not
provide any insurance coverage to ARS or its employees including, but not limited to, workers'
compensation insurance. ARS shall pay all wages, salaries and other amounts due its employees and
shall be responsible for all reports, obligations, and payments pertaining to social security taxation,
income tax withholding, workers' compensation, unemployment compensation, group insurance
coverage, collective bargaining agreements or any other such similar matters. ARS shall have no
authority to bind CLIENT by or with any contract or agreement, nor to impose any liability upon
- 6
ts and take such further action as may be
deemed necessary to more effectively consummate the matters contemplated herein.
5
ttc,n-e_ Ccicri"1t.tSkk!'trt4P 1.. COsy'\
A
ng Allowance,Unit Prices&
Alternates(If applicable). Refer any questions raga dine the Bid or Contract Documents directly to the Park Planning Division a 1,,402.44A-5900 or as noted In the
1 Contract Documents.
I All bidders awarded a contract In the amount of$5,000 or more must comply with the Contract Compliance Ordinance and have on the with the Human Relations Department the Contract
Compliance Report(Form CC-1).This report shalt be in effect for 24 months from the date received by the Human Relations Department Any questions regarding the Contract Compliance
Ordinance or PBEIDEB Listings should be directed to the Human Relations Department at 402.444-5055.
I
�� n r 1�P) .Q,(1. t MC.
(Please Print Legibly or Type) Firm n.Gt�j1 r1u�Yn 11T y te)Incorporated in
Name 6lr i1._Y 1 1 ' 1 , SYYi r '`,, SignatureI -}- Phon )4 s 3-t`Qr wt:��n
FaxOloc2T)453 -a7S
Title I(,�}�(, � ��1
Address • city state Zap
t/P.O.Box
E-Mail Address
74
EXHIBIT B
CITY OF OMAHA, NEBRASKA
REQUEST FOR PROPOSAL
FOR:
THIRD PARTY ADMINISTRATION (TPA) FOR WORK
RELATED INJURIES/ILLNESSES
CLAIMS PROCESSING ONLY
The City of Omaha,Nebraska, is requesting proposals for THIRD PARTY ADMINISTRATION
(TPA)FOR WORK RELATED INJURIES/ILLNESSES—Claims Processing Only.
The attached information summarizes the minimum specifications for the desired services,
materials to be included in the proposal, evaluation criteria, and information relating to the City
experience in this area.
Sealed proposals will be accepted until 11:00 a.m. CST, December 15, 2010, at the City Clerk's
Office in the Omaha/Douglas Civic Center. Proposals should be addressed to:
Buster Brown, City Clerk
Omaha/Douglas Civic Center
1819 Farnam Street,LC-1
Omaha,Nebraska 68183-0011
Those submitting sealed proposals should indicate on the outside of the envelope in the lower
left-hand corner that it is a sealed proposal for the RFP indicated above. The name of the firm
submitting the proposal should also be included on the outside of the envelope. Respondents
must submit one (1) original and four(4) copies of the proposal.
- 1 -
ronic filing to NWCC for FROI and SROI and to Health and
Human Services (HHS) for Section 111 filings
$8,000.00/mo
1
United States Department of Homeland Security or other federal agency authorized to verify the work
eligibility status of a newly hired employee.
If ARS is an individual or sole proprietorship,the following applies:
1. ARS must complete the United States Citizenship Attestation Form, available on the Department
of Administrative Services website at www.das.state.ne.us.
2. If ARS indicates on such attestation form that he or she is a qualified alien, ARS agrees to
provide the US Citizenship and Immigration Services documentation required to verify ARS's lawful
presence in the United States using the Systematic Alien Verification for Entitlements (SAVE) Program.
3. ARS understands and agrees that lawful presence in the United States is required and ARS may
be disqualified or the contract terminated if such lawful presence cannot be verified as required by Neb.
Rev. Stat. §4-108
IN WITNESS WHEREOF, the signers below have entered this Agreement as of the day first above written.
Alternate Risk Services,L.L.C. City of Omaha,Nebraska
By: JA, , L By: Ng,
ATTEST:
Name: i j f- /1.214 r . Name: Suttle
Title: C25 Title: Mayor
.11 .4 /,„gdy
$ e town, City Clerk
p:\law-city council documents\2011\10046dae.doc
APPR .S TC pR
7 DEPUTY CITY ATTORNEY
S and CLIENT that any and all acts that ARS or its
personnel, employees, agents, contractors, or servants, perform pursuant to the terms of this Agreement
shall be undertaken as independent contractors and not as employees of CLIENT. CLIENT and ARS
shall each act in their individual capacities and not as agents, employees, partners, joint venturers or
associates of the other. An employee or agent of one shall not be deemed or construed to be the
employee or agent of the other for any purpose whatsoever. Neither ARS nor its personnel, employees,
agents, contractors, or servants shall be entitled to any City of Omaha benefits. CLIENT shall not
provide any insurance coverage to ARS or its employees including, but not limited to, workers'
compensation insurance. ARS shall pay all wages, salaries and other amounts due its employees and
shall be responsible for all reports, obligations, and payments pertaining to social security taxation,
income tax withholding, workers' compensation, unemployment compensation, group insurance
coverage, collective bargaining agreements or any other such similar matters. ARS shall have no
authority to bind CLIENT by or with any contract or agreement, nor to impose any liability upon
- 6
ts and take such further action as may be
deemed necessary to more effectively consummate the matters contemplated herein.
5
ttc,n-e_ Ccicri"1t.tSkk!'trt4P 1.. COsy'\
A
ng Allowance,Unit Prices&
Alternates(If applicable). Refer any questions raga dine the Bid or Contract Documents directly to the Park Planning Division a 1,,402.44A-5900 or as noted In the
1 Contract Documents.
I All bidders awarded a contract In the amount of$5,000 or more must comply with the Contract Compliance Ordinance and have on the with the Human Relations Department the Contract
Compliance Report(Form CC-1).This report shalt be in effect for 24 months from the date received by the Human Relations Department Any questions regarding the Contract Compliance
Ordinance or PBEIDEB Listings should be directed to the Human Relations Department at 402.444-5055.
I
�� n r 1�P) .Q,(1. t MC.
(Please Print Legibly or Type) Firm n.Gt�j1 r1u�Yn 11T y te)Incorporated in
Name 6lr i1._Y 1 1 ' 1 , SYYi r '`,, SignatureI -}- Phon )4 s 3-t`Qr wt:��n
FaxOloc2T)453 -a7S
Title I(,�}�(, � ��1
Address • city state Zap
t/P.O.Box
E-Mail Address
74
REQUEST FOR PROPOSALS
I. THIRD PARTY ADMINISTRATION (TPA)
INDEX
Statement of Purpose 3
A. General Information 3
Rate Guarantee Period 3
Specifications 3
Eligibility to Submit a Proposal 4
Proposal Submission 4
Background Information 5
Evaluation Criteria 6
Selection Process 6
Contract Period 6
B. Required Services 8
General Provisions 8
TPA Services Provider Questionnaire 10
I. General/Account Management 10
II. Claim Administration 10
Fee Proposal Sheet 12
Exhibits 13
1. Employee Census revised
2. Number of Claims 2009, September 2010
3. Section 23-371 of the Omaha Municipal Code
4. Article 30 of the Civilian Bargaining Unit Contract
5. Article 24 of the Police Union Contract
6. Article 21 of the Fire Union Contract
- 2 -
icated above. The name of the firm
submitting the proposal should also be included on the outside of the envelope. Respondents
must submit one (1) original and four(4) copies of the proposal.
- 1 -
ronic filing to NWCC for FROI and SROI and to Health and
Human Services (HHS) for Section 111 filings
$8,000.00/mo
1
United States Department of Homeland Security or other federal agency authorized to verify the work
eligibility status of a newly hired employee.
If ARS is an individual or sole proprietorship,the following applies:
1. ARS must complete the United States Citizenship Attestation Form, available on the Department
of Administrative Services website at www.das.state.ne.us.
2. If ARS indicates on such attestation form that he or she is a qualified alien, ARS agrees to
provide the US Citizenship and Immigration Services documentation required to verify ARS's lawful
presence in the United States using the Systematic Alien Verification for Entitlements (SAVE) Program.
3. ARS understands and agrees that lawful presence in the United States is required and ARS may
be disqualified or the contract terminated if such lawful presence cannot be verified as required by Neb.
Rev. Stat. §4-108
IN WITNESS WHEREOF, the signers below have entered this Agreement as of the day first above written.
Alternate Risk Services,L.L.C. City of Omaha,Nebraska
By: JA, , L By: Ng,
ATTEST:
Name: i j f- /1.214 r . Name: Suttle
Title: C25 Title: Mayor
.11 .4 /,„gdy
$ e town, City Clerk
p:\law-city council documents\2011\10046dae.doc
APPR .S TC pR
7 DEPUTY CITY ATTORNEY
S and CLIENT that any and all acts that ARS or its
personnel, employees, agents, contractors, or servants, perform pursuant to the terms of this Agreement
shall be undertaken as independent contractors and not as employees of CLIENT. CLIENT and ARS
shall each act in their individual capacities and not as agents, employees, partners, joint venturers or
associates of the other. An employee or agent of one shall not be deemed or construed to be the
employee or agent of the other for any purpose whatsoever. Neither ARS nor its personnel, employees,
agents, contractors, or servants shall be entitled to any City of Omaha benefits. CLIENT shall not
provide any insurance coverage to ARS or its employees including, but not limited to, workers'
compensation insurance. ARS shall pay all wages, salaries and other amounts due its employees and
shall be responsible for all reports, obligations, and payments pertaining to social security taxation,
income tax withholding, workers' compensation, unemployment compensation, group insurance
coverage, collective bargaining agreements or any other such similar matters. ARS shall have no
authority to bind CLIENT by or with any contract or agreement, nor to impose any liability upon
- 6
ts and take such further action as may be
deemed necessary to more effectively consummate the matters contemplated herein.
5
ttc,n-e_ Ccicri"1t.tSkk!'trt4P 1.. COsy'\
A
ng Allowance,Unit Prices&
Alternates(If applicable). Refer any questions raga dine the Bid or Contract Documents directly to the Park Planning Division a 1,,402.44A-5900 or as noted In the
1 Contract Documents.
I All bidders awarded a contract In the amount of$5,000 or more must comply with the Contract Compliance Ordinance and have on the with the Human Relations Department the Contract
Compliance Report(Form CC-1).This report shalt be in effect for 24 months from the date received by the Human Relations Department Any questions regarding the Contract Compliance
Ordinance or PBEIDEB Listings should be directed to the Human Relations Department at 402.444-5055.
I
�� n r 1�P) .Q,(1. t MC.
(Please Print Legibly or Type) Firm n.Gt�j1 r1u�Yn 11T y te)Incorporated in
Name 6lr i1._Y 1 1 ' 1 , SYYi r '`,, SignatureI -}- Phon )4 s 3-t`Qr wt:��n
FaxOloc2T)453 -a7S
Title I(,�}�(, � ��1
Address • city state Zap
t/P.O.Box
E-Mail Address
74
STATEMENT OF PURPOSE
The City of Omaha is soliciting proposals to provide, effective March 1, 2011, administrative
services necessary to provide Third Party Administrative (TPA) services for claims processing
only of work related injuries or illnesses, and to coordinate with current case management/bill
review program.
The proposing company must understand that the City of Omaha has the right to reject any or all
proposals. The City and selected administrator will enter into a contract with the approval of the
City Council.
Responses to this RFP are public records pursuant to Section 84-712 through 84-712.09 R.R.S.
1943. Subject to compliance with Section 48-712.05 R.S. Supp. 1998, the City will maintain in
confidence that information in the responses which is identified by responders as proprietary or
commercial information which, if released, would give advantage to business competitors and
serve no public purpose.
A. GENERAL INFORMATION
Rate Guarantee Period
The proposed contract will be for a minimum of the following period:
March 1, 2011 —December 31, 2011
In addition, the City, in its sole discretion and dependent upon the selected TPA provider's
performance of service to City in 2011, may offer one-year extensions for the periods:
January 1, 2012—December 31, 2012, and
January 1, 2013 —December 31, 2013
Specifications
Request for clarification or questions concerning this RFP must be submitted via emailed to Paul
Murphy at pmurphy@ci.omaha.ne.us by 4:00p.m. CST,November 29, 2010.
Responses to questions will be published as an addendum by December 3, 2010 on the Douglas
County Purchasing Department's web site at www.douglascountypurchasing.org
All proposals must conform to the specifications identified within this RFP. Each proposal shall
include, at a minimum, any and all descriptive matter setting forth the manner and method it
would intend to accomplish the specific program being proposed.
In order to better evaluate all proposals submitted,the City of Omaha may retain an outside party
to review and compare said information and assist the City in making a decision regarding the
rewarding of this contract.
- 3 -
if such lawful presence cannot be verified as required by Neb.
Rev. Stat. §4-108
IN WITNESS WHEREOF, the signers below have entered this Agreement as of the day first above written.
Alternate Risk Services,L.L.C. City of Omaha,Nebraska
By: JA, , L By: Ng,
ATTEST:
Name: i j f- /1.214 r . Name: Suttle
Title: C25 Title: Mayor
.11 .4 /,„gdy
$ e town, City Clerk
p:\law-city council documents\2011\10046dae.doc
APPR .S TC pR
7 DEPUTY CITY ATTORNEY
S and CLIENT that any and all acts that ARS or its
personnel, employees, agents, contractors, or servants, perform pursuant to the terms of this Agreement
shall be undertaken as independent contractors and not as employees of CLIENT. CLIENT and ARS
shall each act in their individual capacities and not as agents, employees, partners, joint venturers or
associates of the other. An employee or agent of one shall not be deemed or construed to be the
employee or agent of the other for any purpose whatsoever. Neither ARS nor its personnel, employees,
agents, contractors, or servants shall be entitled to any City of Omaha benefits. CLIENT shall not
provide any insurance coverage to ARS or its employees including, but not limited to, workers'
compensation insurance. ARS shall pay all wages, salaries and other amounts due its employees and
shall be responsible for all reports, obligations, and payments pertaining to social security taxation,
income tax withholding, workers' compensation, unemployment compensation, group insurance
coverage, collective bargaining agreements or any other such similar matters. ARS shall have no
authority to bind CLIENT by or with any contract or agreement, nor to impose any liability upon
- 6
ts and take such further action as may be
deemed necessary to more effectively consummate the matters contemplated herein.
5
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A
ng Allowance,Unit Prices&
Alternates(If applicable). Refer any questions raga dine the Bid or Contract Documents directly to the Park Planning Division a 1,,402.44A-5900 or as noted In the
1 Contract Documents.
I All bidders awarded a contract In the amount of$5,000 or more must comply with the Contract Compliance Ordinance and have on the with the Human Relations Department the Contract
Compliance Report(Form CC-1).This report shalt be in effect for 24 months from the date received by the Human Relations Department Any questions regarding the Contract Compliance
Ordinance or PBEIDEB Listings should be directed to the Human Relations Department at 402.444-5055.
I
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Eligibility to Submit a Proposal
Your company must meet the following requirements as of November 1, 2010 in order to be
considered:
1. Have five (5) or more years experience in administering and processing workers
compensation benefits.
2. The contract, if awarded to your organization, cannot represent more than 20% of
your total volume of workers compensation business, measured on a ratio of covered
employees.
3. Have an office or an individual in Nebraska, which is authorized to receive any legal
process or notices pursuant to this contract.
4. Have an Affirmative Action Compliance Report (Form CC-1) on file with the Human
Rights &Relations Department, City of Omaha.
5. Must have a local office in Omaha or a WATS line available for City of Omaha
administrative staff or employees to call by March 1, 2011 for assistance on claims
and general information.
Proposal Submission
A TPA Services Provider may submit only one proposal.
In addition to the fee proposal sheet, each TPA Services Provider shall submit, as part of its
response to the request for proposal, a narrative description of the manner and method it
proposes to use to accomplish the requirements contained herein, including, but not limited to: a
response to each of the inquiries in the TPA Services Provider Questionnaire and a statement of
the information and/or assistance needed from the City of Omaha to implement the proposal.
The fee proposal sheet, narrative response, and any additional information that is provided shall
be bound and considered a portion of the agreement between the parties if selected. One (1)
original and four (4) copies of the bound proposal shall be submitted. This document shall be
considered as the TPA Services Provider's complete proposal.
To the extent permitted by law, the City will consider the TPA Services to be professional
services and reserves the right to negotiate with the finalists on their fee structures to insure that
the City is receiving the lowest and best rates.
All proposals must be sealed and forwarded to:
Clerk of the City of Omaha
Omaha/Douglas Civic Center,Room LC-1
1819 Farnam Street
Omaha,NE 68183.
The envelope/container containing your proposal must be plainly marked and identified as
"Response to Request for Proposals —Workers' Compensation TPA" and must be received in the
City Clerk's Office no later than 11:00 a.m. Central Standard Time on December 15, 2010.
-4 -
ATTEST:
Name: i j f- /1.214 r . Name: Suttle
Title: C25 Title: Mayor
.11 .4 /,„gdy
$ e town, City Clerk
p:\law-city council documents\2011\10046dae.doc
APPR .S TC pR
7 DEPUTY CITY ATTORNEY
S and CLIENT that any and all acts that ARS or its
personnel, employees, agents, contractors, or servants, perform pursuant to the terms of this Agreement
shall be undertaken as independent contractors and not as employees of CLIENT. CLIENT and ARS
shall each act in their individual capacities and not as agents, employees, partners, joint venturers or
associates of the other. An employee or agent of one shall not be deemed or construed to be the
employee or agent of the other for any purpose whatsoever. Neither ARS nor its personnel, employees,
agents, contractors, or servants shall be entitled to any City of Omaha benefits. CLIENT shall not
provide any insurance coverage to ARS or its employees including, but not limited to, workers'
compensation insurance. ARS shall pay all wages, salaries and other amounts due its employees and
shall be responsible for all reports, obligations, and payments pertaining to social security taxation,
income tax withholding, workers' compensation, unemployment compensation, group insurance
coverage, collective bargaining agreements or any other such similar matters. ARS shall have no
authority to bind CLIENT by or with any contract or agreement, nor to impose any liability upon
- 6
ts and take such further action as may be
deemed necessary to more effectively consummate the matters contemplated herein.
5
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A
ng Allowance,Unit Prices&
Alternates(If applicable). Refer any questions raga dine the Bid or Contract Documents directly to the Park Planning Division a 1,,402.44A-5900 or as noted In the
1 Contract Documents.
I All bidders awarded a contract In the amount of$5,000 or more must comply with the Contract Compliance Ordinance and have on the with the Human Relations Department the Contract
Compliance Report(Form CC-1).This report shalt be in effect for 24 months from the date received by the Human Relations Department Any questions regarding the Contract Compliance
Ordinance or PBEIDEB Listings should be directed to the Human Relations Department at 402.444-5055.
I
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The Cityof Omaha expressly reserves the right to anyand all proposals.
p Y g reject p P
Only proposals received at the location and within the time frame described herein shall be
considered.
All proposals received in response to this request for proposals shall become the property of the
City of Omaha and shall be retained on file.
Receipt of a proposal by the City does not, in and of itself, constitute a contract with the City and
the City accepts no responsibility or liability for any cost incurred in the preparation and/or
submission of such proposal.
Please insure that your proposal incorporates complete answers to all questions in the Proposal
Specification Questionnaire section of this RFP so that your proposed services and methods of
procedure can be adequately evaluated by the City of Omaha.
Background Information
The City of Omaha has, for over 40 years, been a self-insured/self administered employer. Since
1996 the City has utilized a certified managed care plan as set out by the Nebraska Workers'
Compensation Act, hereinafter,the "Act".
Currently, all claims for work related injuries and/or illnesses by City employees are submitted
to the Benefits Division, Human Resources Department for approval or denial. Employees
whose claims are approved also qualify for the benefits under the City's Injured on Duty
ordinances. (See attached provisions of the City's collective bargaining unit contracts and
Municipal Code, Exhibits 5-8). These ordinances and contract provisions provide for the
continuation of full pay for up to one year, depending on Union Contract, in lieu of temporary
total disability benefits pursuant to the Act. Currently, indemnity payments required by the Act
and Injured on Duty pay are calculated, processed and paid by the Benefits Division and City
Finance Department.
Currently, medical bills relating to the injury or illnesses are processed by OHARA Managed
Care, a certified managed care plan approved by the Nebraska Workers' Compensation Court,
with whom the City contracts. The City pays OHARA for such medical bill costs on a weekly
basis, with OHARA then submitting payments to the appropriate providers. The contract with
OHARA for case management and bill review has been extended for the 2011 calendar year.
Over the last twenty years the City of Omaha has taken an aggressive approach on returning
employees to work by having Limited Duty available. All City of Omaha Departments and their
Divisions support the Limited Duty Program, even where the initial return to work includes
restrictions. The Division in which the employee was employed at the time of the injury has first
option to utilize the employee on limited duty. If the Division is unable to use the employee
within the specified restrictions, the employee's Department has the next option. Finally, if the
employee is unable to be placed within the Department, placement in other Departments will be
reviewed. Please note that injured uniform employees in the Police and Fire Departments are not
placed in Civilian positions at the present time. While an employee is on limited duty status, the
employee's salary rate remains the same as if he/she was working full time without restrictions.
- 5 -
yee or agent of the other for any purpose whatsoever. Neither ARS nor its personnel, employees,
agents, contractors, or servants shall be entitled to any City of Omaha benefits. CLIENT shall not
provide any insurance coverage to ARS or its employees including, but not limited to, workers'
compensation insurance. ARS shall pay all wages, salaries and other amounts due its employees and
shall be responsible for all reports, obligations, and payments pertaining to social security taxation,
income tax withholding, workers' compensation, unemployment compensation, group insurance
coverage, collective bargaining agreements or any other such similar matters. ARS shall have no
authority to bind CLIENT by or with any contract or agreement, nor to impose any liability upon
- 6
ts and take such further action as may be
deemed necessary to more effectively consummate the matters contemplated herein.
5
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A
ng Allowance,Unit Prices&
Alternates(If applicable). Refer any questions raga dine the Bid or Contract Documents directly to the Park Planning Division a 1,,402.44A-5900 or as noted In the
1 Contract Documents.
I All bidders awarded a contract In the amount of$5,000 or more must comply with the Contract Compliance Ordinance and have on the with the Human Relations Department the Contract
Compliance Report(Form CC-1).This report shalt be in effect for 24 months from the date received by the Human Relations Department Any questions regarding the Contract Compliance
Ordinance or PBEIDEB Listings should be directed to the Human Relations Department at 402.444-5055.
I
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Periodic (at least monthly) meetings are held between the Workers' Compensation Coordinator,
Case Manager and various City supervisors to review active cases to determine current status and
what avenues are available to resolve issues arising from said cases, with daily phone contact
occurring between scheduled meetings.
Evaluation Criteria
A committee of individuals representing the City of Omaha will perform evaluation of the
proposals received. The evaluation committee based on below criteria, including but not limited
to, will make the recommendation of a TPA Services Provider(s):
1) Cost quoted by the TPA Services Provider;
2) Performance/service ability, in conjunction with performance guarantees;
3) Experience and ability of the TPA Services Provider to provide requested
services; and,
4) Comprehensiveness of proposal with emphasis on the degree of specifics offered.
Selection Process
The committee will initially assess the TPA Services Providers proposal to insure compliance
with the requirements of this RFP. If proposals do not conform to this RFP or they appear
significantly higher than the other proposals, those companies will be advised that their proposals
will no longer be considered. Interviews, on the remaining proposals, will be held as deemed
necessary by the evaluation committee. TPA Services Providers agree to be available for
interviews or presentations at times mutually convenient to the City and TPA Services Providers.
The Committee will make a final determination and make a recommendation to the Mayor
regarding the selection of the TPA Services Provider.
Subject to the Mayor's approval, an agreement will be prepared with the selected TPA Services
Provider.
of all necessarycontracts and documents, the agreement with the
Upon completiongr
recommended TPA Services Provider will be submitted to the City Council for approval.
Contract Period
The proposed contract term for the Program is ten months, effective March 1, 2011 through
December 31, 2011 with two (2) one year options, at the City's sole discretion, to renew said
contract after December 31, 2011, with the approval of the City Council. All fee proposals must
result in a thirty-four(34)month, March 1, 2011—December 31, 2013, period of guaranteed rates
and, if possible, a yearly cap.
The TPA Services Provider will be required to process claims received on or after March 1,
2011, by the City from any employee whether or not claim arises on or after such date. In
addition, claims for indemnity and/or medical only claims incurred prior to March 1, 2011 will
be the responsibility of the successful TPA Services Provider.
- 6 -
to use the employee
within the specified restrictions, the employee's Department has the next option. Finally, if the
employee is unable to be placed within the Department, placement in other Departments will be
reviewed. Please note that injured uniform employees in the Police and Fire Departments are not
placed in Civilian positions at the present time. While an employee is on limited duty status, the
employee's salary rate remains the same as if he/she was working full time without restrictions.
- 5 -
yee or agent of the other for any purpose whatsoever. Neither ARS nor its personnel, employees,
agents, contractors, or servants shall be entitled to any City of Omaha benefits. CLIENT shall not
provide any insurance coverage to ARS or its employees including, but not limited to, workers'
compensation insurance. ARS shall pay all wages, salaries and other amounts due its employees and
shall be responsible for all reports, obligations, and payments pertaining to social security taxation,
income tax withholding, workers' compensation, unemployment compensation, group insurance
coverage, collective bargaining agreements or any other such similar matters. ARS shall have no
authority to bind CLIENT by or with any contract or agreement, nor to impose any liability upon
- 6
ts and take such further action as may be
deemed necessary to more effectively consummate the matters contemplated herein.
5
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ng Allowance,Unit Prices&
Alternates(If applicable). Refer any questions raga dine the Bid or Contract Documents directly to the Park Planning Division a 1,,402.44A-5900 or as noted In the
1 Contract Documents.
I All bidders awarded a contract In the amount of$5,000 or more must comply with the Contract Compliance Ordinance and have on the with the Human Relations Department the Contract
Compliance Report(Form CC-1).This report shalt be in effect for 24 months from the date received by the Human Relations Department Any questions regarding the Contract Compliance
Ordinance or PBEIDEB Listings should be directed to the Human Relations Department at 402.444-5055.
I
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TPA Services Provider will need to coordinate with OHARA Managed Care on medical case
management of open claims during 2011.
- 7 -
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C. REQUIRED SERVICES
General Provisions
Your proposal shall be expressed as a dollar amount per injured employee for indemnity,
medical only or incident claims for each requested period identified. The term indemnity in these
provisions relates to temporary total, along with any permanent ratings including loss of earnings
(LOE). If there are any additional costs besides the cost per claim, said charges must be
summarized, and fully itemized in the fee section of your proposal.
The successful administrator will be required to process any and all-new claims incurred on or
after March 1, 2011. In addition, any on going claims incurred prior to March 1, 2011 that
remain open will be the responsibility of the vender awarded this contract. If there is a different
charge for these older claims, please identify the cost per injury in relationship to indemnity,
and/or medical.
The proposed fees are to include all of the services required by the Act and the rules of the
Nebraska Workers' Compensation Court, including, but not limited to:
1. Preparation of an agreement outlining the responsibilities of all parties. Both the City of
Omaha and the TPA Services Provider will mutually agree on the contents of this
agreement.
2. Preparation and distribution of all forms or development of websites or software for
electronic notification sites, which TPA Services Provider will require to receive claims
and all forms for information needed to determine compensability.
3. Review and processing of all alleged work related injuries, including investigation as
deemed necessary, acquisition, review and compilation of medical records, and review
with the appropriate representatives from the City of Omaha, and/or managed care
program contracted with the City of Omaha.
4. Maintenance of records necessary to substantiate the determination and action taken on a
work related injury or illness claim. The City shall have the right to audit all such records
at mutually agreeable times and places.
5. Preparation of reports, in a form and frequency acceptable to the City, which shall
include,but not limited to,the following information:
• Bi weekly reports to City indicating the periods, dates and/or hours, indemnity
type, and dollar amounts of indemnity each injured/ill employee whose claim has
been determined to be compensable and entitled to be paid.
• A file showing a recap of each incurred claim for each injured/ill employee.
• Department/Division experience report.
• An inquiry report, which would show the types of inquiries being asked of the
TPA Services Provider by City of Omaha injured employees.
• Report on specific cases, as required
- 8 -
in the specified restrictions, the employee's Department has the next option. Finally, if the
employee is unable to be placed within the Department, placement in other Departments will be
reviewed. Please note that injured uniform employees in the Police and Fire Departments are not
placed in Civilian positions at the present time. While an employee is on limited duty status, the
employee's salary rate remains the same as if he/she was working full time without restrictions.
- 5 -
yee or agent of the other for any purpose whatsoever. Neither ARS nor its personnel, employees,
agents, contractors, or servants shall be entitled to any City of Omaha benefits. CLIENT shall not
provide any insurance coverage to ARS or its employees including, but not limited to, workers'
compensation insurance. ARS shall pay all wages, salaries and other amounts due its employees and
shall be responsible for all reports, obligations, and payments pertaining to social security taxation,
income tax withholding, workers' compensation, unemployment compensation, group insurance
coverage, collective bargaining agreements or any other such similar matters. ARS shall have no
authority to bind CLIENT by or with any contract or agreement, nor to impose any liability upon
- 6
ts and take such further action as may be
deemed necessary to more effectively consummate the matters contemplated herein.
5
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A
ng Allowance,Unit Prices&
Alternates(If applicable). Refer any questions raga dine the Bid or Contract Documents directly to the Park Planning Division a 1,,402.44A-5900 or as noted In the
1 Contract Documents.
I All bidders awarded a contract In the amount of$5,000 or more must comply with the Contract Compliance Ordinance and have on the with the Human Relations Department the Contract
Compliance Report(Form CC-1).This report shalt be in effect for 24 months from the date received by the Human Relations Department Any questions regarding the Contract Compliance
Ordinance or PBEIDEB Listings should be directed to the Human Relations Department at 402.444-5055.
I
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74
• Year-end report of total payments, by indemnity category on a per injury and
citywide basis.
6. Provide properly trained personnel to educate City of Omaha employees about the TPA
Services, initially and periodically, as requested by the City throughout the contract term.
7. Ability to provide records in an acceptable format, for the City to review denial of
compensability under the Act. This would generally include records relating to
investigation of the accident and injury, medical history, physical examination, results,
diagnosis and/or diagnostic results.
8. Provision for access and/or copies of records and related information as deemed
appropriate by the City after the duration of the contract expires for up to seven(7) years.
This provision can be accomplished by permitting access to said files and/or records at
the contractor's place of business.
9. Electronic submission of the necessary records and information required under Section
111 of the Medicare, Medicaid and SCHIP Extension Act of 2007.
10. Electronic submission of the necessary information for the First Reports of Injury (FROI)
and Subsequent Reports of Injury(SROI) reports.
- 9 -
reement.
2. Preparation and distribution of all forms or development of websites or software for
electronic notification sites, which TPA Services Provider will require to receive claims
and all forms for information needed to determine compensability.
3. Review and processing of all alleged work related injuries, including investigation as
deemed necessary, acquisition, review and compilation of medical records, and review
with the appropriate representatives from the City of Omaha, and/or managed care
program contracted with the City of Omaha.
4. Maintenance of records necessary to substantiate the determination and action taken on a
work related injury or illness claim. The City shall have the right to audit all such records
at mutually agreeable times and places.
5. Preparation of reports, in a form and frequency acceptable to the City, which shall
include,but not limited to,the following information:
• Bi weekly reports to City indicating the periods, dates and/or hours, indemnity
type, and dollar amounts of indemnity each injured/ill employee whose claim has
been determined to be compensable and entitled to be paid.
• A file showing a recap of each incurred claim for each injured/ill employee.
• Department/Division experience report.
• An inquiry report, which would show the types of inquiries being asked of the
TPA Services Provider by City of Omaha injured employees.
• Report on specific cases, as required
- 8 -
in the specified restrictions, the employee's Department has the next option. Finally, if the
employee is unable to be placed within the Department, placement in other Departments will be
reviewed. Please note that injured uniform employees in the Police and Fire Departments are not
placed in Civilian positions at the present time. While an employee is on limited duty status, the
employee's salary rate remains the same as if he/she was working full time without restrictions.
- 5 -
yee or agent of the other for any purpose whatsoever. Neither ARS nor its personnel, employees,
agents, contractors, or servants shall be entitled to any City of Omaha benefits. CLIENT shall not
provide any insurance coverage to ARS or its employees including, but not limited to, workers'
compensation insurance. ARS shall pay all wages, salaries and other amounts due its employees and
shall be responsible for all reports, obligations, and payments pertaining to social security taxation,
income tax withholding, workers' compensation, unemployment compensation, group insurance
coverage, collective bargaining agreements or any other such similar matters. ARS shall have no
authority to bind CLIENT by or with any contract or agreement, nor to impose any liability upon
- 6
ts and take such further action as may be
deemed necessary to more effectively consummate the matters contemplated herein.
5
ttc,n-e_ Ccicri"1t.tSkk!'trt4P 1.. COsy'\
A
ng Allowance,Unit Prices&
Alternates(If applicable). Refer any questions raga dine the Bid or Contract Documents directly to the Park Planning Division a 1,,402.44A-5900 or as noted In the
1 Contract Documents.
I All bidders awarded a contract In the amount of$5,000 or more must comply with the Contract Compliance Ordinance and have on the with the Human Relations Department the Contract
Compliance Report(Form CC-1).This report shalt be in effect for 24 months from the date received by the Human Relations Department Any questions regarding the Contract Compliance
Ordinance or PBEIDEB Listings should be directed to the Human Relations Department at 402.444-5055.
I
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Address • city state Zap
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74
TPA Services Provider Questionnaire
All questions in the TPA Services Provider Questionnaire must be fully answered in order for
your proposal to be evaluated. A failure to respond completely and in detail will be cause for
your proposal to be rejected.
General/Account Management
A. State the names and titles of those individuals who will be involved in the day-to-day
administration of the Program. Specify in detail his/her background in TPA services,
specifically for workers' compensation. How will this administration of claims be
distributed to these individuals?
B. Provide at least three (3) references of current clients that are similar in size with
the City of Omaha, including: Company name and address, contact person, email address,
phone number, number of employees, type of program in place, and length of service
with your program. If you are working with any municipality, especially in Nebraska,
please provide similar information.
D. What specific records and other information do you need from the City of Omaha for
conversion of this program for your company to starting administering claims as of
March 1, 2011?
E. Since many City employees work in positions involving various shifts outside the 8 am-5
pm timeframe, explain how your company will need to be notified during hours outside
the 8 am -5 pm time frame and how your company will respond during such time frame?
F. How will emergency cases be handled?
G. State the name of the Electronic Data Interchange (EDI) company that you use to file
First Reports of Injury (FROI) and Subsequent Reports of Injury (SROI) reports. Will
any associated cost be passed on to the City; if so what will be the cost associated with
each transmission? In addition, state the name of the company used for mandatory
reporting requirements of Section 111 of the Medicare, Medicaid and SCHIP Extension
Act of 2007, and the cost, if any, associated with each quarterly submission.
II. Claim Administration
A. State whether your company is able to provide to the City of Omaha an electronic file
every other Monday to the City's Payroll Division on indemnity claims that need to be
paid for the last two weeks. The City does not expect your company to issue indemnity
checks, but forward the appropriate information to the Payroll Division in order that the
Payroll Division can appropriately pay the employee through the City's bi-weekly direct
deposit payroll system.
B. Identify the records, which would belong to the City of Omaha upon contract termination
and the form in which such records would be available. State whether the City of Omaha
- 10 -
Report on specific cases, as required
- 8 -
in the specified restrictions, the employee's Department has the next option. Finally, if the
employee is unable to be placed within the Department, placement in other Departments will be
reviewed. Please note that injured uniform employees in the Police and Fire Departments are not
placed in Civilian positions at the present time. While an employee is on limited duty status, the
employee's salary rate remains the same as if he/she was working full time without restrictions.
- 5 -
yee or agent of the other for any purpose whatsoever. Neither ARS nor its personnel, employees,
agents, contractors, or servants shall be entitled to any City of Omaha benefits. CLIENT shall not
provide any insurance coverage to ARS or its employees including, but not limited to, workers'
compensation insurance. ARS shall pay all wages, salaries and other amounts due its employees and
shall be responsible for all reports, obligations, and payments pertaining to social security taxation,
income tax withholding, workers' compensation, unemployment compensation, group insurance
coverage, collective bargaining agreements or any other such similar matters. ARS shall have no
authority to bind CLIENT by or with any contract or agreement, nor to impose any liability upon
- 6
ts and take such further action as may be
deemed necessary to more effectively consummate the matters contemplated herein.
5
ttc,n-e_ Ccicri"1t.tSkk!'trt4P 1.. COsy'\
A
ng Allowance,Unit Prices&
Alternates(If applicable). Refer any questions raga dine the Bid or Contract Documents directly to the Park Planning Division a 1,,402.44A-5900 or as noted In the
1 Contract Documents.
I All bidders awarded a contract In the amount of$5,000 or more must comply with the Contract Compliance Ordinance and have on the with the Human Relations Department the Contract
Compliance Report(Form CC-1).This report shalt be in effect for 24 months from the date received by the Human Relations Department Any questions regarding the Contract Compliance
Ordinance or PBEIDEB Listings should be directed to the Human Relations Department at 402.444-5055.
I
�� n r 1�P) .Q,(1. t MC.
(Please Print Legibly or Type) Firm n.Gt�j1 r1u�Yn 11T y te)Incorporated in
Name 6lr i1._Y 1 1 ' 1 , SYYi r '`,, SignatureI -}- Phon )4 s 3-t`Qr wt:��n
FaxOloc2T)453 -a7S
Title I(,�}�(, � ��1
Address • city state Zap
t/P.O.Box
E-Mail Address
74
would be charged for transmission of such records to the City or the new TPA Services
Provider.
C. State whether, and if so, for what period, you will keep detailed individual claim histories
on line. State how you will store and retrieve claim histories beyond this time. State how
long you will keep "hard copy" claim records.
D. What paid accumulations will be maintained online for individual cases and/or overall
payments per year?
E. Would the City have online access to this information?
F. How do claim auditors flag a possible pre-existing condition? What steps are taken to
verify a pre-existing condition? How do you address an aggravation to a preexisting
medical condition?
G. Can claims information be broken down into various departments for reporting purposes?
H. What cost is there for any ad hoc reports?
- 11 -
c
J O CO t a. c
H CI ti 0 C-
FEE PROPOSAL SHEET
March 1, 2011 through December 31, 2011
New cases (Injuries incurred on or after March 1, 2011)
$ per indemnity case
$ per medical case
$ per incident case
Old cases (Injuries incurred prior to March 1, 2011)
$ per indemnity case
$ per medical case
$ per incident case
Fee, if any separate charge, for electronic filing to NWCC for FROI and SROI and to
Health and Human Services (HHS) for Section 111 filings $
Alternate monthly flat fee that would include all administrative procedures to process and handle
old and new cases including electronic filing to NWCC for FROI and SROI and to Health and
Human Services (HHS) for Section 111 filings $
January 1, 2012,to December 31, 2012 $ per indemnity case
$ per medical case
$ per incident case
Alternate monthly flat fee that would include all administrative procedures to process and handle
old and new cases including electronic filing to NWCC for FROI and SROI and to Health and
Human Services (HHS) for Section 111 filings $
January 1, 2013,to December 31, 2013 $ per indemnity case
$ per medical case
$ per incident case
•
Alternate monthly flat fee that would include all administrative procedures to process and handle
old and new cases including electronic filing to NWCC for FROI and SROI and to Health and
Human Services (HHS) for Section 111 filings $
Terms:
Indemnity Case: any lost time, including permanent or loss of earning ratings
Medical Cases: only requiring medical attention but no lost reportable time
Incident Cases: cases that were reported but did not require any medical attention
Additional Fees:
- 12 -
ed for mandatory
reporting requirements of Section 111 of the Medicare, Medicaid and SCHIP Extension
Act of 2007, and the cost, if any, associated with each quarterly submission.
II. Claim Administration
A. State whether your company is able to provide to the City of Omaha an electronic file
every other Monday to the City's Payroll Division on indemnity claims that need to be
paid for the last two weeks. The City does not expect your company to issue indemnity
checks, but forward the appropriate information to the Payroll Division in order that the
Payroll Division can appropriately pay the employee through the City's bi-weekly direct
deposit payroll system.
B. Identify the records, which would belong to the City of Omaha upon contract termination
and the form in which such records would be available. State whether the City of Omaha
- 10 -
Report on specific cases, as required
- 8 -
in the specified restrictions, the employee's Department has the next option. Finally, if the
employee is unable to be placed within the Department, placement in other Departments will be
reviewed. Please note that injured uniform employees in the Police and Fire Departments are not
placed in Civilian positions at the present time. While an employee is on limited duty status, the
employee's salary rate remains the same as if he/she was working full time without restrictions.
- 5 -
yee or agent of the other for any purpose whatsoever. Neither ARS nor its personnel, employees,
agents, contractors, or servants shall be entitled to any City of Omaha benefits. CLIENT shall not
provide any insurance coverage to ARS or its employees including, but not limited to, workers'
compensation insurance. ARS shall pay all wages, salaries and other amounts due its employees and
shall be responsible for all reports, obligations, and payments pertaining to social security taxation,
income tax withholding, workers' compensation, unemployment compensation, group insurance
coverage, collective bargaining agreements or any other such similar matters. ARS shall have no
authority to bind CLIENT by or with any contract or agreement, nor to impose any liability upon
- 6
ts and take such further action as may be
deemed necessary to more effectively consummate the matters contemplated herein.
5
ttc,n-e_ Ccicri"1t.tSkk!'trt4P 1.. COsy'\
A
ng Allowance,Unit Prices&
Alternates(If applicable). Refer any questions raga dine the Bid or Contract Documents directly to the Park Planning Division a 1,,402.44A-5900 or as noted In the
1 Contract Documents.
I All bidders awarded a contract In the amount of$5,000 or more must comply with the Contract Compliance Ordinance and have on the with the Human Relations Department the Contract
Compliance Report(Form CC-1).This report shalt be in effect for 24 months from the date received by the Human Relations Department Any questions regarding the Contract Compliance
Ordinance or PBEIDEB Listings should be directed to the Human Relations Department at 402.444-5055.
I
�� n r 1�P) .Q,(1. t MC.
(Please Print Legibly or Type) Firm n.Gt�j1 r1u�Yn 11T y te)Incorporated in
Name 6lr i1._Y 1 1 ' 1 , SYYi r '`,, SignatureI -}- Phon )4 s 3-t`Qr wt:��n
FaxOloc2T)453 -a7S
Title I(,�}�(, � ��1
Address • city state Zap
t/P.O.Box
E-Mail Address
74
Specify any costs, other than the above listed per case fee that your organization would charge
the City of Omaha during the period of this contract for specific services/areas identified under
this proposal. Please attach a separate sheet summarizing these additional fees.
If there are no additional costs, identify that fact below by marking an "X" in the space provided.
TPA Services Provider will not charge the City of Omaha any additional fees other than
the per injured employee fee identified above.
- 13 -
ow do claim auditors flag a possible pre-existing condition? What steps are taken to
verify a pre-existing condition? How do you address an aggravation to a preexisting
medical condition?
G. Can claims information be broken down into various departments for reporting purposes?
H. What cost is there for any ad hoc reports?
- 11 -
c
J O CO t a. c
H CI ti 0 C-
EXHIBITS'
1. Employee Census revised
2. Number of Claims 2009, September 2010
3. Section 23-371 of the Omaha Municipal Code
4. Article 30 of the Civilian Bargaining Unit Contract
5. Article 24 of the Police Union Contract
6. Article 21 of the Fire Union Contract
- 14 -
at fact below by marking an "X" in the space provided.
TPA Services Provider will not charge the City of Omaha any additional fees other than
the per injured employee fee identified above.
- 13 -
ow do claim auditors flag a possible pre-existing condition? What steps are taken to
verify a pre-existing condition? How do you address an aggravation to a preexisting
medical condition?
G. Can claims information be broken down into various departments for reporting purposes?
H. What cost is there for any ad hoc reports?
- 11 -
c
J O CO t a. c
H CI ti 0 C-
EXHIBIT 1
EMPLOYEE CENSUS
Full & Part Time by
Classification
- 15 -
1 of the Omaha Municipal Code
4. Article 30 of the Civilian Bargaining Unit Contract
5. Article 24 of the Police Union Contract
6. Article 21 of the Fire Union Contract
- 14 -
at fact below by marking an "X" in the space provided.
TPA Services Provider will not charge the City of Omaha any additional fees other than
the per injured employee fee identified above.
- 13 -
ow do claim auditors flag a possible pre-existing condition? What steps are taken to
verify a pre-existing condition? How do you address an aggravation to a preexisting
medical condition?
G. Can claims information be broken down into various departments for reporting purposes?
H. What cost is there for any ad hoc reports?
- 11 -
c
J O CO t a. c
H CI ti 0 C-
EXHIBIT 1 -Employee Census (Full & Part Time) by
classification
Account Clerk 0 3
Accountant I 4 4
Accountant II 3 2
Accountant III 2 0
Accountant IV 1 0
Administrative Assistant I 0 2
Administrative Assistant III 1 8
Administrative Clerk 0 10
Administrative Information Manager 0 1
Administrative Typist I 0 2
Administrative Typist II 0 4
After School Program Coordinator 0 1
Applications Analyst 3 0
-----......—....--
Area Supervisor 1 1
Assistant Fire Chief- Non-Suppression 2 0
Assistant Fire Marshal 2 0
Assistant Library Director 0 1
Assistant Pool Manager 4 5
Attorney 3, 6
Automotive Equipment Operator I 98 0
Automotive Equipment Operator II 34 2
Automotive Equipment Operator III 11 0
(Automotive Mechanic 37 0
Automotive Repair Foreman 5 0
Automotive Servicer 7 0
Aviation Mechanic 2 0
Battalion Fire Chief 25 2
Budget Analyst 2 1
Building Inspector 6 1
Buyer 1 0
Cashier 1 1
Cashier(Rec) 2 6
... .—...--------.- ...—.......--.-....-----
Center Programmer 28 43
Chief Building Inspector 1 0
Chief Electrical Inspector 1 0
Chief Field Inspector 1 0
Chief Mechanical Inspector 1 0
Chief of Staff Operations — 1 0
Chief Plumbing Inspector 4 1 0
Chief Service Officer 0 1
City Attorney 1 0
City Clerk 1 0
- 16 -
attention
Additional Fees:
- 12 -
ed for mandatory
reporting requirements of Section 111 of the Medicare, Medicaid and SCHIP Extension
Act of 2007, and the cost, if any, associated with each quarterly submission.
II. Claim Administration
A. State whether your company is able to provide to the City of Omaha an electronic file
every other Monday to the City's Payroll Division on indemnity claims that need to be
paid for the last two weeks. The City does not expect your company to issue indemnity
checks, but forward the appropriate information to the Payroll Division in order that the
Payroll Division can appropriately pay the employee through the City's bi-weekly direct
deposit payroll system.
B. Identify the records, which would belong to the City of Omaha upon contract termination
and the form in which such records would be available. State whether the City of Omaha
- 10 -
Report on specific cases, as required
- 8 -
in the specified restrictions, the employee's Department has the next option. Finally, if the
employee is unable to be placed within the Department, placement in other Departments will be
reviewed. Please note that injured uniform employees in the Police and Fire Departments are not
placed in Civilian positions at the present time. While an employee is on limited duty status, the
employee's salary rate remains the same as if he/she was working full time without restrictions.
- 5 -
yee or agent of the other for any purpose whatsoever. Neither ARS nor its personnel, employees,
agents, contractors, or servants shall be entitled to any City of Omaha benefits. CLIENT shall not
provide any insurance coverage to ARS or its employees including, but not limited to, workers'
compensation insurance. ARS shall pay all wages, salaries and other amounts due its employees and
shall be responsible for all reports, obligations, and payments pertaining to social security taxation,
income tax withholding, workers' compensation, unemployment compensation, group insurance
coverage, collective bargaining agreements or any other such similar matters. ARS shall have no
authority to bind CLIENT by or with any contract or agreement, nor to impose any liability upon
- 6
ts and take such further action as may be
deemed necessary to more effectively consummate the matters contemplated herein.
5
ttc,n-e_ Ccicri"1t.tSkk!'trt4P 1.. COsy'\
A
ng Allowance,Unit Prices&
Alternates(If applicable). Refer any questions raga dine the Bid or Contract Documents directly to the Park Planning Division a 1,,402.44A-5900 or as noted In the
1 Contract Documents.
I All bidders awarded a contract In the amount of$5,000 or more must comply with the Contract Compliance Ordinance and have on the with the Human Relations Department the Contract
Compliance Report(Form CC-1).This report shalt be in effect for 24 months from the date received by the Human Relations Department Any questions regarding the Contract Compliance
Ordinance or PBEIDEB Listings should be directed to the Human Relations Department at 402.444-5055.
I
�� n r 1�P) .Q,(1. t MC.
(Please Print Legibly or Type) Firm n.Gt�j1 r1u�Yn 11T y te)Incorporated in
Name 6lr i1._Y 1 1 ' 1 , SYYi r '`,, SignatureI -}- Phon )4 s 3-t`Qr wt:��n
FaxOloc2T)453 -a7S
Title I(,�}�(, � ��1
Address • city state Zap
t/P.O.Box
E-Mail Address
74
City Council Chief of Staff 11 0
City Council Member 5 1
City Council President 1 0
City Lobbyist 1 0
City Maintenance Foreman I 28 0
City Maintenance Foreman II 11 1
City Maintenance Foreman III 10 0
City Maintenance Superintendent _ 9 1
City Maintenance Supervisor 6 0
City Planner 10 12
City Planner III 10 0
City Planner IV 2 0
City Planner/Developer 2 1
Civil Engineer I 2 0
Civil Engineer II 9 3
Civil Engineer III 5 1
Civil Engineer IV 5 0
Clerk II 9 33
Clerk Messenger 1 0
Clerk Typist.— _ --.- 1,.
Clerk Typist II 2 59
Clubhouse Attendant 29 5
Community Center Programmer 2 2
Community Liaison 1 1
Community Project Director 0 1
!Conference Sales Representative 0 1
'Constituent Services 1 0
Construction Ins ector 14 0
Construction Specialist 10 _ 0
Contract Administration Manager 1 0
Contractual Services Coordinator 1 0
Convention Sales Assistant 0 1
Convention Sales Manager 0 1
Convention Sales Specialist 0 1
Convention Sales Supervisor 1 0
Convention Services Assistant 0 1
Convention Services Manager 0 1
Coordinator of Volunteers 0 1
Council Staff Assistant 3 0
Crime Analysis Supervisor 1 0
Crime Analyst _— — 3 4
Crime Laboratory Manager —_ --- __......— 0--- -- -__ 1
Crime Laboratory Technician 0 5
Crime Prevention Specialist _ 0 4
Criminalist 3 0
Day Camp Counselor 1 2
Day Camp Specialist 0 1
- 17 -
on 111 of the Medicare, Medicaid and SCHIP Extension
Act of 2007, and the cost, if any, associated with each quarterly submission.
II. Claim Administration
A. State whether your company is able to provide to the City of Omaha an electronic file
every other Monday to the City's Payroll Division on indemnity claims that need to be
paid for the last two weeks. The City does not expect your company to issue indemnity
checks, but forward the appropriate information to the Payroll Division in order that the
Payroll Division can appropriately pay the employee through the City's bi-weekly direct
deposit payroll system.
B. Identify the records, which would belong to the City of Omaha upon contract termination
and the form in which such records would be available. State whether the City of Omaha
- 10 -
Report on specific cases, as required
- 8 -
in the specified restrictions, the employee's Department has the next option. Finally, if the
employee is unable to be placed within the Department, placement in other Departments will be
reviewed. Please note that injured uniform employees in the Police and Fire Departments are not
placed in Civilian positions at the present time. While an employee is on limited duty status, the
employee's salary rate remains the same as if he/she was working full time without restrictions.
- 5 -
yee or agent of the other for any purpose whatsoever. Neither ARS nor its personnel, employees,
agents, contractors, or servants shall be entitled to any City of Omaha benefits. CLIENT shall not
provide any insurance coverage to ARS or its employees including, but not limited to, workers'
compensation insurance. ARS shall pay all wages, salaries and other amounts due its employees and
shall be responsible for all reports, obligations, and payments pertaining to social security taxation,
income tax withholding, workers' compensation, unemployment compensation, group insurance
coverage, collective bargaining agreements or any other such similar matters. ARS shall have no
authority to bind CLIENT by or with any contract or agreement, nor to impose any liability upon
- 6
ts and take such further action as may be
deemed necessary to more effectively consummate the matters contemplated herein.
5
ttc,n-e_ Ccicri"1t.tSkk!'trt4P 1.. COsy'\
A
ng Allowance,Unit Prices&
Alternates(If applicable). Refer any questions raga dine the Bid or Contract Documents directly to the Park Planning Division a 1,,402.44A-5900 or as noted In the
1 Contract Documents.
I All bidders awarded a contract In the amount of$5,000 or more must comply with the Contract Compliance Ordinance and have on the with the Human Relations Department the Contract
Compliance Report(Form CC-1).This report shalt be in effect for 24 months from the date received by the Human Relations Department Any questions regarding the Contract Compliance
Ordinance or PBEIDEB Listings should be directed to the Human Relations Department at 402.444-5055.
I
�� n r 1�P) .Q,(1. t MC.
(Please Print Legibly or Type) Firm n.Gt�j1 r1u�Yn 11T y te)Incorporated in
Name 6lr i1._Y 1 1 ' 1 , SYYi r '`,, SignatureI -}- Phon )4 s 3-t`Qr wt:��n
FaxOloc2T)453 -a7S
Title I(,�}�(, � ��1
Address • city state Zap
t/P.O.Box
E-Mail Address
74
|
.
Del,utv City Clerk O 1
Deputy Communications Director O 1
Om"ub/ Police Chief 2 2
Director ofCommunications O _ 1
Director O 1
Oia"otcher 1 O
�
OroftinoTeohnioian | 1 D
_____________
Drafting Technician || 3 O
Dnofting / chnioion U| O 1
�� �����������
Ori|| &Uonhar D/ 1
_
Driver/Messenger_ 3 O
Driver/Security. 3 1
Electrical Inspector G O
Electrician 8 O
'------'
EMS Shift Supervisor 2 1
Enaineerina Aide | 8 O
En i h /�d ||| 13 O
��`�.��
Engineering Technician | O O
Environmental 10 5
��� �
Environmental Quality Control Supervisor 1 O
Environmental C> U Control Technician | 7 O
Environmental Quality Control Technician 3 1
�������������� ���.
Environmental 1 O
E i t8o��eo �anog�� 1
�g��nn�n
Event Staff orkar 1U5 G8
VV
Evidence 2 O
_
Executive Assistant O 1
ExecuUve8eoretory __� ____________ O ___�G
ExeouUmaSaoret� H R O' 2
� � �
ExecuUmaSaoratary- Low O 1
Fabrication 5 O
_
Field Inspector 1 O
Finance Director O 1
Fire ApparatunEn i r 105 2
Fire Chief 1 0
F_--ll ===='-' 0 7 �
Fleet and Facilities—_ Coordinator_General Services Manager 0 1
Golf Concession Worker 4' 19
Golf Maintenance Worker 0
- 18 -
2
Day Camp Specialist 0 1
- 17 -
on 111 of the Medicare, Medicaid and SCHIP Extension
Act of 2007, and the cost, if any, associated with each quarterly submission.
II. Claim Administration
A. State whether your company is able to provide to the City of Omaha an electronic file
every other Monday to the City's Payroll Division on indemnity claims that need to be
paid for the last two weeks. The City does not expect your company to issue indemnity
checks, but forward the appropriate information to the Payroll Division in order that the
Payroll Division can appropriately pay the employee through the City's bi-weekly direct
deposit payroll system.
B. Identify the records, which would belong to the City of Omaha upon contract termination
and the form in which such records would be available. State whether the City of Omaha
- 10 -
Report on specific cases, as required
- 8 -
in the specified restrictions, the employee's Department has the next option. Finally, if the
employee is unable to be placed within the Department, placement in other Departments will be
reviewed. Please note that injured uniform employees in the Police and Fire Departments are not
placed in Civilian positions at the present time. While an employee is on limited duty status, the
employee's salary rate remains the same as if he/she was working full time without restrictions.
- 5 -
yee or agent of the other for any purpose whatsoever. Neither ARS nor its personnel, employees,
agents, contractors, or servants shall be entitled to any City of Omaha benefits. CLIENT shall not
provide any insurance coverage to ARS or its employees including, but not limited to, workers'
compensation insurance. ARS shall pay all wages, salaries and other amounts due its employees and
shall be responsible for all reports, obligations, and payments pertaining to social security taxation,
income tax withholding, workers' compensation, unemployment compensation, group insurance
coverage, collective bargaining agreements or any other such similar matters. ARS shall have no
authority to bind CLIENT by or with any contract or agreement, nor to impose any liability upon
- 6
ts and take such further action as may be
deemed necessary to more effectively consummate the matters contemplated herein.
5
ttc,n-e_ Ccicri"1t.tSkk!'trt4P 1.. COsy'\
A
ng Allowance,Unit Prices&
Alternates(If applicable). Refer any questions raga dine the Bid or Contract Documents directly to the Park Planning Division a 1,,402.44A-5900 or as noted In the
1 Contract Documents.
I All bidders awarded a contract In the amount of$5,000 or more must comply with the Contract Compliance Ordinance and have on the with the Human Relations Department the Contract
Compliance Report(Form CC-1).This report shalt be in effect for 24 months from the date received by the Human Relations Department Any questions regarding the Contract Compliance
Ordinance or PBEIDEB Listings should be directed to the Human Relations Department at 402.444-5055.
I
�� n r 1�P) .Q,(1. t MC.
(Please Print Legibly or Type) Firm n.Gt�j1 r1u�Yn 11T y te)Incorporated in
Name 6lr i1._Y 1 1 ' 1 , SYYi r '`,, SignatureI -}- Phon )4 s 3-t`Qr wt:��n
FaxOloc2T)453 -a7S
Title I(,�}�(, � ��1
Address • city state Zap
t/P.O.Box
E-Mail Address
74
Golf Manager ---1 1 0
Golf Ranger 13 0
Grant Administrator 0 1
Grant Assistant 0 1
Grant Staff Assistant 1 0
Graphics & Printing Foreman 1 0
Graphics Operator 0 1
Graphics Specialist 0 1
Greater Omaha After School Alliance Asst 0 1
Grounds Maintenance Worker 62 0
Gym Assistant 5 4
Gym Programmer 14 5
H.V.A.C. Inspector 3 0
Handyman Worker 2 0
Hotline Assistant 1 1
Housekeeper I 2 1
Housing Inspector 9 1
HRIS Administrator 1 0
Human Relations Representative I 1 4
Human Relations Representative II 0 1
Human Relations Specialist 0 2
Human Resources Director 1 0
•Human Resources Specialist 0 4
1Human Resources Technician I 2 3
Human Resources Technician II 0 2
irHuman Resources Technician III 0' 1
'Human Resources Technician IV 3 0
Ice Arena Shift Leader 1 0
Ice Rink Programmer 15 3
Impound Lot Manager 0 1
Information Services Technician 3 7
Instructor 1 6
Intern 3 4
Laboratory Technician I 2 0
Laborer 4 1
Landscape Gardener 24 3
Legal Investigator 2 0
Librarian I 3 25
Librarian II 1 12
Librarian III 0 1
Library Aide 26 74
Library Director Library Special Projects Manager 0 1
Library Specialist 13 30
Lifeguard 27 43
Maintenance Mechanic II 13 0
Maintenance Repairer I 1 11 0
- 19 -
oncession Worker 4' 19
Golf Maintenance Worker 0
- 18 -
2
Day Camp Specialist 0 1
- 17 -
on 111 of the Medicare, Medicaid and SCHIP Extension
Act of 2007, and the cost, if any, associated with each quarterly submission.
II. Claim Administration
A. State whether your company is able to provide to the City of Omaha an electronic file
every other Monday to the City's Payroll Division on indemnity claims that need to be
paid for the last two weeks. The City does not expect your company to issue indemnity
checks, but forward the appropriate information to the Payroll Division in order that the
Payroll Division can appropriately pay the employee through the City's bi-weekly direct
deposit payroll system.
B. Identify the records, which would belong to the City of Omaha upon contract termination
and the form in which such records would be available. State whether the City of Omaha
- 10 -
Report on specific cases, as required
- 8 -
in the specified restrictions, the employee's Department has the next option. Finally, if the
employee is unable to be placed within the Department, placement in other Departments will be
reviewed. Please note that injured uniform employees in the Police and Fire Departments are not
placed in Civilian positions at the present time. While an employee is on limited duty status, the
employee's salary rate remains the same as if he/she was working full time without restrictions.
- 5 -
yee or agent of the other for any purpose whatsoever. Neither ARS nor its personnel, employees,
agents, contractors, or servants shall be entitled to any City of Omaha benefits. CLIENT shall not
provide any insurance coverage to ARS or its employees including, but not limited to, workers'
compensation insurance. ARS shall pay all wages, salaries and other amounts due its employees and
shall be responsible for all reports, obligations, and payments pertaining to social security taxation,
income tax withholding, workers' compensation, unemployment compensation, group insurance
coverage, collective bargaining agreements or any other such similar matters. ARS shall have no
authority to bind CLIENT by or with any contract or agreement, nor to impose any liability upon
- 6
ts and take such further action as may be
deemed necessary to more effectively consummate the matters contemplated herein.
5
ttc,n-e_ Ccicri"1t.tSkk!'trt4P 1.. COsy'\
A
ng Allowance,Unit Prices&
Alternates(If applicable). Refer any questions raga dine the Bid or Contract Documents directly to the Park Planning Division a 1,,402.44A-5900 or as noted In the
1 Contract Documents.
I All bidders awarded a contract In the amount of$5,000 or more must comply with the Contract Compliance Ordinance and have on the with the Human Relations Department the Contract
Compliance Report(Form CC-1).This report shalt be in effect for 24 months from the date received by the Human Relations Department Any questions regarding the Contract Compliance
Ordinance or PBEIDEB Listings should be directed to the Human Relations Department at 402.444-5055.
I
�� n r 1�P) .Q,(1. t MC.
(Please Print Legibly or Type) Firm n.Gt�j1 r1u�Yn 11T y te)Incorporated in
Name 6lr i1._Y 1 1 ' 1 , SYYi r '`,, SignatureI -}- Phon )4 s 3-t`Qr wt:��n
FaxOloc2T)453 -a7S
Title I(,�}�(, � ��1
Address • city state Zap
t/P.O.Box
E-Mail Address
74
Maintenance Repairer II 31 0
Management Analyst 0 1
Marina Caretaker 1 0
Marina Worker 6 0
Marketing Manager 0 1
Master Electrician 1 0
Master Plumber 1 0
Mayor 1 0
Mayor's Hotline Director 0 1
Mayors Receptionist 0 1
Mechanical Inspector 3 0
OCVB Tourism Assistant 0 2
Office Manager 0 5
• Office Manager- Mayor's Office 0 1
Office Supervisor 1 8
_
P.R.&P.P. Director 0 1
Painter 3 0
Paralegal Assistant 0 1
Park Caretaker II 6 0
Park Maintenance Manager 1 0
Park Maintenance Worker 2 2
Parks& Recreation Planner II 2 1
Parts Driver 1 1
Partskeeper I 4 0
Partskeeper II 2 1
Payroll Analyst 0 2
Payroll Manager 0 1
Plan Examiner 2 0
Plan Review Engineer 1 0
Planner Assistant 2 0
Planning Director 1 0
Playground Assistant 0 1
Plumber 3 0
Plumbing Inspector 6• 0
Police Captain 5 3
Police Chief 1 0
Police Information Operator I 2 25
Police Information Operator II 0 4
Police Lieutenant 21 10
Police Officer 483 103
Police Officer 2 0
Police Officer- PB 43 5
Police Officer(part-time) 21 1
Police Sergeant 78 25
—
Police Sergeant 1 0
Policy Advisor 1 0
Policy Analyst 1 0
- 20 -
11 0
- 19 -
oncession Worker 4' 19
Golf Maintenance Worker 0
- 18 -
2
Day Camp Specialist 0 1
- 17 -
on 111 of the Medicare, Medicaid and SCHIP Extension
Act of 2007, and the cost, if any, associated with each quarterly submission.
II. Claim Administration
A. State whether your company is able to provide to the City of Omaha an electronic file
every other Monday to the City's Payroll Division on indemnity claims that need to be
paid for the last two weeks. The City does not expect your company to issue indemnity
checks, but forward the appropriate information to the Payroll Division in order that the
Payroll Division can appropriately pay the employee through the City's bi-weekly direct
deposit payroll system.
B. Identify the records, which would belong to the City of Omaha upon contract termination
and the form in which such records would be available. State whether the City of Omaha
- 10 -
Report on specific cases, as required
- 8 -
in the specified restrictions, the employee's Department has the next option. Finally, if the
employee is unable to be placed within the Department, placement in other Departments will be
reviewed. Please note that injured uniform employees in the Police and Fire Departments are not
placed in Civilian positions at the present time. While an employee is on limited duty status, the
employee's salary rate remains the same as if he/she was working full time without restrictions.
- 5 -
yee or agent of the other for any purpose whatsoever. Neither ARS nor its personnel, employees,
agents, contractors, or servants shall be entitled to any City of Omaha benefits. CLIENT shall not
provide any insurance coverage to ARS or its employees including, but not limited to, workers'
compensation insurance. ARS shall pay all wages, salaries and other amounts due its employees and
shall be responsible for all reports, obligations, and payments pertaining to social security taxation,
income tax withholding, workers' compensation, unemployment compensation, group insurance
coverage, collective bargaining agreements or any other such similar matters. ARS shall have no
authority to bind CLIENT by or with any contract or agreement, nor to impose any liability upon
- 6
ts and take such further action as may be
deemed necessary to more effectively consummate the matters contemplated herein.
5
ttc,n-e_ Ccicri"1t.tSkk!'trt4P 1.. COsy'\
A
ng Allowance,Unit Prices&
Alternates(If applicable). Refer any questions raga dine the Bid or Contract Documents directly to the Park Planning Division a 1,,402.44A-5900 or as noted In the
1 Contract Documents.
I All bidders awarded a contract In the amount of$5,000 or more must comply with the Contract Compliance Ordinance and have on the with the Human Relations Department the Contract
Compliance Report(Form CC-1).This report shalt be in effect for 24 months from the date received by the Human Relations Department Any questions regarding the Contract Compliance
Ordinance or PBEIDEB Listings should be directed to the Human Relations Department at 402.444-5055.
I
�� n r 1�P) .Q,(1. t MC.
(Please Print Legibly or Type) Firm n.Gt�j1 r1u�Yn 11T y te)Incorporated in
Name 6lr i1._Y 1 1 ' 1 , SYYi r '`,, SignatureI -}- Phon )4 s 3-t`Qr wt:��n
FaxOloc2T)453 -a7S
Title I(,�}�(, � ��1
Address • city state Zap
t/P.O.Box
E-Mail Address
74
4
Pool Manager 01 2
Power Systems Mechanic II 10 0
Pre-school Assistant 0 7
Pre-School Programmer 0 2
Process Control Systems Technician I 2 0
Process Control Systems Technician II 2 0
Public Works Director 1 0
Public Works Specialist 0 2
Purchasing Agent 1 0
Quality Control Manager 1 1
Recreation Coordinator 3 4 1
Recreation Leader 3 1
Recreation Manager 0 1
Recreation Supervisor 3 7
Research and Planning Specialist 1 1
Retail Office Manger 0 1
Revenue Manager 0 1
Right of Way Agent I 1 0
Right of Way Agent II 1 0
Right of Way Manager 1 0
Sales Associate 3 5
School Resource Officer 141 3
Secretary I 0 16
Secretary II A 4
Secretary_ III 1 1
Secretary to the City Council 0 1
Semi-Skilled Laborer 51 0
Senior Administrative Clerk 2 2
Senior Attorney 5 2
Senior Clerk 2 10
Senior Crime Laboratory Technician 5 2
Senior Golf Professional 3 0
Senior Payroll Clerk 0 1
Senior Programmer 2 3
..,
Show Wagon Driver 1 0
Sign Painter 1 0
Special Projects Coordinator 0 2
Stablehand 0 1
Stationary Engineer I 6 0
Storekeeper I 3 1
Storekeeper II 1 0
Street Maintenance Worker 31 1
Sustainability Coordinator 0 1
Tennis Administrative Assistant 0 1
Tennis Instructor 2 7
Tennis Programmer 2 1
Ticket Seller 1 5
_ ..
- 21 -
- 18 -
2
Day Camp Specialist 0 1
- 17 -
on 111 of the Medicare, Medicaid and SCHIP Extension
Act of 2007, and the cost, if any, associated with each quarterly submission.
II. Claim Administration
A. State whether your company is able to provide to the City of Omaha an electronic file
every other Monday to the City's Payroll Division on indemnity claims that need to be
paid for the last two weeks. The City does not expect your company to issue indemnity
checks, but forward the appropriate information to the Payroll Division in order that the
Payroll Division can appropriately pay the employee through the City's bi-weekly direct
deposit payroll system.
B. Identify the records, which would belong to the City of Omaha upon contract termination
and the form in which such records would be available. State whether the City of Omaha
- 10 -
Report on specific cases, as required
- 8 -
in the specified restrictions, the employee's Department has the next option. Finally, if the
employee is unable to be placed within the Department, placement in other Departments will be
reviewed. Please note that injured uniform employees in the Police and Fire Departments are not
placed in Civilian positions at the present time. While an employee is on limited duty status, the
employee's salary rate remains the same as if he/she was working full time without restrictions.
- 5 -
yee or agent of the other for any purpose whatsoever. Neither ARS nor its personnel, employees,
agents, contractors, or servants shall be entitled to any City of Omaha benefits. CLIENT shall not
provide any insurance coverage to ARS or its employees including, but not limited to, workers'
compensation insurance. ARS shall pay all wages, salaries and other amounts due its employees and
shall be responsible for all reports, obligations, and payments pertaining to social security taxation,
income tax withholding, workers' compensation, unemployment compensation, group insurance
coverage, collective bargaining agreements or any other such similar matters. ARS shall have no
authority to bind CLIENT by or with any contract or agreement, nor to impose any liability upon
- 6
ts and take such further action as may be
deemed necessary to more effectively consummate the matters contemplated herein.
5
ttc,n-e_ Ccicri"1t.tSkk!'trt4P 1.. COsy'\
A
ng Allowance,Unit Prices&
Alternates(If applicable). Refer any questions raga dine the Bid or Contract Documents directly to the Park Planning Division a 1,,402.44A-5900 or as noted In the
1 Contract Documents.
I All bidders awarded a contract In the amount of$5,000 or more must comply with the Contract Compliance Ordinance and have on the with the Human Relations Department the Contract
Compliance Report(Form CC-1).This report shalt be in effect for 24 months from the date received by the Human Relations Department Any questions regarding the Contract Compliance
Ordinance or PBEIDEB Listings should be directed to the Human Relations Department at 402.444-5055.
I
�� n r 1�P) .Q,(1. t MC.
(Please Print Legibly or Type) Firm n.Gt�j1 r1u�Yn 11T y te)Incorporated in
Name 6lr i1._Y 1 1 ' 1 , SYYi r '`,, SignatureI -}- Phon )4 s 3-t`Qr wt:��n
FaxOloc2T)453 -a7S
Title I(,�}�(, � ��1
Address • city state Zap
t/P.O.Box
E-Mail Address
74
Tourism Coordinator 1 0
Tourism Marketing Manager 0 1
Traffic Engineering Aide 2 0
Traffic Maintenance Worker 11 0
Traffic Signal Tech I 5 0
Traffic Signal Technician II 5 0
Trainee Worker 5 0
Training Specialist-Academy 1 0
Tree Trimmer I 1 0
Tree Trimmer II 2 0
Uniformed Security Guard 10 4
Union Officer 1 0
W.W.Treatment Plant Foreman 1 0
W.W. Treatment Plant Manager 2 0
Wastewater Monitoring Technician 1 1
Wastewater Residuals Technician 2 0
Wastewater Treatment Plant Chief Operator 11 2
Wastewater Treatment Plant Operator 14 0
Water Safety Instructor 1 0 16
Weed &Seed Coordinator 0 1
Totals 2543 983
-22
J O CO t a. c
H CI ti 0 C-
•
EXHIBIT 2
2009 & 2010 Claims
- 23 -
0 1
Traffic Engineering Aide 2 0
Traffic Maintenance Worker 11 0
Traffic Signal Tech I 5 0
Traffic Signal Technician II 5 0
Trainee Worker 5 0
Training Specialist-Academy 1 0
Tree Trimmer I 1 0
Tree Trimmer II 2 0
Uniformed Security Guard 10 4
Union Officer 1 0
W.W.Treatment Plant Foreman 1 0
W.W. Treatment Plant Manager 2 0
Wastewater Monitoring Technician 1 1
Wastewater Residuals Technician 2 0
Wastewater Treatment Plant Chief Operator 11 2
Wastewater Treatment Plant Operator 14 0
Water Safety Instructor 1 0 16
Weed &Seed Coordinator 0 1
Totals 2543 983
-22
J O CO t a. c
H CI ti 0 C-
EXHIBIT 2 -2009 &2010 Claims
Open Case Breakdown
#New Lost #New Med Only #of New Total Reports Filed
Time Claims Incidents
2009 97 219 135 451
*2010 89 208 184 481
Open Workers'Compensation Claims at End of Calendar
Year
Year Total
2009 989
*2010 -this includes the 481 cases so far in 2010
Note: *As of 11/15/2010
The City is continuing to close out old cases, and it is felt that the remaining old cases,
excluding the current year, should be approximately 700
•
- 24 -
Wastewater Residuals Technician 2 0
Wastewater Treatment Plant Chief Operator 11 2
Wastewater Treatment Plant Operator 14 0
Water Safety Instructor 1 0 16
Weed &Seed Coordinator 0 1
Totals 2543 983
-22
J O CO t a. c
H CI ti 0 C-
EXHIBIT 3
SECTION 23 - 371 OF THE
OMAHA MUNICIPAL CODE
- 25 -
New Total Reports Filed
Time Claims Incidents
2009 97 219 135 451
*2010 89 208 184 481
Open Workers'Compensation Claims at End of Calendar
Year
Year Total
2009 989
*2010 -this includes the 481 cases so far in 2010
Note: *As of 11/15/2010
The City is continuing to close out old cases, and it is felt that the remaining old cases,
excluding the current year, should be approximately 700
•
- 24 -
Wastewater Residuals Technician 2 0
Wastewater Treatment Plant Chief Operator 11 2
Wastewater Treatment Plant Operator 14 0
Water Safety Instructor 1 0 16
Weed &Seed Coordinator 0 1
Totals 2543 983
-22
J O CO t a. c
H CI ti 0 C-
Sec. 23-371. Temporary disability sustained in the line of duty.
Except as provided hereinafter, any employee who is a member of the police and fire
retirement system or the employees' retirement system who shall sustain injuries or sickness
arising out of and in the course of his/her employment, which are of such a character as to unfit
him or her temporarily for active duty, shall be paid his/her temporary disability, for each injury
along with such medical, surgical and hospital expenses as may be incurred as a result of the
injury or sickness, but the salary and other benefits, being in excess of benefits under the
workmen's compensation act, shall be in lieu thereof, hereinafter referred to injury on duty
(IOD).
(1) Functional. For functional employees, the IOD pay provided for herein shall not
exceed six months.
Any functional employee who receives IOD pay shall not receive an amount greater than
the employee's after tax compensation.
(2) CMPTEC. For CMPTEC employees, the IOD pay provided for herein shall not
exceed nine months, to be paid at the rate of full salary for the first six months and at the
rate of 66 percent of full salary for the last three-month period.
Any CMPTEC employee who receives IOD pay shall not receive an amount greater than
the employee's after tax compensation.
(3) AEC. For AEC employees, the IOD pay provided for herein shall not exceed nine
months, to be paid at the rate of full salary for the first six months and at the rate of 66
percent of full salary for the last three-month period.
Any AEC employee who receives IOD pay shall not receive an amount greater than the
employee's after tax compensation.
(4) Police management. For police management employees, the IOD pay provided for
herein shall not exceed 365 calendar days.
Any police management employee who receives IOD pay shall not receive an amount
greater than the employee's after tax compensation.
(5) Fire management. For fire management employees, the IOD pay provided for
herein shall not exceed 365 calendar days.
Any fire management employee who receives IOD pay shall not receive an amount
greater than the employee's after tax compensation.
(Code 1980, § 23-371; Ord. No. 33687, § 1, 10-31-95; Ord. No. 34452, § 1, 1-27-98; Ord. No.
34485, § 1, 3-3-98; Ord. No. 34723, § 1, 10-27-98; Ord. No. 35625, § 1, 6-19-01)
-26 -
e employee through the City's bi-weekly direct
deposit payroll system.
B. Identify the records, which would belong to the City of Omaha upon contract termination
and the form in which such records would be available. State whether the City of Omaha
- 10 -
Report on specific cases, as required
- 8 -
in the specified restrictions, the employee's Department has the next option. Finally, if the
employee is unable to be placed within the Department, placement in other Departments will be
reviewed. Please note that injured uniform employees in the Police and Fire Departments are not
placed in Civilian positions at the present time. While an employee is on limited duty status, the
employee's salary rate remains the same as if he/she was working full time without restrictions.
- 5 -
yee or agent of the other for any purpose whatsoever. Neither ARS nor its personnel, employees,
agents, contractors, or servants shall be entitled to any City of Omaha benefits. CLIENT shall not
provide any insurance coverage to ARS or its employees including, but not limited to, workers'
compensation insurance. ARS shall pay all wages, salaries and other amounts due its employees and
shall be responsible for all reports, obligations, and payments pertaining to social security taxation,
income tax withholding, workers' compensation, unemployment compensation, group insurance
coverage, collective bargaining agreements or any other such similar matters. ARS shall have no
authority to bind CLIENT by or with any contract or agreement, nor to impose any liability upon
- 6
ts and take such further action as may be
deemed necessary to more effectively consummate the matters contemplated herein.
5
ttc,n-e_ Ccicri"1t.tSkk!'trt4P 1.. COsy'\
A
ng Allowance,Unit Prices&
Alternates(If applicable). Refer any questions raga dine the Bid or Contract Documents directly to the Park Planning Division a 1,,402.44A-5900 or as noted In the
1 Contract Documents.
I All bidders awarded a contract In the amount of$5,000 or more must comply with the Contract Compliance Ordinance and have on the with the Human Relations Department the Contract
Compliance Report(Form CC-1).This report shalt be in effect for 24 months from the date received by the Human Relations Department Any questions regarding the Contract Compliance
Ordinance or PBEIDEB Listings should be directed to the Human Relations Department at 402.444-5055.
I
�� n r 1�P) .Q,(1. t MC.
(Please Print Legibly or Type) Firm n.Gt�j1 r1u�Yn 11T y te)Incorporated in
Name 6lr i1._Y 1 1 ' 1 , SYYi r '`,, SignatureI -}- Phon )4 s 3-t`Qr wt:��n
FaxOloc2T)453 -a7S
Title I(,�}�(, � ��1
Address • city state Zap
t/P.O.Box
E-Mail Address
74
EXHIBIT 4
ARTICLE 30 OF THE
CIVILIAN BARGAINING UNIT CONTRACT
-2'7 -
w Total Reports Filed
Time Claims Incidents
2009 97 219 135 451
*2010 89 208 184 481
Open Workers'Compensation Claims at End of Calendar
Year
Year Total
2009 989
*2010 -this includes the 481 cases so far in 2010
Note: *As of 11/15/2010
The City is continuing to close out old cases, and it is felt that the remaining old cases,
excluding the current year, should be approximately 700
•
- 24 -
Wastewater Residuals Technician 2 0
Wastewater Treatment Plant Chief Operator 11 2
Wastewater Treatment Plant Operator 14 0
Water Safety Instructor 1 0 16
Weed &Seed Coordinator 0 1
Totals 2543 983
-22
J O CO t a. c
H CI ti 0 C-
ARTICLE 30
INJURIES IN THE LINE OF DUTY --
TEMPORARY DISABILITY
SECTION 1 Any bargaining unit employee who'shall sustain injuries or sickness, arising
out of and in the course of his/her employment which are of such a character
as to unfit him temporarily for active duty, shall be paid an amount which will
compensate him with the same amount of"take home" (gross pay is net less
federal and state taxes) pay that he was receiving prior to the injury. (I.O.D.
pay is not taxable so the base pay will be lowered to an amount sufficient to
allow for the same take home, but not a windfall for the period of such
temporary disability,but not to exceed three hundred sixty-five (365) calendar
days for each injury. Injury in the line of duty payments, provided herein
shall be approved within thirty (30) calendar days following date of temporary
total disability and in the event it is not approved prior to that date it shall be
presumed to be denied and the employee or his UNION representative
thereafter shall be entitled to pursue his remedies at law or under this contract,
provided, that the UNION or the employee and the CITY may mutually agree
to a time extension.
- 28 -
reater than
the employee's after tax compensation.
(3) AEC. For AEC employees, the IOD pay provided for herein shall not exceed nine
months, to be paid at the rate of full salary for the first six months and at the rate of 66
percent of full salary for the last three-month period.
Any AEC employee who receives IOD pay shall not receive an amount greater than the
employee's after tax compensation.
(4) Police management. For police management employees, the IOD pay provided for
herein shall not exceed 365 calendar days.
Any police management employee who receives IOD pay shall not receive an amount
greater than the employee's after tax compensation.
(5) Fire management. For fire management employees, the IOD pay provided for
herein shall not exceed 365 calendar days.
Any fire management employee who receives IOD pay shall not receive an amount
greater than the employee's after tax compensation.
(Code 1980, § 23-371; Ord. No. 33687, § 1, 10-31-95; Ord. No. 34452, § 1, 1-27-98; Ord. No.
34485, § 1, 3-3-98; Ord. No. 34723, § 1, 10-27-98; Ord. No. 35625, § 1, 6-19-01)
-26 -
e employee through the City's bi-weekly direct
deposit payroll system.
B. Identify the records, which would belong to the City of Omaha upon contract termination
and the form in which such records would be available. State whether the City of Omaha
- 10 -
Report on specific cases, as required
- 8 -
in the specified restrictions, the employee's Department has the next option. Finally, if the
employee is unable to be placed within the Department, placement in other Departments will be
reviewed. Please note that injured uniform employees in the Police and Fire Departments are not
placed in Civilian positions at the present time. While an employee is on limited duty status, the
employee's salary rate remains the same as if he/she was working full time without restrictions.
- 5 -
yee or agent of the other for any purpose whatsoever. Neither ARS nor its personnel, employees,
agents, contractors, or servants shall be entitled to any City of Omaha benefits. CLIENT shall not
provide any insurance coverage to ARS or its employees including, but not limited to, workers'
compensation insurance. ARS shall pay all wages, salaries and other amounts due its employees and
shall be responsible for all reports, obligations, and payments pertaining to social security taxation,
income tax withholding, workers' compensation, unemployment compensation, group insurance
coverage, collective bargaining agreements or any other such similar matters. ARS shall have no
authority to bind CLIENT by or with any contract or agreement, nor to impose any liability upon
- 6
ts and take such further action as may be
deemed necessary to more effectively consummate the matters contemplated herein.
5
ttc,n-e_ Ccicri"1t.tSkk!'trt4P 1.. COsy'\
A
ng Allowance,Unit Prices&
Alternates(If applicable). Refer any questions raga dine the Bid or Contract Documents directly to the Park Planning Division a 1,,402.44A-5900 or as noted In the
1 Contract Documents.
I All bidders awarded a contract In the amount of$5,000 or more must comply with the Contract Compliance Ordinance and have on the with the Human Relations Department the Contract
Compliance Report(Form CC-1).This report shalt be in effect for 24 months from the date received by the Human Relations Department Any questions regarding the Contract Compliance
Ordinance or PBEIDEB Listings should be directed to the Human Relations Department at 402.444-5055.
I
�� n r 1�P) .Q,(1. t MC.
(Please Print Legibly or Type) Firm n.Gt�j1 r1u�Yn 11T y te)Incorporated in
Name 6lr i1._Y 1 1 ' 1 , SYYi r '`,, SignatureI -}- Phon )4 s 3-t`Qr wt:��n
FaxOloc2T)453 -a7S
Title I(,�}�(, � ��1
Address • city state Zap
t/P.O.Box
E-Mail Address
74
EXHIBIT 5
ARTICLE 24 OF THE
OMAHA POLICE UNION CONTRACT
- 29 -
Total Reports Filed
Time Claims Incidents
2009 97 219 135 451
*2010 89 208 184 481
Open Workers'Compensation Claims at End of Calendar
Year
Year Total
2009 989
*2010 -this includes the 481 cases so far in 2010
Note: *As of 11/15/2010
The City is continuing to close out old cases, and it is felt that the remaining old cases,
excluding the current year, should be approximately 700
•
- 24 -
Wastewater Residuals Technician 2 0
Wastewater Treatment Plant Chief Operator 11 2
Wastewater Treatment Plant Operator 14 0
Water Safety Instructor 1 0 16
Weed &Seed Coordinator 0 1
Totals 2543 983
-22
J O CO t a. c
H CI ti 0 C-
ARTICLE 24
INJURIES IN THE LINE OF DUTY -TEMPORARY DISABILITY
SECTION 1 Any employee who is a member of the Police and Fire Retirement
System who shall sustain injuries or sickness, arising out of and in the
course of his employment which are of such a character as to unfit him
temporarily for active duty, shall be paid his full base pay for the period
of such temporary disability, but not to exceed three hundred sixty-five
(365) calendar days for each such injury or sickness. In addition
thereto, the CITY shall pay such medical, surgical and hospital
expenses as may be incurred as a result of the injury or sickness, but
the salary and other benefits, being in excess of benefits under the
Nebraska Workers' Compensation Act, shall be in lieu thereof.
- 30 -
-22
J O CO t a. c
H CI ti 0 C-
EXHIBIT 6
ARTICLE 21 OF THE
OMAHA FIRE UNION CONTRACT
- 31 -
Any employee who is a member of the Police and Fire Retirement
System who shall sustain injuries or sickness, arising out of and in the
course of his employment which are of such a character as to unfit him
temporarily for active duty, shall be paid his full base pay for the period
of such temporary disability, but not to exceed three hundred sixty-five
(365) calendar days for each such injury or sickness. In addition
thereto, the CITY shall pay such medical, surgical and hospital
expenses as may be incurred as a result of the injury or sickness, but
the salary and other benefits, being in excess of benefits under the
Nebraska Workers' Compensation Act, shall be in lieu thereof.
- 30 -
-22
J O CO t a. c
H CI ti 0 C-
ARTICLE 21
INJURIES IN THE LINE OF DUTY -- TEMPORARY DISABILITY
SECTION 1 Any employee who is a member of the Police and Firemen's Pension
System who shall sustain injuries or sickness, arising out of and in the
course of his/her employment which are of such a character as to unfit
him temporarily for active duty, shall be paid his full salary for the
period of such temporary disability, but not to exceed three hundred
sixty-five (365) calendar days for each such injury and, in addition
thereto, such medical, surgical and hospital expenses as may be
incurred as the result of the injury or sickness, but the salary and other
benefits, being in excess of benefits under the Nebraska Worker's
Compensation Act, shall be in lieu thereof.
It is understood that an employee's limited duty time; that is, the time
the injured employee spends working on limited duty assignments,
should not be counted toward the 365 days set out above.
Any injuries suffered by an employee during training exercises,
approved by the Fire Chief or his/her designee, while employed by the
City and engaged in such training (whether such employee is being
paid for such time or not) at any location (whether such facility is
owned by the City or not) shall be treated and compensated in
accordance with this Section.
SECTION 2 Any application for injured on-duty benefits by an employee shall be
filed within 48-hours of the incident that caused the injury, if possible.
The employee must contact the Workers Compensation case manager
as soon as practically possible after the injury, preferably prior to, or at
the same time, he/she seeks medical attention. The employee shall be
marked on IOD status upon filing of the application. It is understood
by and between the parties that the employee being marked IOD in no
way implies the granting of IOD status.
This determination shall be promptly made within forty-five (45)
calendar days from the date of receipt of the injury report to the
Personnel Department. Should circumstances prevail that an
extension of the time period be necessary this may be permitted by
mutual agreement of both the City and Union.
If facts and circumstances indicate the employee should not be
granted IOD status, the employee will be promptly notified and such
leave will be changed from IOD to either sick leave, annual leave, or
leave without pay at the discretion of the employee. If the employee
has left City employment and has become entitled to payoff of his/her
accrued sick and/or annual leave payout, such amounts shall be
deducted from these leaves before they are paid to the employee.
- 32 -
l be
reviewed. Please note that injured uniform employees in the Police and Fire Departments are not
placed in Civilian positions at the present time. While an employee is on limited duty status, the
employee's salary rate remains the same as if he/she was working full time without restrictions.
- 5 -
yee or agent of the other for any purpose whatsoever. Neither ARS nor its personnel, employees,
agents, contractors, or servants shall be entitled to any City of Omaha benefits. CLIENT shall not
provide any insurance coverage to ARS or its employees including, but not limited to, workers'
compensation insurance. ARS shall pay all wages, salaries and other amounts due its employees and
shall be responsible for all reports, obligations, and payments pertaining to social security taxation,
income tax withholding, workers' compensation, unemployment compensation, group insurance
coverage, collective bargaining agreements or any other such similar matters. ARS shall have no
authority to bind CLIENT by or with any contract or agreement, nor to impose any liability upon
- 6
ts and take such further action as may be
deemed necessary to more effectively consummate the matters contemplated herein.
5
ttc,n-e_ Ccicri"1t.tSkk!'trt4P 1.. COsy'\
A
ng Allowance,Unit Prices&
Alternates(If applicable). Refer any questions raga dine the Bid or Contract Documents directly to the Park Planning Division a 1,,402.44A-5900 or as noted In the
1 Contract Documents.
I All bidders awarded a contract In the amount of$5,000 or more must comply with the Contract Compliance Ordinance and have on the with the Human Relations Department the Contract
Compliance Report(Form CC-1).This report shalt be in effect for 24 months from the date received by the Human Relations Department Any questions regarding the Contract Compliance
Ordinance or PBEIDEB Listings should be directed to the Human Relations Department at 402.444-5055.
I
�� n r 1�P) .Q,(1. t MC.
(Please Print Legibly or Type) Firm n.Gt�j1 r1u�Yn 11T y te)Incorporated in
Name 6lr i1._Y 1 1 ' 1 , SYYi r '`,, SignatureI -}- Phon )4 s 3-t`Qr wt:��n
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Title I(,�}�(, � ��1
Address • city state Zap
t/P.O.Box
E-Mail Address
74
In the event this application is denied by the Personnel Department
Benefits Manager, the employee or union may appeal this decision to
the Personnel Director. If the Personnel Director should reverse the
decision and award injuries on duty benefits to the employee, then the
City shall be liable for all expenses incurred by the employee or the
Union in the appeal.
In the event the Personnel Director declines the appeal, then the
employee may be free to pursue the matter in the appropriate state
court and in the event that the judgment is in favor of the employee,
the City shall be liable for all expenses incurred by the employee which
are directly related to the suit.
SECTION 3 If an employee is on approved IOD status, he/she shall not be required to
take his/her previously bid furlough period while on IOD status. When
such employee is released to full duty, he/she will be allowed to utilize
his/her untaken furlough period within his/her full duty assignment.
However, this furlough period must be taken within the payroll year or will
not be compensated, unless: (1) such employee has never been released
to limited duty; or (2) because of the circumstances, it is impossible for the
employee to take such furlough within the payroll year.
p:\law-city council documents\2011\10048dae.doc
- 33 -
compensated in
accordance with this Section.
SECTION 2 Any application for injured on-duty benefits by an employee shall be
filed within 48-hours of the incident that caused the injury, if possible.
The employee must contact the Workers Compensation case manager
as soon as practically possible after the injury, preferably prior to, or at
the same time, he/she seeks medical attention. The employee shall be
marked on IOD status upon filing of the application. It is understood
by and between the parties that the employee being marked IOD in no
way implies the granting of IOD status.
This determination shall be promptly made within forty-five (45)
calendar days from the date of receipt of the injury report to the
Personnel Department. Should circumstances prevail that an
extension of the time period be necessary this may be permitted by
mutual agreement of both the City and Union.
If facts and circumstances indicate the employee should not be
granted IOD status, the employee will be promptly notified and such
leave will be changed from IOD to either sick leave, annual leave, or
leave without pay at the discretion of the employee. If the employee
has left City employment and has become entitled to payoff of his/her
accrued sick and/or annual leave payout, such amounts shall be
deducted from these leaves before they are paid to the employee.
- 32 -
l be
reviewed. Please note that injured uniform employees in the Police and Fire Departments are not
placed in Civilian positions at the present time. While an employee is on limited duty status, the
employee's salary rate remains the same as if he/she was working full time without restrictions.
- 5 -
yee or agent of the other for any purpose whatsoever. Neither ARS nor its personnel, employees,
agents, contractors, or servants shall be entitled to any City of Omaha benefits. CLIENT shall not
provide any insurance coverage to ARS or its employees including, but not limited to, workers'
compensation insurance. ARS shall pay all wages, salaries and other amounts due its employees and
shall be responsible for all reports, obligations, and payments pertaining to social security taxation,
income tax withholding, workers' compensation, unemployment compensation, group insurance
coverage, collective bargaining agreements or any other such similar matters. ARS shall have no
authority to bind CLIENT by or with any contract or agreement, nor to impose any liability upon
- 6
ts and take such further action as may be
deemed necessary to more effectively consummate the matters contemplated herein.
5
ttc,n-e_ Ccicri"1t.tSkk!'trt4P 1.. COsy'\
A
ng Allowance,Unit Prices&
Alternates(If applicable). Refer any questions raga dine the Bid or Contract Documents directly to the Park Planning Division a 1,,402.44A-5900 or as noted In the
1 Contract Documents.
I All bidders awarded a contract In the amount of$5,000 or more must comply with the Contract Compliance Ordinance and have on the with the Human Relations Department the Contract
Compliance Report(Form CC-1).This report shalt be in effect for 24 months from the date received by the Human Relations Department Any questions regarding the Contract Compliance
Ordinance or PBEIDEB Listings should be directed to the Human Relations Department at 402.444-5055.
I
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Title I(,�}�(, � ��1
Address • city state Zap
t/P.O.Box
E-Mail Address
74
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iod within his/her full duty assignment.
However, this furlough period must be taken within the payroll year or will
not be compensated, unless: (1) such employee has never been released
to limited duty; or (2) because of the circumstances, it is impossible for the
employee to take such furlough within the payroll year.
p:\law-city council documents\2011\10048dae.doc
- 33 -
compensated in
accordance with this Section.
SECTION 2 Any application for injured on-duty benefits by an employee shall be
filed within 48-hours of the incident that caused the injury, if possible.
The employee must contact the Workers Compensation case manager
as soon as practically possible after the injury, preferably prior to, or at
the same time, he/she seeks medical attention. The employee shall be
marked on IOD status upon filing of the application. It is understood
by and between the parties that the employee being marked IOD in no
way implies the granting of IOD status.
This determination shall be promptly made within forty-five (45)
calendar days from the date of receipt of the injury report to the
Personnel Department. Should circumstances prevail that an
extension of the time period be necessary this may be permitted by
mutual agreement of both the City and Union.
If facts and circumstances indicate the employee should not be
granted IOD status, the employee will be promptly notified and such
leave will be changed from IOD to either sick leave, annual leave, or
leave without pay at the discretion of the employee. If the employee
has left City employment and has become entitled to payoff of his/her
accrued sick and/or annual leave payout, such amounts shall be
deducted from these leaves before they are paid to the employee.
- 32 -
l be
reviewed. Please note that injured uniform employees in the Police and Fire Departments are not
placed in Civilian positions at the present time. While an employee is on limited duty status, the
employee's salary rate remains the same as if he/she was working full time without restrictions.
- 5 -
yee or agent of the other for any purpose whatsoever. Neither ARS nor its personnel, employees,
agents, contractors, or servants shall be entitled to any City of Omaha benefits. CLIENT shall not
provide any insurance coverage to ARS or its employees including, but not limited to, workers'
compensation insurance. ARS shall pay all wages, salaries and other amounts due its employees and
shall be responsible for all reports, obligations, and payments pertaining to social security taxation,
income tax withholding, workers' compensation, unemployment compensation, group insurance
coverage, collective bargaining agreements or any other such similar matters. ARS shall have no
authority to bind CLIENT by or with any contract or agreement, nor to impose any liability upon
- 6
ts and take such further action as may be
deemed necessary to more effectively consummate the matters contemplated herein.
5
ttc,n-e_ Ccicri"1t.tSkk!'trt4P 1.. COsy'\
A
ng Allowance,Unit Prices&
Alternates(If applicable). Refer any questions raga dine the Bid or Contract Documents directly to the Park Planning Division a 1,,402.44A-5900 or as noted In the
1 Contract Documents.
I All bidders awarded a contract In the amount of$5,000 or more must comply with the Contract Compliance Ordinance and have on the with the Human Relations Department the Contract
Compliance Report(Form CC-1).This report shalt be in effect for 24 months from the date received by the Human Relations Department Any questions regarding the Contract Compliance
Ordinance or PBEIDEB Listings should be directed to the Human Relations Department at 402.444-5055.
I
�� n r 1�P) .Q,(1. t MC.
(Please Print Legibly or Type) Firm n.Gt�j1 r1u�Yn 11T y te)Incorporated in
Name 6lr i1._Y 1 1 ' 1 , SYYi r '`,, SignatureI -}- Phon )4 s 3-t`Qr wt:��n
FaxOloc2T)453 -a7S
Title I(,�}�(, � ��1
Address • city state Zap
t/P.O.Box
E-Mail Address
74
=-_ alternativeriskservices
December 9, 2010
City of Omaha
Buster Brown
City Clerk
Omaha/Douglas Civic Center
1819 Farnam Street, LC-1
Omaha, NE 68183-0011
Dear Mr. Brown;
We are pleased to convey herewith a proposal for the provision of certain risk management services
for the City of Omaha; Nebraska. This proposal follows the received request for proposal our office
obtained from the website. It is the goal of this proposal to assist the City improving the efficiencies
of the City's workers cohnpensation program.
Alternative Risk Services(ARS) has over twenty-five years of experience in the provision of risk
management services including; program administration, claims administration, underwriting,
customized risk assessments, nurse case management, and integrated bill review. In particular,ARS
has specialized in providing its mix of risk management services to local governments and quasi
political subdivisions. We are experienced and familiar with the challenges and uniqueness of
managing workers cohiipensation programs in the public sector. The attached proposal details the
requests the City has 'made within the RFP.
We are available for further discussions of this proposal or to provide clarification of any issues
contained herein.
We await our opportunity to be of service.
Sincerely;
Elizabeth Long
Vice President Program Services
816-582-2934
P 0 Box 901610 A Kansas City, Missouri 64190 A (800)934-2671 A (816)412-4500 A fax(816)412-4501
filed within 48-hours of the incident that caused the injury, if possible.
The employee must contact the Workers Compensation case manager
as soon as practically possible after the injury, preferably prior to, or at
the same time, he/she seeks medical attention. The employee shall be
marked on IOD status upon filing of the application. It is understood
by and between the parties that the employee being marked IOD in no
way implies the granting of IOD status.
This determination shall be promptly made within forty-five (45)
calendar days from the date of receipt of the injury report to the
Personnel Department. Should circumstances prevail that an
extension of the time period be necessary this may be permitted by
mutual agreement of both the City and Union.
If facts and circumstances indicate the employee should not be
granted IOD status, the employee will be promptly notified and such
leave will be changed from IOD to either sick leave, annual leave, or
leave without pay at the discretion of the employee. If the employee
has left City employment and has become entitled to payoff of his/her
accrued sick and/or annual leave payout, such amounts shall be
deducted from these leaves before they are paid to the employee.
- 32 -
l be
reviewed. Please note that injured uniform employees in the Police and Fire Departments are not
placed in Civilian positions at the present time. While an employee is on limited duty status, the
employee's salary rate remains the same as if he/she was working full time without restrictions.
- 5 -
yee or agent of the other for any purpose whatsoever. Neither ARS nor its personnel, employees,
agents, contractors, or servants shall be entitled to any City of Omaha benefits. CLIENT shall not
provide any insurance coverage to ARS or its employees including, but not limited to, workers'
compensation insurance. ARS shall pay all wages, salaries and other amounts due its employees and
shall be responsible for all reports, obligations, and payments pertaining to social security taxation,
income tax withholding, workers' compensation, unemployment compensation, group insurance
coverage, collective bargaining agreements or any other such similar matters. ARS shall have no
authority to bind CLIENT by or with any contract or agreement, nor to impose any liability upon
- 6
ts and take such further action as may be
deemed necessary to more effectively consummate the matters contemplated herein.
5
ttc,n-e_ Ccicri"1t.tSkk!'trt4P 1.. COsy'\
A
ng Allowance,Unit Prices&
Alternates(If applicable). Refer any questions raga dine the Bid or Contract Documents directly to the Park Planning Division a 1,,402.44A-5900 or as noted In the
1 Contract Documents.
I All bidders awarded a contract In the amount of$5,000 or more must comply with the Contract Compliance Ordinance and have on the with the Human Relations Department the Contract
Compliance Report(Form CC-1).This report shalt be in effect for 24 months from the date received by the Human Relations Department Any questions regarding the Contract Compliance
Ordinance or PBEIDEB Listings should be directed to the Human Relations Department at 402.444-5055.
I
�� n r 1�P) .Q,(1. t MC.
(Please Print Legibly or Type) Firm n.Gt�j1 r1u�Yn 11T y te)Incorporated in
Name 6lr i1._Y 1 1 ' 1 , SYYi r '`,, SignatureI -}- Phon )4 s 3-t`Qr wt:��n
FaxOloc2T)453 -a7S
Title I(,�}�(, � ��1
Address • city state Zap
t/P.O.Box
E-Mail Address
74
I. General/Account Management
A. State the names and titles of those individuals who will be involved in the
day-to day administration of the Program. Specify in detail his/her
background in TPA services, specifically for workers' compensation,
and/or exposure to blood or body fluids programs. How will this
administration of claims be distributed to these individuals?
Alternative Risk Services works on a team concept to meet the specific
needs of our clients. Superior customer service is obtained by dedicating
a Team Leader, Account Manager, Claim Manager, and the appropriate
number of adjusters and administrative staff to properly adjudicate your
claims. ARS will also provide loss control services if desired.
Your team will include individuals who have in-depth knowledge of the
jurisdiction issues, state requirements and a long history of working with
medical providers in Nebraska. In working with various self-insured clients
in Nebraska and several public entities we are able to customize
necessary information to meet State requirements as well as design
custom reports to meet your needs.
Your account will be lead by Beth Long, Team Leader. Beth has been
with Alternative Risk Services (ARS) for ten years and before moving to the
team leader position, worked as an adjuster in our office handling severe
claims for multiple jurisdictions, including Nebraska. As the main point of
contact, Beth will ensure your workers' compensation program is
successful and you are receiving necessary information from our office.
Kay Bryan, Account Manager, has over twenty years of experience in
working in risk management. Kay has worked for both insurance carriers
and self-insured employers. Kay currently handles several accounts for
Nebraska clients. Her expertise in this area will ensure a smooth transition
for the City of Omaha.
Greg Dalton, Claims Manager, has been with ARS for over twelve years.
Greg has experience in handling claims for multiple jurisdictions and is
trained for all the states that Alternative Risk Services operates in. Greg •
monitors all large dollar loss claims and is always available to discuss
questionable circumstances with every adjuster or client.
Tiffany Felkner, Senior Claims Adjuster, Tiffany has been with ARS for over
fifteen years. Tiffany has over a decade of experience in handling
Nebraska lost time claims. Her expertise is in handling Nebraska claims
and she specializes in large dollar losses with excess carriers and claims
requiring vocational rehabilitation and difficult litigation. Tiffany will be
responsible for adjusting your lost time claims as well as overseeing the
activity of all medical only claims.
ccrued sick and/or annual leave payout, such amounts shall be
deducted from these leaves before they are paid to the employee.
- 32 -
l be
reviewed. Please note that injured uniform employees in the Police and Fire Departments are not
placed in Civilian positions at the present time. While an employee is on limited duty status, the
employee's salary rate remains the same as if he/she was working full time without restrictions.
- 5 -
yee or agent of the other for any purpose whatsoever. Neither ARS nor its personnel, employees,
agents, contractors, or servants shall be entitled to any City of Omaha benefits. CLIENT shall not
provide any insurance coverage to ARS or its employees including, but not limited to, workers'
compensation insurance. ARS shall pay all wages, salaries and other amounts due its employees and
shall be responsible for all reports, obligations, and payments pertaining to social security taxation,
income tax withholding, workers' compensation, unemployment compensation, group insurance
coverage, collective bargaining agreements or any other such similar matters. ARS shall have no
authority to bind CLIENT by or with any contract or agreement, nor to impose any liability upon
- 6
ts and take such further action as may be
deemed necessary to more effectively consummate the matters contemplated herein.
5
ttc,n-e_ Ccicri"1t.tSkk!'trt4P 1.. COsy'\
A
ng Allowance,Unit Prices&
Alternates(If applicable). Refer any questions raga dine the Bid or Contract Documents directly to the Park Planning Division a 1,,402.44A-5900 or as noted In the
1 Contract Documents.
I All bidders awarded a contract In the amount of$5,000 or more must comply with the Contract Compliance Ordinance and have on the with the Human Relations Department the Contract
Compliance Report(Form CC-1).This report shalt be in effect for 24 months from the date received by the Human Relations Department Any questions regarding the Contract Compliance
Ordinance or PBEIDEB Listings should be directed to the Human Relations Department at 402.444-5055.
I
�� n r 1�P) .Q,(1. t MC.
(Please Print Legibly or Type) Firm n.Gt�j1 r1u�Yn 11T y te)Incorporated in
Name 6lr i1._Y 1 1 ' 1 , SYYi r '`,, SignatureI -}- Phon )4 s 3-t`Qr wt:��n
FaxOloc2T)453 -a7S
Title I(,�}�(, � ��1
Address • city state Zap
t/P.O.Box
E-Mail Address
74
Deborah Beam, Medical Only Adjuster, Deborah has been with ARS for
five years and handles claims for our Nebraska clients.
B. Provide at least three (3) references of current clients that are similar in
size with the City of Omaha, including: Company name and address,
contact person, email address, phone number, number of employees,
type of program in place, and length of service with your program. If you
are working with any municipality please provide similar information.
Below is list of public entity contacts as well as other clients ARS currently
have in Nebraska;
Jackson County Missouri
Joanne Mossie
415 East 12th Street, 1st Floor
Kansas City, MO 64106
816-881-3136
jmossie@jacksongov.org
6/1/1994 became a client for workers' compensation claims
administration
• 2,044 total employees
Bryan LGH Medical Center
Ron Anderson
1600 South 48th Street
Lincoln, NE 68506
402-475-1011
ron.anderson@bryanlgh.org
6/1/1991 became a client of ARS for workers' compensation claims
administration
3,975 total employees
Unified Government of Kansas City
Reginald Lindsey
701 North 7th Street STE 628
Kansas City, KS 66101
913-573-5095
rlindsey@wycokck.org
11/1/1989 became a client of ARS for workers' compensation claims
administration
• 1,665 total employees
severe
claims for multiple jurisdictions, including Nebraska. As the main point of
contact, Beth will ensure your workers' compensation program is
successful and you are receiving necessary information from our office.
Kay Bryan, Account Manager, has over twenty years of experience in
working in risk management. Kay has worked for both insurance carriers
and self-insured employers. Kay currently handles several accounts for
Nebraska clients. Her expertise in this area will ensure a smooth transition
for the City of Omaha.
Greg Dalton, Claims Manager, has been with ARS for over twelve years.
Greg has experience in handling claims for multiple jurisdictions and is
trained for all the states that Alternative Risk Services operates in. Greg •
monitors all large dollar loss claims and is always available to discuss
questionable circumstances with every adjuster or client.
Tiffany Felkner, Senior Claims Adjuster, Tiffany has been with ARS for over
fifteen years. Tiffany has over a decade of experience in handling
Nebraska lost time claims. Her expertise is in handling Nebraska claims
and she specializes in large dollar losses with excess carriers and claims
requiring vocational rehabilitation and difficult litigation. Tiffany will be
responsible for adjusting your lost time claims as well as overseeing the
activity of all medical only claims.
ccrued sick and/or annual leave payout, such amounts shall be
deducted from these leaves before they are paid to the employee.
- 32 -
l be
reviewed. Please note that injured uniform employees in the Police and Fire Departments are not
placed in Civilian positions at the present time. While an employee is on limited duty status, the
employee's salary rate remains the same as if he/she was working full time without restrictions.
- 5 -
yee or agent of the other for any purpose whatsoever. Neither ARS nor its personnel, employees,
agents, contractors, or servants shall be entitled to any City of Omaha benefits. CLIENT shall not
provide any insurance coverage to ARS or its employees including, but not limited to, workers'
compensation insurance. ARS shall pay all wages, salaries and other amounts due its employees and
shall be responsible for all reports, obligations, and payments pertaining to social security taxation,
income tax withholding, workers' compensation, unemployment compensation, group insurance
coverage, collective bargaining agreements or any other such similar matters. ARS shall have no
authority to bind CLIENT by or with any contract or agreement, nor to impose any liability upon
- 6
ts and take such further action as may be
deemed necessary to more effectively consummate the matters contemplated herein.
5
ttc,n-e_ Ccicri"1t.tSkk!'trt4P 1.. COsy'\
A
ng Allowance,Unit Prices&
Alternates(If applicable). Refer any questions raga dine the Bid or Contract Documents directly to the Park Planning Division a 1,,402.44A-5900 or as noted In the
1 Contract Documents.
I All bidders awarded a contract In the amount of$5,000 or more must comply with the Contract Compliance Ordinance and have on the with the Human Relations Department the Contract
Compliance Report(Form CC-1).This report shalt be in effect for 24 months from the date received by the Human Relations Department Any questions regarding the Contract Compliance
Ordinance or PBEIDEB Listings should be directed to the Human Relations Department at 402.444-5055.
I
�� n r 1�P) .Q,(1. t MC.
(Please Print Legibly or Type) Firm n.Gt�j1 r1u�Yn 11T y te)Incorporated in
Name 6lr i1._Y 1 1 ' 1 , SYYi r '`,, SignatureI -}- Phon )4 s 3-t`Qr wt:��n
FaxOloc2T)453 -a7S
Title I(,�}�(, � ��1
Address • city state Zap
t/P.O.Box
E-Mail Address
74
1
' C. What specific records and other information do you need from the current
administrator for conversion of this program to your administration for
March 1, 2011?
' Alternative Risk Services would like to receive, in an electronic format, all
historical payment and claim information. The more information we are
' able to obtain from your prior carrier allows a better historical picture for
the City as we move forward.
' D. Since many City employees work in positions involving various shifts
outside the 8am-5pm timeframe, explain how your company will need to
be notified during hours outside the 8am-5pm time frame and hours will
' your company will respond during such time frame?
ARS is available for 24/7 to respond to all of our clients needs. Your team
I leader's direct contact information will be given to all essential City
contacts and can be utilized at any time. A toll-free number will also be
distributed to all individuals and departments who may have "off" hour
situations.
E. How will emergency cases be handled?
ARS believes every employee should seek prompt medical attention.
Once the City is aware of an event, ARS should be contacted. This will
allow us to reach out immediately to the injured worker. We will attempt
to direct medical care as much as possible and stay in contact with the
injured worker or his/her family, promoting a smooth claim handling
process. Discussions with providers will ensure proper care and billing.
F. State the name of the Electronic Data Interchange (EDI) company that
you use to file First Reports of Injury (FROI) and Subsequent Reports of
Injury(SROI) reports. Will any associated cost be passed on to the City; if
so what will be the cost associated with each transmission? In addition,
state the name of the company used for mandatory report requirements
of Section 111 of the Medicare, Medicaid and SCHIP Extension Act of
2007, and the cost, if any, associated with each quarterly submission.
Alternative Risk Services utilizes HealthTech as our first report of injury and
subsequent report of injury electronic data interchange company.
HealthTech was one of the first companies approved to operate EDI in the
State of Nebraska. There is no additional cost to the City of ARS regarding
EDI filings.
ARS utilizes Med Allocators to submit data regarding Section 111 and the
SCHIP Extension Act. This cost is covered under the administrative charges
for the City. ARS will assist the City in becoming an RRE and establishing
ing vocational rehabilitation and difficult litigation. Tiffany will be
responsible for adjusting your lost time claims as well as overseeing the
activity of all medical only claims.
ccrued sick and/or annual leave payout, such amounts shall be
deducted from these leaves before they are paid to the employee.
- 32 -
l be
reviewed. Please note that injured uniform employees in the Police and Fire Departments are not
placed in Civilian positions at the present time. While an employee is on limited duty status, the
employee's salary rate remains the same as if he/she was working full time without restrictions.
- 5 -
yee or agent of the other for any purpose whatsoever. Neither ARS nor its personnel, employees,
agents, contractors, or servants shall be entitled to any City of Omaha benefits. CLIENT shall not
provide any insurance coverage to ARS or its employees including, but not limited to, workers'
compensation insurance. ARS shall pay all wages, salaries and other amounts due its employees and
shall be responsible for all reports, obligations, and payments pertaining to social security taxation,
income tax withholding, workers' compensation, unemployment compensation, group insurance
coverage, collective bargaining agreements or any other such similar matters. ARS shall have no
authority to bind CLIENT by or with any contract or agreement, nor to impose any liability upon
- 6
ts and take such further action as may be
deemed necessary to more effectively consummate the matters contemplated herein.
5
ttc,n-e_ Ccicri"1t.tSkk!'trt4P 1.. COsy'\
A
ng Allowance,Unit Prices&
Alternates(If applicable). Refer any questions raga dine the Bid or Contract Documents directly to the Park Planning Division a 1,,402.44A-5900 or as noted In the
1 Contract Documents.
I All bidders awarded a contract In the amount of$5,000 or more must comply with the Contract Compliance Ordinance and have on the with the Human Relations Department the Contract
Compliance Report(Form CC-1).This report shalt be in effect for 24 months from the date received by the Human Relations Department Any questions regarding the Contract Compliance
Ordinance or PBEIDEB Listings should be directed to the Human Relations Department at 402.444-5055.
I
�� n r 1�P) .Q,(1. t MC.
(Please Print Legibly or Type) Firm n.Gt�j1 r1u�Yn 11T y te)Incorporated in
Name 6lr i1._Y 1 1 ' 1 , SYYi r '`,, SignatureI -}- Phon )4 s 3-t`Qr wt:��n
FaxOloc2T)453 -a7S
Title I(,�}�(, � ��1
Address • city state Zap
t/P.O.Box
E-Mail Address
74
•
' the correct reporting agent and account designees necessary for proper
reporting.
•
•
•
I
I
I
I
I
1
ustain injuries or sickness, arising out of and in the
course of his employment which are of such a character as to unfit him
temporarily for active duty, shall be paid his full base pay for the period
of such temporary disability, but not to exceed three hundred sixty-five
(365) calendar days for each such injury or sickness. In addition
thereto, the CITY shall pay such medical, surgical and hospital
expenses as may be incurred as a result of the injury or sickness, but
the salary and other benefits, being in excess of benefits under the
Nebraska Workers' Compensation Act, shall be in lieu thereof.
- 30 -
-22
J O CO t a. c
H CI ti 0 C-
II. Claim Administration
A. State whether your company is able to provide the City of Omaha an
electronic file every other Monday to the City's Payroll Division on
indemnity claims that need to be paid for the last two weeks. The City
does not expect your company to issue indemnity checks, but forward the
appropriate information to the Payroll Division, in order that the Payroll
Division can appropriately pay the employee through the City's bi-weekly
direct deposit payroll system.
ARS is able to provide the City an electronic file every other Monday,
beginning on a date determined by the City. This file will be outlined by
the individual injured worker and state what benefit type the payments
I,! are for, the amount of the payment and if payments are expected to
continue into the future as well as any lien information the City should be
made aware of. If additional or different information is desired the
electronic file can be modified to meet your needs. Alternative Risk
Services currently has a similar process to this in place with our current
client base and can promptly establish this for the City.
B. Identify the records, which would belong to the City of Omaha upon
contract termination and the form in which such records would be
available. State whether the City of Omaha would be changed for
transmission of such records to the City or the new TPA Services Provider.
ARS operates within a paperless environment. If the City of Omaha were
to terminate our services, all file information and historic data that had
been loaded into our system would be available to the City in an
electronic format. The new provider could then print file information or
upload the data into their system. This data can be dropped into a disc
or formatted for specific fields. This will be dependant upon the new
provider and their requests. There is no charge for the City of Omaha to
obtain their data, or for their data to be sent to a new TPA Service
Provider.
C. State whether, and if so, for what period, you will keep detailed individual
claim histories on line. State how you will store and retrieve claim histories
beyond this time. State how long you will keep "hard copy" claim
records.
ARS uses a paperless claim filing system so all file data is available at any
time. ARS operates an internet-based risk management system, C3.This
customized cost containment system allows users to access our system to
view medical information, payment history, wage information, claim
charges and legal information through a secure log-in. This information is
responsible for adjusting your lost time claims as well as overseeing the
activity of all medical only claims.
ccrued sick and/or annual leave payout, such amounts shall be
deducted from these leaves before they are paid to the employee.
- 32 -
l be
reviewed. Please note that injured uniform employees in the Police and Fire Departments are not
placed in Civilian positions at the present time. While an employee is on limited duty status, the
employee's salary rate remains the same as if he/she was working full time without restrictions.
- 5 -
yee or agent of the other for any purpose whatsoever. Neither ARS nor its personnel, employees,
agents, contractors, or servants shall be entitled to any City of Omaha benefits. CLIENT shall not
provide any insurance coverage to ARS or its employees including, but not limited to, workers'
compensation insurance. ARS shall pay all wages, salaries and other amounts due its employees and
shall be responsible for all reports, obligations, and payments pertaining to social security taxation,
income tax withholding, workers' compensation, unemployment compensation, group insurance
coverage, collective bargaining agreements or any other such similar matters. ARS shall have no
authority to bind CLIENT by or with any contract or agreement, nor to impose any liability upon
- 6
ts and take such further action as may be
deemed necessary to more effectively consummate the matters contemplated herein.
5
ttc,n-e_ Ccicri"1t.tSkk!'trt4P 1.. COsy'\
A
ng Allowance,Unit Prices&
Alternates(If applicable). Refer any questions raga dine the Bid or Contract Documents directly to the Park Planning Division a 1,,402.44A-5900 or as noted In the
1 Contract Documents.
I All bidders awarded a contract In the amount of$5,000 or more must comply with the Contract Compliance Ordinance and have on the with the Human Relations Department the Contract
Compliance Report(Form CC-1).This report shalt be in effect for 24 months from the date received by the Human Relations Department Any questions regarding the Contract Compliance
Ordinance or PBEIDEB Listings should be directed to the Human Relations Department at 402.444-5055.
I
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E-Mail Address
74
always the property of the City of Omaha and can be sent to the City at
anytime. Hard copy information is kept within our office ninety days from
the date of scanning to ensure there are no viewing problems with
attachments. The benefit of a paperless environment is that documents
can always be retrieved without the storage retrieval wait time and
reports can be obtained within minutes for prior claim history information.
D. Which of the paid accumulation will be maintained online for individual
cases and/or payment per year?
ARS operates using internet-based risk management software. These
reports are uploaded to our secure internet site for your viewing,
downloading, or printing needs. The City is able to view claim specific
payments at any time. Reports can be generated to meet specific needs
the City may have in regards to capturing certain payment types.
Risk Management reports are run monthly and capture data regarding
the specific policy, as well as data by department, location and/or
specific claimants. These reports can be detailed for paid totals, incurred
total or broken out by payment category. During the implementation
phase ARS will discuss with the City what information you need to see and
how best to submit this information to you.
Attached you will find some sample risk management reports that ARS
currently utilizes for our clients. Specific reports can always be designed to
meet your needs. The fee for training and utilizing our risk management
system is incorporated into the annual administration fee.
E. Would the City have online access to this information?
The City of Omaha will always have online access to claim information as
well as risk management reports. An on-site training session will be
provided to the City so any user will have the capability to maneuver
throughout the system.
F. How do claim auditors flag a possible pre-existing condition? What steps
are taken to verify a pre-existing condition? How do you address an
aggravation to a pre-existing medical condition?
ARS risk management system, C3, has an electronic flag that adjusters
select once a pre-existing condition has been identified. This flag is visible
on any screen when working the claim file. The visual reminder assists the
adjuster when making payments, entering medical information or
authorizing medical care as to potential issues outside the specific injury.
Pre-existing conditions are verified through recorded statements from
employees, prior medical records and possibly an independent medical
examination. Aggravations are addressed in writing to determine the
compensability of the condition.
claims.
ccrued sick and/or annual leave payout, such amounts shall be
deducted from these leaves before they are paid to the employee.
- 32 -
l be
reviewed. Please note that injured uniform employees in the Police and Fire Departments are not
placed in Civilian positions at the present time. While an employee is on limited duty status, the
employee's salary rate remains the same as if he/she was working full time without restrictions.
- 5 -
yee or agent of the other for any purpose whatsoever. Neither ARS nor its personnel, employees,
agents, contractors, or servants shall be entitled to any City of Omaha benefits. CLIENT shall not
provide any insurance coverage to ARS or its employees including, but not limited to, workers'
compensation insurance. ARS shall pay all wages, salaries and other amounts due its employees and
shall be responsible for all reports, obligations, and payments pertaining to social security taxation,
income tax withholding, workers' compensation, unemployment compensation, group insurance
coverage, collective bargaining agreements or any other such similar matters. ARS shall have no
authority to bind CLIENT by or with any contract or agreement, nor to impose any liability upon
- 6
ts and take such further action as may be
deemed necessary to more effectively consummate the matters contemplated herein.
5
ttc,n-e_ Ccicri"1t.tSkk!'trt4P 1.. COsy'\
A
ng Allowance,Unit Prices&
Alternates(If applicable). Refer any questions raga dine the Bid or Contract Documents directly to the Park Planning Division a 1,,402.44A-5900 or as noted In the
1 Contract Documents.
I All bidders awarded a contract In the amount of$5,000 or more must comply with the Contract Compliance Ordinance and have on the with the Human Relations Department the Contract
Compliance Report(Form CC-1).This report shalt be in effect for 24 months from the date received by the Human Relations Department Any questions regarding the Contract Compliance
Ordinance or PBEIDEB Listings should be directed to the Human Relations Department at 402.444-5055.
I
�� n r 1�P) .Q,(1. t MC.
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FaxOloc2T)453 -a7S
Title I(,�}�(, � ��1
Address • city state Zap
t/P.O.Box
E-Mail Address
74
I
G. information be broken down into various departments fo
r
Can claims o p s
Ireporting purposes?
Yes. During the implementation phase ARS will discuss in detail what
' reports and in what format the City would like to see their data, as well as
frequency.
H. What cost is there for any ad hoc reports?
There is no charge for ad hoc reports. It is ARS's policy to provide
informative reports to our clients as required.
I
I
I
I
I
I .
I
I
I
I
I
thereto, the CITY shall pay such medical, surgical and hospital
expenses as may be incurred as a result of the injury or sickness, but
the salary and other benefits, being in excess of benefits under the
Nebraska Workers' Compensation Act, shall be in lieu thereof.
- 30 -
-22
J O CO t a. c
H CI ti 0 C-
IFee Proposal Sheet
March 1, 2011 through December 31, 2011
New cases (Injuries incurred on or after March 1, 2011) •
' $800 per indemnity case
$160 per medical case
I $30 per incident case
Old cases (Injuries incurred prior to March 1, 2011)
There is no charge to adjust claims reported and open prior to March 1,
2011. Claims occurring prior to March 1, 2011 but not reported until after
March 1, 2011 will fall within the new case fee structure.
Fee, if any separate charge,for electronic filing to NWCC for FROI and
SRO! and to Health and Human Services (HHS) for Section 111 filings $0
There is no fee to EDI FROI or SROI to NWCC. There is no charge to
perform Section 111 quarterly queries or report filings.
January 1, 2012, to December 31, 2012
I $825 per indemnity case
$170 per medical case •
' $30 per incident case
Alternate monthly flat fee that would include all administrative procedures
to process and handle old and new cases including electronic filing to
NWCC for FROI and SROI and to Health and Human Services (HHS)for
Section 111 filings
I $8,000.00/mo
January 1, 2013, to December 31, 2013
$825 per indemnity case
$170 per medical case
I $30 per incident case
Alternate monthly flat fee that would include all administrative procedures
to process and handle old and new cases including electronic filing to
NWCC for FROI and SROI and to Health and Human Services (HHS) for
I Section 111 filings
$8,000.00/mo
incorporated into the annual administration fee.
E. Would the City have online access to this information?
The City of Omaha will always have online access to claim information as
well as risk management reports. An on-site training session will be
provided to the City so any user will have the capability to maneuver
throughout the system.
F. How do claim auditors flag a possible pre-existing condition? What steps
are taken to verify a pre-existing condition? How do you address an
aggravation to a pre-existing medical condition?
ARS risk management system, C3, has an electronic flag that adjusters
select once a pre-existing condition has been identified. This flag is visible
on any screen when working the claim file. The visual reminder assists the
adjuster when making payments, entering medical information or
authorizing medical care as to potential issues outside the specific injury.
Pre-existing conditions are verified through recorded statements from
employees, prior medical records and possibly an independent medical
examination. Aggravations are addressed in writing to determine the
compensability of the condition.
claims.
ccrued sick and/or annual leave payout, such amounts shall be
deducted from these leaves before they are paid to the employee.
- 32 -
l be
reviewed. Please note that injured uniform employees in the Police and Fire Departments are not
placed in Civilian positions at the present time. While an employee is on limited duty status, the
employee's salary rate remains the same as if he/she was working full time without restrictions.
- 5 -
yee or agent of the other for any purpose whatsoever. Neither ARS nor its personnel, employees,
agents, contractors, or servants shall be entitled to any City of Omaha benefits. CLIENT shall not
provide any insurance coverage to ARS or its employees including, but not limited to, workers'
compensation insurance. ARS shall pay all wages, salaries and other amounts due its employees and
shall be responsible for all reports, obligations, and payments pertaining to social security taxation,
income tax withholding, workers' compensation, unemployment compensation, group insurance
coverage, collective bargaining agreements or any other such similar matters. ARS shall have no
authority to bind CLIENT by or with any contract or agreement, nor to impose any liability upon
- 6
ts and take such further action as may be
deemed necessary to more effectively consummate the matters contemplated herein.
5
ttc,n-e_ Ccicri"1t.tSkk!'trt4P 1.. COsy'\
A
ng Allowance,Unit Prices&
Alternates(If applicable). Refer any questions raga dine the Bid or Contract Documents directly to the Park Planning Division a 1,,402.44A-5900 or as noted In the
1 Contract Documents.
I All bidders awarded a contract In the amount of$5,000 or more must comply with the Contract Compliance Ordinance and have on the with the Human Relations Department the Contract
Compliance Report(Form CC-1).This report shalt be in effect for 24 months from the date received by the Human Relations Department Any questions regarding the Contract Compliance
Ordinance or PBEIDEB Listings should be directed to the Human Relations Department at 402.444-5055.
I
�� n r 1�P) .Q,(1. t MC.
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FaxOloc2T)453 -a7S
Title I(,�}�(, � ��1
Address • city state Zap
t/P.O.Box
E-Mail Address
74
Terms:
Indemnity Case: any lost time, including permanent or loss of
earning ratings
Medical Cases: only requiring medical attention but no lost
reportable time
Incident Cases: cases that were reports but did not require any
I medical attention
- Additional Fees:
Specify any costs, other than the above listed per case fee that your organization
would charge the City of Omaha during the period of this contract for specific
services/areas identified under this proposal. Please attach a separate sheet
summarizing these additional fees.
Please see the attached sheet.
I .
as a result of the injury or sickness, but
the salary and other benefits, being in excess of benefits under the
Nebraska Workers' Compensation Act, shall be in lieu thereof.
- 30 -
-22
J O CO t a. c
H CI ti 0 C-
Additional Fees:
i
ri Specify any costs, other than the above listed per case fee that your organization
would charge the City of Omaha during the period of this contract for specific
services/areas identified under this proposal. Please attach a separate sheet
summarizing these additional fees.
There is only one additional fee associated with the workers' compensation
program Alternative Risk Services administers. This is an annual program
administration fee of$9,500.00.
This fee covers services outside of the specific claims adjucation duties. This fee
allows for a variety of client services to be performed including;
• Quarterly on site claim reviews
• On-line access to ARS risk management system, C3
• On-site training session for ARS risk management system, C3
• Required State filings to maintain self insurance capabilities
• Assistance with excess insurance placement
• Report customizations and report design as necessary
• Midwest Managed Care assessments on lost time file
• Annual loss analysis
• Quarterly trending of losses
)for
Section 111 filings
I $8,000.00/mo
January 1, 2013, to December 31, 2013
$825 per indemnity case
$170 per medical case
I $30 per incident case
Alternate monthly flat fee that would include all administrative procedures
to process and handle old and new cases including electronic filing to
NWCC for FROI and SROI and to Health and Human Services (HHS) for
I Section 111 filings
$8,000.00/mo
incorporated into the annual administration fee.
E. Would the City have online access to this information?
The City of Omaha will always have online access to claim information as
well as risk management reports. An on-site training session will be
provided to the City so any user will have the capability to maneuver
throughout the system.
F. How do claim auditors flag a possible pre-existing condition? What steps
are taken to verify a pre-existing condition? How do you address an
aggravation to a pre-existing medical condition?
ARS risk management system, C3, has an electronic flag that adjusters
select once a pre-existing condition has been identified. This flag is visible
on any screen when working the claim file. The visual reminder assists the
adjuster when making payments, entering medical information or
authorizing medical care as to potential issues outside the specific injury.
Pre-existing conditions are verified through recorded statements from
employees, prior medical records and possibly an independent medical
examination. Aggravations are addressed in writing to determine the
compensability of the condition.
claims.
ccrued sick and/or annual leave payout, such amounts shall be
deducted from these leaves before they are paid to the employee.
- 32 -
l be
reviewed. Please note that injured uniform employees in the Police and Fire Departments are not
placed in Civilian positions at the present time. While an employee is on limited duty status, the
employee's salary rate remains the same as if he/she was working full time without restrictions.
- 5 -
yee or agent of the other for any purpose whatsoever. Neither ARS nor its personnel, employees,
agents, contractors, or servants shall be entitled to any City of Omaha benefits. CLIENT shall not
provide any insurance coverage to ARS or its employees including, but not limited to, workers'
compensation insurance. ARS shall pay all wages, salaries and other amounts due its employees and
shall be responsible for all reports, obligations, and payments pertaining to social security taxation,
income tax withholding, workers' compensation, unemployment compensation, group insurance
coverage, collective bargaining agreements or any other such similar matters. ARS shall have no
authority to bind CLIENT by or with any contract or agreement, nor to impose any liability upon
- 6
ts and take such further action as may be
deemed necessary to more effectively consummate the matters contemplated herein.
5
ttc,n-e_ Ccicri"1t.tSkk!'trt4P 1.. COsy'\
A
ng Allowance,Unit Prices&
Alternates(If applicable). Refer any questions raga dine the Bid or Contract Documents directly to the Park Planning Division a 1,,402.44A-5900 or as noted In the
1 Contract Documents.
I All bidders awarded a contract In the amount of$5,000 or more must comply with the Contract Compliance Ordinance and have on the with the Human Relations Department the Contract
Compliance Report(Form CC-1).This report shalt be in effect for 24 months from the date received by the Human Relations Department Any questions regarding the Contract Compliance
Ordinance or PBEIDEB Listings should be directed to the Human Relations Department at 402.444-5055.
I
�� n r 1�P) .Q,(1. t MC.
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FaxOloc2T)453 -a7S
Title I(,�}�(, � ��1
Address • city state Zap
t/P.O.Box
E-Mail Address
74
EXHIBIT D
EQUAL OPPORTUNITY CLAUSE
During the performance of this contract, the contractor agrees as follows:
1) The contractor shall not discriminate against any employee applicant for employment because of
race, religion, color, sex, national origin, or disability as defined by the Americans With
Disabilities Act of 1990 and Omaha Municipal Code 13-82. The contractor shall take
affirmative action to ensure that applicants are employed and that employees are treated during
employment without regard to their race, religion, color, sex or national origin. The contractor
shall take all actions necessary to comply with the Americans With Disabilities Act of 1990 and
Omaha Municipal Code (Chapter 13) including, but not limited to, reasonable accommodation.
As used herein, the word "treated" shall mean and include, without limitation, the following:
Recruited, whether advertising or by other means; compensated; selected for training, including
apprenticeship; promoted; upgraded; demoted; downgraded; transferred; laid off; and terminated.
The contractor agrees to and shall post in conspicuous places, available to employees and
applicants for employment, notices to be provided by the contracting officers setting forth the
provisions of this nondiscrimination clause.
2) The contractor shall, in all solicitations or advertisements for employees placed by or on behalf
of the contractor, state that all qualified applicants will receive consideration for employment
without regard to race, religion, color, sex or national origin.
3) The contractor shall send to each labor union or representative of workers with which he has a
collective bargaining agreement or other contract or understanding a notice advising the labor
union or worker's representative of the contractor's commitments under the equal employment
opportunity clause of the city and shall post copies of the notice in conspicuous places available
to employees and applicants for employment.
4) The contractor shall furnish to the contract compliance officer all federal forms containing the
information and reports required by the federal government for federal contracts under federal
rules and regulations, and including the information required by section 10-192 to 10-194,
inclusive, and shall permit reasonable access to his records. Records accessible to the contract
compliance officer shall be those which are related to paragraphs (1) through (7) of this
subsection and only after reasonable notice is given the contractor. The purpose of this provision
is to provide for investigation to ascertain compliance with the program provided for herein.
5) The contractor shall take such actions with respect to any subcontractor as the city may direct as
a means of enforcing the provisions of paragraphs (1) through (7) herein, including penalties and
sanctions for noncompliance; however, in the event the contractor becomes involved in or is
threatened with litigation as the result of such directions by the city, the city will enter into such
litigation as is necessary to protect the interests of the city and to effectuate these provisions (of
this division); and in the case of contracts receiving federal assistance, the contractor or the city
he other for any purpose whatsoever. Neither ARS nor its personnel, employees,
agents, contractors, or servants shall be entitled to any City of Omaha benefits. CLIENT shall not
provide any insurance coverage to ARS or its employees including, but not limited to, workers'
compensation insurance. ARS shall pay all wages, salaries and other amounts due its employees and
shall be responsible for all reports, obligations, and payments pertaining to social security taxation,
income tax withholding, workers' compensation, unemployment compensation, group insurance
coverage, collective bargaining agreements or any other such similar matters. ARS shall have no
authority to bind CLIENT by or with any contract or agreement, nor to impose any liability upon
- 6
ts and take such further action as may be
deemed necessary to more effectively consummate the matters contemplated herein.
5
ttc,n-e_ Ccicri"1t.tSkk!'trt4P 1.. COsy'\
A
ng Allowance,Unit Prices&
Alternates(If applicable). Refer any questions raga dine the Bid or Contract Documents directly to the Park Planning Division a 1,,402.44A-5900 or as noted In the
1 Contract Documents.
I All bidders awarded a contract In the amount of$5,000 or more must comply with the Contract Compliance Ordinance and have on the with the Human Relations Department the Contract
Compliance Report(Form CC-1).This report shalt be in effect for 24 months from the date received by the Human Relations Department Any questions regarding the Contract Compliance
Ordinance or PBEIDEB Listings should be directed to the Human Relations Department at 402.444-5055.
I
�� n r 1�P) .Q,(1. t MC.
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FaxOloc2T)453 -a7S
Title I(,�}�(, � ��1
Address • city state Zap
t/P.O.Box
E-Mail Address
74
•
may request the United States to enter into such litigation to protect the interests of the United
States.
6) The contractor shall file and shall cause his subcontractors, if any to file compliance reports with
the contractor in the same form and to the same extent as required by the federal government for
federal contracts under federal rules and regulations. Such compliance reports shall be filed with
the contract compliance officer. Compliance reports filed at such times as directed shall contain
information as to the employment practices, policies, programs and statistics of the contractor
and his subcontractors.
7) The contractor shall include the provisions of paragraphs (1) through (7) of this section, "Equal
Employment Opportunity Clause," and section 10-193 in every subcontract of purchase order so
that such provisions will be binding upon each subcontractor or vendor.
p:\law-city council documents\2011\10055dae.doc
1
training, including
apprenticeship; promoted; upgraded; demoted; downgraded; transferred; laid off; and terminated.
The contractor agrees to and shall post in conspicuous places, available to employees and
applicants for employment, notices to be provided by the contracting officers setting forth the
provisions of this nondiscrimination clause.
2) The contractor shall, in all solicitations or advertisements for employees placed by or on behalf
of the contractor, state that all qualified applicants will receive consideration for employment
without regard to race, religion, color, sex or national origin.
3) The contractor shall send to each labor union or representative of workers with which he has a
collective bargaining agreement or other contract or understanding a notice advising the labor
union or worker's representative of the contractor's commitments under the equal employment
opportunity clause of the city and shall post copies of the notice in conspicuous places available
to employees and applicants for employment.
4) The contractor shall furnish to the contract compliance officer all federal forms containing the
information and reports required by the federal government for federal contracts under federal
rules and regulations, and including the information required by section 10-192 to 10-194,
inclusive, and shall permit reasonable access to his records. Records accessible to the contract
compliance officer shall be those which are related to paragraphs (1) through (7) of this
subsection and only after reasonable notice is given the contractor. The purpose of this provision
is to provide for investigation to ascertain compliance with the program provided for herein.
5) The contractor shall take such actions with respect to any subcontractor as the city may direct as
a means of enforcing the provisions of paragraphs (1) through (7) herein, including penalties and
sanctions for noncompliance; however, in the event the contractor becomes involved in or is
threatened with litigation as the result of such directions by the city, the city will enter into such
litigation as is necessary to protect the interests of the city and to effectuate these provisions (of
this division); and in the case of contracts receiving federal assistance, the contractor or the city
he other for any purpose whatsoever. Neither ARS nor its personnel, employees,
agents, contractors, or servants shall be entitled to any City of Omaha benefits. CLIENT shall not
provide any insurance coverage to ARS or its employees including, but not limited to, workers'
compensation insurance. ARS shall pay all wages, salaries and other amounts due its employees and
shall be responsible for all reports, obligations, and payments pertaining to social security taxation,
income tax withholding, workers' compensation, unemployment compensation, group insurance
coverage, collective bargaining agreements or any other such similar matters. ARS shall have no
authority to bind CLIENT by or with any contract or agreement, nor to impose any liability upon
- 6
ts and take such further action as may be
deemed necessary to more effectively consummate the matters contemplated herein.
5
ttc,n-e_ Ccicri"1t.tSkk!'trt4P 1.. COsy'\
A
ng Allowance,Unit Prices&
Alternates(If applicable). Refer any questions raga dine the Bid or Contract Documents directly to the Park Planning Division a 1,,402.44A-5900 or as noted In the
1 Contract Documents.
I All bidders awarded a contract In the amount of$5,000 or more must comply with the Contract Compliance Ordinance and have on the with the Human Relations Department the Contract
Compliance Report(Form CC-1).This report shalt be in effect for 24 months from the date received by the Human Relations Department Any questions regarding the Contract Compliance
Ordinance or PBEIDEB Listings should be directed to the Human Relations Department at 402.444-5055.
I
�� n r 1�P) .Q,(1. t MC.
(Please Print Legibly or Type) Firm n.Gt�j1 r1u�Yn 11T y te)Incorporated in
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FaxOloc2T)453 -a7S
Title I(,�}�(, � ��1
Address • city state Zap
t/P.O.Box
E-Mail Address
74
C-25A CITY OF OMAHA
LEGISLATIVE CHAMBER
Omaha,Nebraska
RESOLVED BY THE CITY COUNCIL OF THE CITY OF OMAHA:
WHEREAS, the City of Omaha is a court approved self insured employer pursuant to
Section 48-145 of the Nebraska Workers' Compensation Act and has established a,self-funded
workers' compensation program; and,
WHEREAS, the City requested proposals for third party administration of its self funded
workers' compensation program and selected Alternate Risk Services from among the
responders to provide coordinated administration, claims, and risk management information
system services in connection with said program; and,
WHEREAS, attached hereto is a Service Agreement between the City of Omaha and
Alternate Risk Services setting forth the terms and conditions of the provision of such third party
administration services for the period March 1, 2011 through December 31, 2011; and,
WHEREAS, it is in the best interests of the citizens of the City of Omaha to approve the
attached Service Agreement.
NOW THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF
OMAHA:
THAT, the attached Service Agreement between the City of Omaha and Alternate Risk
Services for the provision of third party administration services for the City's self insured
workers' compensation program for the period March 1, 2011 through December 31, 2011 in the _
amount of$87,920 is hereby approved.
FURTHER THAT, the Finance Director is authorized to pay the cost thereof, in
accordance with the terms of the Service Agreement, from General Fund 11111, Organization
105011.
APPROVED AS TO FORM:
6 -0/1 ' 1/
TY CIT ATTORNEY DATE
p:\law-city council documents\2011\10045dae.doc
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By f. /.
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Adopted AR .—.1 2011 o.
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Approved...
Mayor
r employment.
4) The contractor shall furnish to the contract compliance officer all federal forms containing the
information and reports required by the federal government for federal contracts under federal
rules and regulations, and including the information required by section 10-192 to 10-194,
inclusive, and shall permit reasonable access to his records. Records accessible to the contract
compliance officer shall be those which are related to paragraphs (1) through (7) of this
subsection and only after reasonable notice is given the contractor. The purpose of this provision
is to provide for investigation to ascertain compliance with the program provided for herein.
5) The contractor shall take such actions with respect to any subcontractor as the city may direct as
a means of enforcing the provisions of paragraphs (1) through (7) herein, including penalties and
sanctions for noncompliance; however, in the event the contractor becomes involved in or is
threatened with litigation as the result of such directions by the city, the city will enter into such
litigation as is necessary to protect the interests of the city and to effectuate these provisions (of
this division); and in the case of contracts receiving federal assistance, the contractor or the city
he other for any purpose whatsoever. Neither ARS nor its personnel, employees,
agents, contractors, or servants shall be entitled to any City of Omaha benefits. CLIENT shall not
provide any insurance coverage to ARS or its employees including, but not limited to, workers'
compensation insurance. ARS shall pay all wages, salaries and other amounts due its employees and
shall be responsible for all reports, obligations, and payments pertaining to social security taxation,
income tax withholding, workers' compensation, unemployment compensation, group insurance
coverage, collective bargaining agreements or any other such similar matters. ARS shall have no
authority to bind CLIENT by or with any contract or agreement, nor to impose any liability upon
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ts and take such further action as may be
deemed necessary to more effectively consummate the matters contemplated herein.
5
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A
ng Allowance,Unit Prices&
Alternates(If applicable). Refer any questions raga dine the Bid or Contract Documents directly to the Park Planning Division a 1,,402.44A-5900 or as noted In the
1 Contract Documents.
I All bidders awarded a contract In the amount of$5,000 or more must comply with the Contract Compliance Ordinance and have on the with the Human Relations Department the Contract
Compliance Report(Form CC-1).This report shalt be in effect for 24 months from the date received by the Human Relations Department Any questions regarding the Contract Compliance
Ordinance or PBEIDEB Listings should be directed to the Human Relations Department at 402.444-5055.
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as a result of the injury or sickness, but
the salary and other benefits, being in excess of benefits under the
Nebraska Workers' Compensation Act, shall be in lieu thereof.
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