HomeMy WebLinkAboutCity of Tamarac Resolution R-2004-217Temp. Reso. #10634
September 13, 2004
Page 1
Revision 1 - September 13, 2004
CITY OF TAMARAC, FLORIDA
RESOLUTION NO. R-2004- ,2/'7
A RESOLUTION OF THE CITY COMMISSION OF
THE CITY OF TAMARAC, FLORIDA, AUTHORIZING
THE APPROPRIATE CITY OFFICIALS TO AWARD
RFP 04-27R, WORKERS' COMPENSATION
INSURANCE, EMPLOYER'S LIABILITY INSURANCE
AND CLAIMS ADMINISTRATION WITH THE
FLORIDA MUNICIPAL INSURANCE TRUST FOR A
ONE (1) YEAR PERIOD BEGINNING OCTOBER 1,
2004 AT A COST OF $459,476 AND PAYMENT OF
ANY INCREASE RESULTING FROM THE ANNUAL
PREMIUM AUDIT; PROVIDING FOR CONFLICTS;
PROVIDING FOR SEVERABILITY; AND PROVIDING
FOR AN EFFECTIVE DATE.
WHEREAS, the City's Workers' Compensation Insurance, Employer's
Liability Insurance and Claims Administrative Service is scheduled to expire with
Florida Municipal Insurance Trust (FMIT) on October 1, 2004; and
WHEREAS, a Request for Proposal (RFP) for the City's Workers'
Compensation Insurance, Employer's Liability Insurance, and Claims
Administration Service was issued; and
WHEREAS, on August 19, 2004 the City received four proposals from:
Johns Eastern, the FMIT, Multi -Line Claims Service, and the Public Risk
Insurance Agency (PRIA); and
WHEREAS, the City Manager appointed a proposal evaluation committee
consisting of the Fire Rescue Division Chief, the Benefits Coordinator, the City
Manager's Office Management Intern, and the Risk & Safety Manager; and
WHEREAS, the process was facilitated by the Purchasing and Contracts
Manager; and
Temp. Reso. #10534
September 13, 2004
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WHEREAS, Johns Eastern and Multi -Line Claims Service were
considered as non -responsive due to their failure to provide pricing for Workers'
Compensation and Employer's Liability Insurance; and
WHEREAS, the proposals were evaluated, presentations were given by
the two remaining proposers, FMIT and PRIA, and after careful consideration of
all aspects of the proposals, the final ranking by the Evaluation Committee was:
(1) FMIT; and (2) PRIA; and
WHEREAS, Workers' Compensation Insurance, Employer's Liability
Insurance and Claims Administration premiums were anticipated and were
budgeted for accordingly in the FY05 Budget; and
WHEREAS, if the City awards its Workers' Compensation, Employer's
Liability, and Claims Administration Service to the FMIT, FMIT will provide
payment for all defense costs incurred with the City being responsible for
settlement and judgment costs up to $25,000 per claim for Workers'
Compensation and Employer's Liability; and
WHEREAS, the City's policy with the FMIT for Workers' Compensation
and Employer's Liability are quoted as an estimated annual premium, and are
subject to adjustment based on the annual premium audit; and
WHEREAS it is the recommendation of the City Manager and the Director
of Human Resources that RFP 04-27R (hereto attached as Exhibit 1) be
awarded to and coverage be executed with the FMIT for a one year period
beginning effective October 1, 2004 based on the RPF proposal of $459,476 as
submitted by FMIT (hereto attached as Exhibit 2) and to pay any additional
Temp. Reso. #10534
September 13, 2004
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premium resulting from the annual premium audit which has been approved by
the City manager after notification to the City Commission; and
WHEREAS, the City Commission of the City of Tamarac, Florida deems it
to be in the best interest of the citizens and residents of the City of Tamarac to
award RFP 04-27R for the Workers' Compensation Insurance, Employer's
Liability Insurance, and Claims Administration policies to the FMIT for a one year
period beginning on October 1, 2004 as outlined above.
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COMMISSION OF
THE CITY OF TAMARAC, FLORIDA:
SECTION 1: The foregoing "WHEREAS" clauses are hereby
ratified and confirmed as being true and correct and are hereby made a specific
part of this Resolution.
SECTION 2: That the appropriate City officials of the City of
Tamarac are authorized to award the RFP for Workers' Compensation
Insurance, Employer's Liability Insurance, and Claims Administration Service to
the FMIT for a one year period beginning on 10/1/04 at a cost of $459,476 per
the proposal (hereto attached as Exhibit 2) with said lines of coverage to expire
on October 1, 2005, and to pay any additional premium resulting from the annual
premium audit which has been approved by the City Manager after notification to
the City Commission.
SECTION 3: All resolutions or parts of resolutions in conflict
herewith are hereby repealed to the extent of such conflict.
SECTION 4: If any clause, section, or other part or application of
this Resolution is held by any court of competent jurisdiction to be
Temp. Reso. #10534
September 13, 2004
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unconstitutional or invalid, in part or application, it shall not affect the validity of
the remaining portions or applications of this Resolution.
SECTION 5: This Resolution shall become effective immediately
upon its passage and adoption.
PASSED, ADOPTED AND APPROVED this 22ND day of September, 2004.
ATTEST:
MARION SWENSON, CMC
CITY CLERK
I HEREBY CERTIFY that
I have approved this
RESOLUTION as to form.
MITCHEY-L S. KRAF
CITY ATTORNEY
JOE SCHREIBER
MAYOR
RECORD OF COMMISSION VOTE:
MAYOR SCHREIBER
DIST 1: COMM. PORTNER
DIST 2: COMM. FLANSBAUM-TALAB
DIST 3: V/M SULTANOF
DIST 4: COMM. ROBERTS 4,1wpwi
1
1
EXHIBIT 1
REQUEST FOR PROPOSALS
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RFP 04-27R
Worker's Compensation, Employer's
Liability and Claims Administration
City of Tamarac
Purchasing Division
7525 NW 881h Avenue
Room 108
Tamarac, Florida 33321-2401
(954) 724-2450
SUBMIT PROPOSAL TO:
CITY OF TAMARAC
PURCHASING AND CONTRACTS DIVISION
7525 NW 88TH AVENUE
TAMARAC, FL 33321
954-724-2450
REQUEST FOR PROPOSALS
Proposer Acknowledgement
RFP NO.: 04-27R
RFP TITLE: Worker's Compensation, Employer's Liability and Claims Administration
PROPOSAL OPENING DATE/TIME: August 19, 2004, 4:00 PM local time
BUYER NAME: Keith K. Glatz, CPPO
BUYER PHONE: 954-724-1322
BUYER EMAIL: keithg@tamarac.org
PRE -PROPOSAL CONFERENCE/SITE INSPECTION: N/A
BONDING: N/A
GENERAL CONDITIONS
THESE INSTRUCTIONS ARE STANDARD FOR ALL PROPOSALS FOR SERVICES ISSUED BY THE CITY OF TAMARAC. THE CITY OF
TAMARAC MAY DELETE, SUPERSEDE OR MODIFY ANY OF THESE STANDARD INSTRUCTIONS FOR A PARTICULAR PROPOSAL
BY iNDICATING SUCH CHANGE IN THE INSTRUCTIONS TO OFFERORS OR IN THE SPECIAL CONDITIONS OF THE PROPOSAL.
ANY AND ALL SPECIAL CONDITIONS THAT MAY VARY FROM THESE GENERAL CONDITIONS SHALL PREVAIL OVER ANY
CONFLICTING PROVISION WITHIN ANY VENDOR'S STANDARD TERMS AND CONDITIONS REGARDLESS OF ANY LANGUAGE IN
VENDOR'S DOCUMENTATION TO THE CONTRARY.
SEALED PROPOSALS
THIS FORM SHOULD BE EXECUTED AND SUBMITTED WITH ALL PROPOSAL FORMS IN A SEALED ENVELOPE. THE FACE OF THE
ENVELOPE SHALL CONTAIN THE ABOVE ADDRESS, THE RFP NUMBER AND THE RFP TITLE, PROPOSALS NOT SUBMITTED ON
THE ATTACHED PROPOSAL FORM MAY BE DEEMED NON -RESPONSIVE. ALL PROPOSALS ARE SUBJECT TO THE TERMS AND
CONDITIONS SPECIFIED HEREIN. THOSE PROPOSALS THAT DO NOT COMPLY WITH THESE CONDITIONS MAY BE DEEMED NOW
RESPONSIVE.
PROPOSER COMPANY NAME:
COMPANY ADDRESS:
COMPANY PHONE:
NAME OF AUTHORIZED AGENT:
TITLE OF AUTHORIZED AGENT:
AUTHORIZED AGENT EMAIL ADDRESS:
PROPOSER TAXPAYER ID OR SOCIAL SECURITY NUMBER:
SIGNATURE OF AUTHORIZED AGENT:
I certify that this Proposal Acknowledgement is made without prior understanding, agreement or connection with any
corporation, firm or person submitting a Proposal for the same commodities and/or services and is in all respects fair and
without collusion or fraud. I agree to abide by all conditions of this Proposal and certify that I am authorized to sign this
Proposal as an agent for the Proposer.
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It is the intent of the City to award a contract to the
responsible and responsive Proposer whose proposal is
determined to be the most advantageous to the City, taking
into consideration price and response to the evaluation
criteria set forth herein. The City reserves the right to accept
or reject any or all Proposals and to waive any informality
concerning the Proposals when such rejection or waiver is
deemed to be in the best interest of the City. The City
reserves the right to award the contract on a split order, lump
sum or individual item basis unless otherwise stated,
whichever is in the best interest of the City.
This solicitation is issued pursuant to the City of Tamarac
Code, Chapter 6, "Finance & Taxation", Article V,
"Purchasing Procedures", Section 6-141 at seq.
GENERAL TERMS AND CONDITIONS
These general terms and conditions apply to all offers made
to the City of Tamarac by all prospective Proposers including
but not limited to Requests for Quotes, Invitations to Bid and
Requests for Proposals. As such the words "bid" and
"proposal" are used interchangeably in reference to all offers
submitted by prospective Proposers.
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The Proposer is directed to deliver sealed Proposals to the
City of Tamarac, Purchasing Division, 7525 N. W. 88th
Avenue, Room 108, Tamarac, Florida 33321, no later than
the date and time specified on the Proposal
Acknowledgement page of this document. At the specified
time, the Proposals will be opened, the names of all
Proposers will be announced and all Proposals shall become
a matter of public record. All Proposers and their
representatives are invited to attend. The Proposer should
show the RFP number, RFP title, and the time and date of
the Proposal opening on the outside of the sealed Proposal
package. Delivery of the sealed Proposals to the Purchasing
Office on or before the above date and time is solely and
strictly the responsibility of the Proposer. Late Proposals will
NOT be accepted and will be returned unopened to the
Proposer.
It is the Proposer's responsibility to read and understand the
requirements of this Proposal. Unless otherwise specified,
the Proposer must use the Proposal form furnished in the
Proposal document. The Proposer shall submit one (1)
original and five (5) copies of the Proposal. The original
Proposal must be manually and duly signed in ink by a
Corporate Manager, Principal, or Partner with the
authority to bind the bidding company or fine by his/her
signature. All Proposal forms must be typewritten or
completed in ink. The Proposer must initial any erasures or
corrections in ink, All prices, terms and conditions quoted in
the submitted Proposal will be firm for acceptance for sixty
days from the date of the Proposal opening unless otherwise
stated by the City.
The Proposer preparing a Proposal in response to this
solicitation shall bear all expenses associated with its
preparation. The Proposer shall prepare a Proposal with the
understanding that no claim for reimbursement shall be
submitted to the City for expenses related to its preparation.
2. WITHDRAWAL OF PROPOSAL
Any Proposer may withdraw its Proposal prior to the indicated
opening time. The request for withdrawal must be submitted
in writing to the Purchasing Office.
3. PUBLIC ENTITY CRIMES STATEMENT
A person or affiliate who has been placed on the convicted
vendor list following a conviction for public entity crime may
not submit a Proposal on a contract to provide any goods or
services to a public entity, may not submit a Proposal on a
contract with a public entity for the construction or repair of a
public building or public work, may not submit Proposals on
leases of real property to a public entity, may not be awarded
or perform work as a contractor, supplier, subcontractor, or
consultant under a contract with any public entity, and may
not transact business with any public entity in excess of the
threshold amount provided in Section 287.017, for Category
Two, for a period of 36 months from the date of being placed
on the convicted vendor list.
4. NON -COLLUSIVE AFFIDAVIT
Each Firm shall complete the Non -Collusive Affidavit Form
and shall submit this form with the bid/proposal. The City
considers the failure of the Firm to submit this document to be
a major irregularity, and may be cause for rejection of the
Proposal.
5. CONFLICT OF INTEREST
The award hereunder is subject to the provisions of Chapter
112 of the State of Florida Statutes. Proposers shall disclose
the name of any Manager, director, partner, proprietor,
associate or agent who is also a public Manager or employee
of the City or any of its agencies.
6. QUANTITIES
Quantities shown are estimates only. No guarantee or
warranty is given or implied by the City as to the total amount
that may or may not be purchased from any resulting
contract. The City reserves the right to decrease or increase
quantities or add or delete any item from the contract if it is
determined that it best serves the interests of the City.
7. PRICES, PAYMENTS AND DISCOUNTS
Proposal prices shall be fixed and firm to the extent required
under Special Conditions. In the absence of a reference in
the Special Conditions, Proposal prices shall be fixed and
firm for a period of sixty (60) calendar days, or ninety (90)
calendar days when the contract must be approved by
another agency. Payment will be made only after receipt and
acceptance of materials/services. Cash discounts may be
offered for prompt payment; however, such discounts shall
not be considered in determining the lowest net cost for
Proposal evaluation.
Proposers are encouraged to provide prompt payment terms
on the Proposal Form. Payment is deemed made on the date
of the mailing of the check. All payments shall be governed
by the Florida Prompt Payment Act, F.S. Chapter 218.
8. SAMPLES AND DEMONSTRATIONS
When requested, samples are to be furnished free of charge
to the City. If a sample is requested it must be delivered
within seven days of the request unless otherwise stated in
the Proposal. Each sample must be marked with the
Proposer's name and manufacturer's brand name. The City
will not be responsible for returning samples. The City may
request a full demonstration of any product or service before
the award of a contract. All demonstrations will be done at the
expense of the Proposer.
.................................................................................................... .
9. BACKGROUND INVESTIGATION
As a part of the Proposal evaluation process, the City may
conduct a background investigation including a criminal record
check by the Broward County Sheriffs Office of Proposer's
Managers and/or employees. Proposer's submission of a
Proposal constitutes acknowledgement of and consent to such
investigation. City shall be the sole judge in determining
Proposers qualifications.
10. CONDITIONS OF MATERIALS
All materials and products supplied by the Proposer in
conjunction with this Proposal shall be new, warranted for
their merchantability, fit for a particular purpose, free from
defects and consistent with industry standards. The products
shall be delivered to the City in excellent condition. In the
event that any of the products supplied to the City are found
to be defective or do not conform to the specifications, the
City reserves the right to return the product to the Proposer at
no cost to the City.
Successful Proposer shall furnish all guarantees and
warranties to the Purchasing Office prior to final acceptance
and payment. The warranty period shall commence upon
final acceptance of the product.
11. COPYRIGHTS OR PATENT RIGHTS
The Proposer warrants that there has been no violation of
copyrights or patent rights in manufacturing, producing or
selling the goods shipped or ordered as a result of this
Proposal. The seller agrees to hold the City harmless from all
liability, loss or expense occasioned by any such violation.
12. SAFETY STANDARDS
The Proposer warrants that the product(s) supplied to the City
conform in all respects to the standards set forth in the
Occupational Safety and Health Act and its amendments to
any industry standards, if applicable.
13. PERFORMANCE
Failure on the part of the successful Proposer to comply with
the conditions, terms, specifications and requirements of the
Proposal shall be just cause for cancellation of the Proposal
award. The City may, by written notice to the successful
Proposer, terminate the contract for failure to perform. The
date of termination shall be stated in the notice. The City shall
be the sole judge of nonperformance.
14. INSPECTION
The City shall have the right to inspect any materials,
components, equipment, supplies, services or completed work
specified herein. Any of said items not complying with these
specifications are subject to rejection at the option of the City.
Any items rejected shall be removed from City premises and/or
replaced at the entire expense of the successful vendor.
16. TERMINATION
a. DEFAULT
Default by Contractor: In addition to all other remedies
available to the City, this Agreement shall be subject
to cancellation by the City should the Contractor
neglect or fail to perform or observe any of the terms,
provisions, conditions, or requirements herein
contained, if such neglect or failure shall continue for a
period of thirty (30) days after receipt by Contractor of
written notice of such neglect or failure.
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and Contracls Division
b. TERMINATION FOR CONVENIENCE OF CITY
Upon seven (7) calendar days written notice delivered
by certified mail, return receipt requested, to the
Proposer, the City may without cause and without
prejudice to any other right or remedy, terminate the
agreement for the City's convenience whenever the
City determines that such termination is in the best
interest of the City. Where the agreement is
terminated for the convenience of the City, the notice
of termination to the Proposer must state that the
contract is being terminated for the convenience of the
City under the termination clause and the extent of
termination. Upon receipt of the notice of termination
for convenience, the Proposer shall promptly
discontinue all work at the time and to the extent
indicated on the notice of termination, shall terminate
all outstanding sub -contractors and purchase orders to
the extent that they relate to the terminated portion of
the Contract, and refrain from placing further orders
and sub -contracts except as they may be necessary,
and shall complete any continued portions of the work.
c. FUNDING OUT
This agreement shall remain in full force and effect
only as long as the expenditures provided for in the
Agreement have been appropriated by the City
Commission of the City of Tamarac in the annual
budget for each fiscal year of this Agreement, and is
subject to termination based on lack of funding.
16. ASSIGNMENT
The Proposer shall not transfer or assign the performance
required by this Proposal without the prior written consent of
the City. Any award issued pursuant to this Proposal and
monies that may become due hereunder are not assignable
except with prior written approval of the City.
17. EMPLOYEES
Employees of the Proposer shall at all times be under its sole
direction and not an employee or agent of the City. The
Proposer shall supply competent and physically capable
employees. The City may require the Proposer to remove an
employee it deems careless, incompetent, insubordinate or
otherwise objectionable. Proposer shall be responsible to the
City for the acts and omissions of all employees working under
its directions.
18. EQUAL EMPLOYMENT OPPORTUNITY
No firm shall discriminate against any employee or applicant for
employment because of race, religion, color, gender, national
origin, or physical or mental handicap if qualified. Firm shall
take affirmative action to ensure that applicants are employed,
and that employees are treated during their employment
without regard to their race, religion, color, gender, national
origin, or physical or mental handicap. Such actions shall
include, but not be limited to the following: employment,
upgrading, demotion or transfer, recruitment or recruitment
advertising, layoff or termination, rates of pay or other forms of
compensation; and selection for training, including
apprenticeship. The firm agrees to post in conspicuous places,
available to employees and applicants for employment, notices
setting forth the provisions of this non-discrimination clause.
The firm further agrees it will ensure that subcontractors, if any,
will be made aware of and will comply with this
nondiscrimination clause.
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19. TAXES
The City of Tamarac is exempt from all Federal, State, and
Local taxes. An exemption certificate will be provided where
applicable upon request.
20. OMISSION OF DETAILS
Omission of any essential details from these specifications
will not relieve the Proposer of supplying such product(s) as
specified.
21. INSURANCE REQUIREMENTS
Proposer agrees to, in the performance of work and services
under this Agreement, comply with all federal, state, and local
laws and regulations now in effect, or hereinafter enacted
during the term of this agreement that are applicable to
Successful Proposer, its employees, agents, or
subcontractors, if any, with respect to the work and services
described herein.
Proposer shall obtain at Proposer's expense all necessary
insurance in such form and amount as required by the City's
Risk & Safety Manager before beginning work under this
Agreement. Proposer shall maintain such insurance in full
force and effect during the life of this Agreement. Proposer
shall provide to the City's Risk & Safety Manager certificates
of all insurance required under this section prior to beginning
any work under this Agreement. Proposer shall indemnify
and save the City harmless from any damage resulting to it
for failure of either Proposer or any subcontractor to obtain or
maintain such insurance.
The following are required types and minimum limits of
insurance coverage, which the Proposer agrees to maintain
during the term of this contract:
Line of Business/ Occurrence Aggregate
Coverage
Commercial General $1,000,000 $1,000,000
Liability
Including:
Premises/Operations
Contractual Liability
Personal Injury
Explosion, Collapse, Underground Hazard
Products/Completed Operations
Broad Form Property Damage
Cross Liability and Severability of Interest Clause
Automobile Liability $1,000,000 $1,000,000
Workers' Compensation & Statutory
Employer's Liability
The City reserves the right to require higher limits depending
upon the scope of work under this Agreement,
Neither Proposer nor any subcontractor shall commence
work under this contract until they have obtained all insurance
required under this section and have supplied the City with
evidence of such coverage in the form of an insurance
certificate and endorsement. The Proposerwill ensure that all
subcontractors will comply with the above guidelines and will
maintain the necessary coverage throughout the term of this
Agreement.
All insurance carriers shall be rated at least A-VII per A.M.
Best's Key Rating Guide and be licensed to do business in
Florida. Policies shall be "Occurrence" form.
Each carrier will give the City sixty (60) days notice prior to
cancellation.
The Proposer's liability insurance policies shall be endorsed
to add the City of Tamarac as an "additional insured". The
Proposer's Worker's Compensation carrier will provide a
Waiver of Subrogation to the City. The Proposer shall be
responsible for the payment of all deductibles and self -
insured retentions.
The City may require that the Proposer purchase a bond to
cover the full amount of the deductible or self -insured
retention. If the Proposer is to provide professional services
under this Agreement, the Proposer must provide the City
with evidence of Professional Liability insurance with, at a
minimum, a limit of $1,000,000 per occurrence and in the
aggregate. "Claims -Made" forms are acceptable for
Professional Liability insurance.
22. INDEMNIFICATION
The Proposer shall indemnify and hold harmless the City of
Tamarac, its elected and appointed officials and employees
from any and all claims, suits, actions, damages, liability, and
expenses (including attorneys' fees) in connection with loss of
life, bodily or personal injury, or property damage, including
loss of use thereof, directly or indirectly caused by, resulting
from, arising out of or occurring in connection with the
operations of the Proposer or his Subcontractors, agents,
Managers, employees or independent contractors, excepting
only such loss of life, bodily or personal injury, or property
damage solely attributable to the gross negligence or willful
misconduct of the City of Tamarac or its elected or appointed
officials and employees.
23. CLARIFICATION & ADDENDA
Where there appekOfte variances or conflicts between the
General Terms and Conditions and the Special Conditions
and/or Detailed Specifications outlined in this Proposal, the
Special Conditions and/or the Detailed Specifications shall
prevail.
The Proposer shall examine all Proposal documents and
shall judge all matters relating to the adequacy and accuracy
of such documents. If, upon review, any material errors in
specifications are found, the Proposer shall contact the
Purchasing Office immediately. Any inquires, suggestions,
requests concerning clarification, or requests for additional
information shall be submitted in writing to the Purchasing
and Contracts Manager_
The City of Tamarac reserves the right to amend this
Proposal prior to the Proposal opening date indicated by
written addenda. Written addenda shall serve as the sole
means of clarification. The City shall not be responsible for
oral interpretations given by any City employee or its
representative.
24. PUBLIC RECORDS
Pursuant to F.S. §119.07(1)(m), sealed Proposals or
proposals received by an agency pursuant to invitations to
bid or requests for proposals are exempt from the provisions
of subsection (1) and s. 24(a), Article I of the State
Constitution until such time as the agency provides notice of
a decision or intended decision pursuant to F.S.
§120.57(3)(a), or within 10 days after bid/proposal opening,
whichever is earlier.
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25. RECORDSMUDITS
The Successful Proposer shall maintain during the term of
the contract all books, reports and records in accordance with
generally accepted accounting practices and standards for
records directly related to this contract. The form of all
records and reports shall be subject to the approval of the
City's Auditor. The Successful Proposer agrees to make
available to the City's Auditor, during normal business hours
and in Broward, Dade or Palm Beach Counties, all books of
account, reports and records relating to this contract for the
duration of the contract and retain them for a minimum period
of one (1) year beyond the last day of the contract term.
26. UNIT PRICES
Where a discrepancy between unit price and total price is
indicated on a Proposer's submitted Price Proposal Form, the
unit prices shall prevail.
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INSTRUCTIONS TO OFFERORS
STANDARD TERMS AND CONDITIONS
RFP 04-27R
DEFINED TERMS
Terms used in these Instructions to Offerors are defined as follows:
1.1. "Offeror" - one who submits a Proposal in response to a solicitation, as distinct
from a Sub -Offeror, who submits a Proposal to the Offeror.
1.2. "Proposer' -- one who submits a Proposal in response to a solicitation. The
terms "Offeror" and "Proposer" are used interchangeably and have the same
meaning.
1.3. "Successful Offeror"- the qualified, responsible and responsive Offeror to whom
City (on the basis of City's evaluation as hereinafter provided) makes an award.
1.4. "City" - the City of Tamarac, a municipal corporation of the State of Florida.
1.5. "Proposal Documents" - the Request for Proposals, Instructions to Offerors,
Offeror's Qualifications Statement, Non -Collusive Affidavit, Certified Resolution,
Vendor Drug -Free Workplace, Offerors Proposal, Proposal Security and
Specifications, if any, and the proposed Contract Documents (including all
Addenda issued prior to opening of Proposals).
1.6. "Contractor" - the individual(s) or firm(s) to whom the award is made and who
executes the Contract Documents.
2. SPECIAL CONDITIONS
Any and all Special Conditions that may vary from the General Conditions shall have
precedence.
3. EXAMINATION OF CONTRACT DOCUMENTS AND SITE
4.1. Before submitting a Proposal, each Offeror must visit the site (if applicable) to
familiarize himself with the facilities and equipment that may in any manner
affect cost or performance of the work; must consider federal, state and local
laws, ordinances, rules and regulations that may in any manner affect cost or
performance of the work, must carefully compare the Offeror's observations
made during site visits or in review of applicable laws with the Proposal
Documents; and must promptly notify the Purchasing and Contracts Manager of
all conflicts, errors and discrepancies, if any, in the Proposal Documents.
4.2. The Offeror, by and through the submission of a Proposal, agrees that he shall
be held responsible for having examined the facilities and equipment (if
applicable); familiarized himself with the nature and extent of the work and any
local conditions that may affect the work, and is familiar with the equipment,
materials, parts and labor required to successfully perform the work.
5. SPECIFICATIONS
4.3. The apparent silence of the specifications as to any detail, or the apparent omission
of a detailed description concerning any point, shall be regarded as meaning that
only the best commercial practice is to prevail, and that only material and
workmanship of the finest quality is to be used. All interpretations of the
specifications shall be made on the basis of this statement.
4.4. For the purpose of evaluation, the Offeror must indicate any variance or exceptions
to the stated Specifications, no matter how slight. Deviations should be explained
in detail. Absence of variations and/or corrections will be interpreted to mean that
the Offeror meets all the Specifications in every respect.
4.5. Any manufacturers' names, trade names, brand names, information and/or part or
item numbers used herein are for the purpose of describing and establishing a
general standard of quality, performance and characteristics, and are not intended
to limit or restrict competition. The Offeror may propose any brand that meets or
exceeds the specifications for any item(s). If a Proposal is based on a uiivalent
products, indicate the product manufacturer's name and part or item number.
Offeror shall submit detailed, descriptive literature and/or specifications on the
proposed equivalent. The Offeror should also verify and be able to prove that the
proposed equivalent will meet the specifications, and will not be considered an
exception thereto. The City shall be the sole judge of equivalency. If Offeror fails to
name a substitute, it will be assumed that,the Offeror is proposing, and will be
required to furnish, goods or services identical to the solicitation's standards and
specifications.
5. INTERPRETATIONS AND ADDENDA
If the Offeror is in doubt as to the meaning of any of the Proposal Documents, believes that
the General Conditions, Special Conditions and/or Technical Specifications contain errors,
contradictions or obvious omissions, or has any questions concerning the information
contained in the RFP documents, the Offeror shall submit a written request to the
Purchasing Office for interpretation or clarification. Such request must reference RFP
name and number, and should be received by the Purchasing Office at least ten (10)
calendar days prior to the Proposal opening date. Questions received less than ten (10)
calendar days prior to the Proposal opening may not be answered. Interpretations or
clarifications in response to such questions will be issued in the form of a written addendum
transmitted via either fax or email to all parties recorded by the Purchasing Office as having
received the Proposal Documents. The issuance of a written addendum shall be the only
official method whereby such an interpretation or clarification will be made.
6. COSTS AND COMPENSATION
6.1. Costs and compensation shall be shown in both unit prices and extensions
whenever applicable. In the event of discrepancies existing between unit prices
and extensions or totals, the unit prices shall govern.
6.2. All costs and compensation shall remain firm and fixed for acceptance for
calendar days after the day of the Proposal opening.
6.3. The price proposal shall include all franchise fees, royalties, license fees, etc.,
as well as all costs for transportation or delivery as applicable within the scope
of the solicitation.
7. NON -COLLUSIVE AFFIDAVIT
Each Offeror shall complete the Non -Collusive Affidavit form and shall submit the form
with their Proposal. City considers the failure of the Offeror to submit this document to
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be a major irregularity, and may be cause for rejection of the Proposal.
8. PUBLIC ENTITY CRIMES
In accordance_ with F.S. §287.133 (2)(a): A person or affiliate who has been placed
on the convicted vendor list following a conviction for public entity crime may not
submit a bid on a contract to provide any goods or services to a public entity, may
not submit a bid on a contract with a public entity for the construction or repair of a
public building or public work, may not submit bids on leases of real property to
public entity, may not be awarded or perform work as a contractor, supplier,
subcontractor, or consultant under a contract with any public entity, and may not
transact business with any public entity in excess of the threshold amount provided
in Florida Statutes Section 287,017, for CATEGORY TWO for a period of 36 months
from the date of being placed on the convicted vendor list.
9. CONFLICT OF INTEREST
The award of any contract hereunder is subject to the provisions of Chapter 112,
Florida Statutes. Offerors must disclose with their Proposal the name of any officer,
director, partner, proprietor, associate or agent who is also an officer or employee of
City or any of its agencies. Further, all Offerors must disclose the name of any officer
or employee of City who owns, directly or indirectly, an interest of five percent (5%) or
more in the Offeror's firm or any of its branches or affiliate companies.
10. PERFORMANCE BONDS AND INSURANCE
Upon award of a contract, the Successful Offeror, as required within the scope of the
solicitation, shall submit performance bonds and/or certificates of insurance in the
manner, form and amount(s) specified.
11. SUMMARY OF DOCUMENTS TO BE SUBMITTED WITH PROPOSALS
The following is a summary of documents to be submitted by each Offeror:
a. Proposal
b. Certification Form
C. Certified Resolution Form (or firm's own Corporate Resolution)
d. Offeror's Qualifications Statement Form
e. Vendor Drug Free Workplace Form
f. Non -Collusive Affidavit Form
g. Proof of applicable insurance
12. SUBMISSION OF PROPOSALS
12.1. Proposals must be typed or printed in ink. Use of erasable ink is not permitted.
All corrections to prices made by the Offeror must be initialed.
12.2. Proposals must contain a manual signature of a corporate officer or designee
with the proven authority to bind the firm in matters of this nature. The address
and telephone number for any communications regarding the Proposal must be
included.
12.3. Proposals shall contain an acknowledgment of receipt of all addenda.
12.4. Proposals by corporations must be executed in the corporation's legal name by
the President or other corporate officer, accompanied by evidence of authority
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to sign. Evidence of authority shall be provided on the enclosed Certified
Resolution form, or by the company's own Corporate Resolution.
12.5. Proposals by partnerships must be executed in the partnership name and
signed by a partner, whose title must appear under the signature.
12.6. Proposals shall be submitted to the Purchasing Office on or before the time
indicated in the Request for Proposals. Proposals shall be submitted in a sealed
envelope (faxed proposals will not be accepted under any circumstances). The
envelope should be clearly marked on the exterior with the applicable
solicitation name and number. The envelope should state the name and
address of the Offeror and should be include all documents as specified in the
Request for Proposals. Purchasing and Contracts Division staff is not
responsible for the premature opening of a Proposal that is not properly
addressed and identified.
12.7. In accordance with Florida Statutes, Chapter §119.07(1)(a) and except as may
be provided by other applicable state and federal law, the Request for
Proposals and the responses thereto are in the public domain. However,
Proposers are requested to specifically identify in the submitted Proposal any
financial information considered confidential and/or proprietary which may be
considered exempt under Florida Statute §119.07(t).
12.8. All Proposals received from Offerors in response to the Request for Proposals
will become the property of City and will not be returned. In the event of
Contract award, all documentation produced as part of the Contract shall
become the exclusive property of City.
13. MODIFICATION AND WITHDRAWAL OF PROPOSALS
13.1. Proposals may be modified or withdrawn by a duly executed document signed
by a corporate officer or other employee with designated signature authority.
Evidence of such authority must accompany the request for withdrawal or
modification. The request must be delivered to the Purchasing Office at any
time prior to the deadline for submitting Proposals. Withdrawal of a Proposal
will not prejudice the rights of an Offeror to submit a new Proposal prior to the
Proposal opening date and time. No Proposal may be withdrawn or modified
after the date of proposal opening has passed.
13.2. If, within twenty-four (24) hours after Proposals are opened, any Offeror files a
duly signed, written notice with City, and within five (5) calendar days thereafter
demonstrates to the reasonable satisfaction of City by clear and convincing
evidence there was a material and substantial mistake in the preparation of its
Proposal, or that the mistake is clearly evident on the face of the Proposal but
the intended correct Proposal is not similarly evident, Offeror may withdraw its
Proposal and any bid security will be returned. Thereafter, the Offeror will be
disqualified from further bidding on the subject Contract.
14. REJECTION OF PROPOSALS
14.1. To the extent permitted by appNcable state and federal laws and regulations,
City reserves the right to reject any and all Proposals, to waive any and all
informalities not involving price, time or changes in the work with the Successful
Offeror, and to disregard all nonconforming, non -responsive, unbalanced or
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conditional Proposals. Proposal will be considered irregular and may be
rejected if they show serious omissions, alterations in form, additions not called
for, conditions or unauthorized alterations, or irregularities of any kind.
14.2. City reserves the right to reject the Proposal of any Offeror if City believes that it
would not be in its best interest of to make an award to that Offeror, whether
because the Proposal is not responsive, the Offeror is unqualified, of doubtful
financial ability, or fails to meet any other pertinent criteria established by City
within the scope of the solicitation.
16. QUALIFICATIONS OF PROPOSERS
15.1. Each Offeror shall complete the Offeror's Qualifications Statement and submit
the form with the Proposal. Failure to submit the Offeror's Qualifications
Statement and the documents required thereunder may constitute grounds for
rejection of the Proposal.
15.2. As a part of the Proposal evaluation process, City may conduct a background
check which may include a records check by the Broward Sheriffs Office.
Offeror's submission of a Proposal constitutes acknowledgement of the process
and consent to such investigation.
15.3. No proposal shall be accepted from, nor will any contract be awarded to, any
person who is in arrears to City for any debt or contract, who is a defaulter, as
surety or otherwise, of any obligation to City, or who is deemed irresponsible for
unreliable by City. City will be the sole judge of said determination.
15.4. City reserves the right to make a pre -award inspection of the Offeror's facilities
and equipment prior to award of Contract.
16. INSURANCE
16.1. Offeror agrees to, in the performance of work and services under this
Agreement, comply with all federal, state, and local laws and regulations now
in effect, or hereinafter enacted during the term of this agreement that are
applicable to Offeror, its employees, agents, or subcontractors, if any, with
respect to the work and services described herein.
16.2. Offeror shall obtain at Offeror's expense all necessary insurance in such form
and amount as required by the City's Risk Manager before beginning work
under this Agreement. Offeror shall maintain such insurance in full force and
effect during the life of this Agreement. Offeror shall provide to the City's Risk
Manager current certificates of all insurance required under this section prior
to beginning any work under this Agreement.
16.3. Offeror shall indemnify and save the City harmless from any damage
resulting to it for failure of either Offeror or any Sub -Offeror to obtain or
maintain such insurance.
16.4. The following are required types and minimum limits of insurance coverage,
which the Offeror agrees to maintain during the term of this contract:
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Line of Business/ Coverage Occurrence Aggregate
Commercial General Liability $1,000,000 $1,000,000
Including:
Premises/Operations
Contractual Liability
Personal Injury
Explosion, Collapse, Underground Hazard
Products/Completed Operations
Broad Form Property Damage
Cross Liability and Severability of Interest Clause
Automobile Liability $1,000,000 $1,000,000
Workers' Compensation & Employer's Statutory
Liability
16.5. The City reserves the right to require higher limits depending upon the
scope of work under this Agreement.
16.6. Neither Offeror nor any Sub -Offeror shall commence work under this
contract until they have obtained all insurance required under this section
and have supplied the City with evidence of such coverage in the form of an
insurance certificate and endorsement. The Offeror will ensure that all Sub -
Offerors will comply with the above guidelines and will maintain the
necessary coverages throughout the term of this Agreement.
16.7. All insurance carriers shall be rated at least A-VII per Best's Key Rating
Guide and shall be licensed to do business in Florida. Policies shall be
"Occurrence" form. Each carrier will give the City sixty (60) days notice
prior to cancellation.
16.8. The Offeror's liability insurance policies shall be endorsed to add the City of
Tamarac as an "additional insured". The Offeror's Workers' Compensation
carrier will provide a Waiver of Subrogation to the City.
16.9. The Offeror shall be responsible for the payment of all deductibles and self -
insured retentions. The City may require that the Offeror purchase a bond
to cover the full amount of the deductible or self -insured retention.
16.10. If the Offeror is to provide professional services under this Agreement, the
Offeror must provide the City with evidence of Professional Liability
insurance with, at a minimum, a limit of $1,000,000 per occurrence and in
the aggregate. "Claims -Made" forms are acceptable for Professional
Liability.
16.11, The Successful Offeror agrees to perform the work under the Contract as
an independent contractor, and not as a subcontractor, agent or employee
of City.
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17. INDEMNIFICATION
17.1. To the fullest extent permitted by laws and regulations, Successful Offeror shall
indemnify, defend, save and hold harmless the City, its officers, elected officials,
agents and employees from any and all claims, damages, losses, liabilities and
expenses, direct, indirect, consequential or inconsequential, arising out of or
alleged to have arisen out of the products, goods or services furnished by, or
the operations of, the Successful Offeror or its subcontractors, agents, officers,
employees or independent contractors pursuant to the Contract, specifically
including, but not limited to, those caused by or arising out of the following
conditions:
17.1.1 any act, omission or default of the Successful Offeror and/or its
subcontractors, agents, servants or employees in the provision of the
goods and/or services under the Contract;
17.2.1 any and all bodily injuries, sickness, disease or death;
17.3.1 injury to or destruction of tangible property, including the loss of use
resulting therefrom;
17.4.1 the use of any improper materials;
17.5.1 a defective condition in any goods provided pursuant to the Contract,
whether patent or latent;
17.6.1 the violation of any federal, state, county or municipal laws,
ordinances or regulations by Successful Offeror, its subcontractors,
agents, servants, independent contractors or employees;
17.7.1 the breach or alleged breach by Successful Offeror of any term,
warranty or guarantee of the Contract.
17.2. The Successful Offeror shall pay all claims, losses, liens, settlements or
judgments of any nature whatsoever in connection with the foregoing
indemnifications including, but not limited to, reasonable attorney's fees
(including appellate attorney's fees) and costs.
17.3. City reserves the right to select its own legal counsel to conduct any defense in
any such proceeding and all costs and fees associated therewith shall be the
responsibility of Successful Offeror under the indemnification agreement.
Nothing contained herein is intended nor shall it be construed to waive City's
rights and immunities under the common law or Florida Statute 768.28 as
amended from time to time.
18. WARRANTIES
18.1. Successful Offeror warrants to City that the consummation of the work provided
for in the Contract documents will not result in the breach of any term or
provision of, or constitute a default under any indenture, mortgage, contract, or
agreement to which Successful Offeror is a party.
18.2. Successful Offeror warrants to City that it is not insolvent, it is not in bankruptcy
proceedings or receivership, nor is it engaged in or threatened with any
litigation, arbitration or other legal or administrative proceedings or
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investigations of any kind which would have an adverse effect on its ability to
perform its obligations under the Contract.
18.3. Successful Offeror warrants to City that it will comply with all applicable federal,
state and local laws, regulations and orders in carrying out its obligations under
the Contract.
18A, All warranties made by Successful Offeror together with service warranties and
guarantees shall run to City and the successors and assigns of City.
19. NON-DISCRIMINATION AND EQUAL OPPORTUNITY EMPLOYMENT
During the performance of the Contract, the Successful Offeror shall not discriminate
against any employee or applicant for employment because of race, religion, color, sex
or national origin. The Successful Offeror will take affirmative action to ensure that
employees are treated during employment, without regard to their race, creed, color, or
national original. Such action must include, but not be limited to, the following:
employment, upgrading; demotion or transfer; recruitment or recruitment advertising,
layoff or termination; rates of pay or other forms of compensation; and selection for
training, including apprenticeship. The Successful Offeror(s) shall agree to post in
conspicuous places, available to employees and applicants for employment, notices to
be provided by the contracting officer setting forth the provisions of this
nondiscrimination clause.
20. TAXES
Successful Offeror shall pay all applicable sales, consumer use and other similar taxes
required by law.
21. PERMITS, FEES AND NOTICES
Successful Offeror shall secure and pay for all permits and fees, licenses and charges
necessary for the proper execution and completion of the work, if applicable. The costs
of all permits, fees, licenses and charges shall be included in the Price Proposal except
where expressly noted in the specifications.
22. TERMINATION FOR CAUSE AND DEFAULT
In the event Successful Offeror shall default in any of the terms, obligations, restrictions
or conditions in any of the Proposal documents, City shall give written notice by
certified mail, return receipt requested to Successful Offeror of the default and that such
default shall be corrected, or the actions taken to correct such default, shall be
commenced within seven (7) calendar days thereof. In the event Successful Offeror
has failed to correct the conditions of default or the default is not remedied to the
satisfaction and approval of City, City shall have all legal remedies available to it,
including, but not limited to termination of the Contract, in which case Successful
Offeror shall be liable for all procurement or re -procurement costs, and any and all
damages permitted by law arising from the default and breach of the Contract.
23. TERMINATION FOR CONVENIENCE OF CITY
Upon seven (7) calendar days written notice delivered by certified mail, return receipt
requested, to Successful Offeror, City may without cause and without prejudice to any
other right or remedy, terminate the agreement for City's convenience whenever City
determines that such termination is in the best interests of City. Where the agreement
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is terminated for the convenience of City, the notice of termination to Successful Offeror
must state that the Contract is being terminated for the convenience of City under the
termination clause and the extent of termination. Upon receipt of the notice of
termination for convenience, Successful Offeror shall promptly discontinue all work
and, to the extent indicated on the notice of termination, shall terminate all outstanding
subcontracts and purchase orders as they relate to the terminated portion of the
Contract, shall refrain from placing further orders and/or contracting with
subcontractors, and shall complete any continued portions of the work.
24. AUDIT RIGHTS
City reserves the right to audit the records of Successful Offeror, relating to this
contract, at any time during the term of the Contract, and for a period of three (3) years
after completion of contract. If required by City, Successful Offeror shall agree to
submit to an audit by an independent Certified Public Accountant selected by City.
Successful Offeror shall allow City to examine and review the records of Successful
Offeror at any and all times during normal business hours during the term of the
Contract.
25. ASSIGNMENT
25.1. Successful Offeror shall not assign, transfer or subject the Contract or its rights,
title, interests or obligations therein without City's prior written approval.
25.2. Violation of the terms of this paragraph shall constitute a breach of the Contract
by Successful Offeror and City may, at its discretion, cancel the Contract. All
rights, title, interest and obligations of Successful Offeror shall thereupon cease
and terminate.
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RFP 04-27R
WORKERS' COMPENSATION INSURANCE AND
CLAIMS ADMINISTRATION SERVICE
I. INTRODUCTION
The City of Tamarac is seeking competitive sealed proposals from qualified brokers and
carriers to provide Worker's Compensation and Employer's Liability insurance.
II. BACKGROUND
The City employs 408 full-time employees with an additional 61 seasonal or part-time
employees for summer camp. There are 11 departments as follows: Building; City Clerk;
Community Development; Finance; Fire Rescue; Information Technology; Parks and
Recreation; Human Resources; Public Works; Utilities; and the City Manager's Office.
Police duties are contracted to the Broward County Sheriffs Office.
Leadership is provided by a City Manager, Mayor and four (4) Commissioners.
The Risk Management Division reports to the Human Resources Director. Risk
Management is comprised of a Risk & Safety Manager, a Risk & Safety Coordinator, and
an Administrative Secretary. The primary mission of the Risk Management Division is to
protect the physical, financial, and personal assets of the City of Tamarac through the
identification and analysis of risk, the implementation or loss control programs, and the
selection of risk transfer and financing techniques.
Current loss prevention activities include but are not limited to the following:
A. Implementation of a Florida Drug & Alcohol Free Workplace Program, a
Commercial Drivers' License (CDL) Alcohol & Drug Free Workplace
Program, and a Mass Transit Drug and Alcohol Free Workplace Program,
B. Policies and training and education on sexual harassment, discrimination
prevention, vehicle usage and defensive driving, employee accidentlincident
investigation and reporting, workplace health & safety, transitional alternate
duty, and violence in the workplace prevention.
C. Random drug testing for CDL holders and Mass Transit Bus System
Operators.
D. Competent person designations for trenching and excavating and confined
space entry.
E. Crane Institute and Florida MOT (Maintenance of Traffic) training for heavy
equipment operators.
F. An active Labor/Management Safety Committee.
G. Various other OSHA Compliance and safety specific programs based on
departmental exposures.
H. Defensive Driver Training based on "high risk" groups.
I. Incident Reduction by focusing on the primary loss cause categories.
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The City has averaged 50 claims per year in the past five years. On average, approximately
3 of these claims, per year, are indemnity payments; the remainder are first aid or medical
payments only. Approximately 2 % of all claims have been litigated in the last 5 years (5
out of 250 claims).
For details on the structure of the current insurance program, please refer to the "Schedule
of Insurance in Force" located in the Appendix.
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A. Scope
The purpose of this Request for Proposals is to obtain the services of a qualified
insurance carrier and claims administration firm to provide Workers' Compensation
and Employers Liability Insurance and claims administration for the claims
associated with these coverages.
The City is seeking a contract for an initial term of one year (1) year, with the option
to renew annually, in one (1) year increments, based upon satisfactory performance
and mutual agreement of both parties. The insurance policy and claims handling
service will be for initial effective dates of 10/1/04 to 10/1105.
The purpose of the Proposal is to demonstrate the qualifications, competence and
capacity of the organizations seeking to undertake the engagement of the City of
Tamarac in conformity with the requirements of this request for proposals. As such,
the substance of proposals will carry more weight than their form or manner of
presentation. The Proposal should demonstrate the qualifications and services of
the organization.
The Proposer should address all the points outlined in the Request for Proposals.
The Proposal should be prepared simply and economically, providing a
straightforward, concise description of the Proposer's capabilities to satisfy the
requirements of the Request for Proposals.
B. Services to be provided
Please review the exhibits provided for your convenience prior to submitting your
firm's proposal. In general, the following services are to be provided:
1. Insurance Coverage
2. Claims Handling and Administration (Including Bill Review and
payment)
3. Loss Control Services
4. Investigation Services
C. Items to be submitted with this proposal
1. Pricing to be submitted on Pricing Proposal Form.
2. Rates used by payroll class and premium calculations with credits,
modifiers and discounts shown.
3. Detail on Stop loss limits, deductible, and loss sensitive plan options
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available (i.e., paid loss retro's, dividend, guaranteed cost, deductible
levels, etc.)
4. Claims and Loss Control Service expectations defined.
5. Samples and frequency of reports for loss runs available and options
for additional reports.
6. Detail of additional flat fees and pricing and/or commissions if any.
7. Detail of Managed Care Network and provider list.
8. Detail of claim reporting process.
9. Sample Policy of coverages and conditions.
IV. REQUIREMENTS OF THE PROPOSAL
Attachment "A" of the Proposal Form, included herein, is a questionnaire designed
to help the City determine your firm's capabilities and its ability to meet the City's
requirements. Make sure to answer each question fully, with as much detail as
possible.
A. DEVIATIONS — Any and all deviations from the criteria delineated in the
proposal documents shall be fully explained.
B. RATES — Proposer's premium rates by line of coverage shall be provided on
the Proposal Pricing form.
C. SCOPE OF COVERAGE — Proposers will outline fully the coverage afforded
under all policies. Coverage will follow guidelines given in the requirements
section given below. A sample policy has been provided. Coverage and
program enhancements are encouraged and options for better protection and
efficacy are encouraged.
D. UNDERWRITING FLEXIBILITY — Underwriters are encouraged to be flexible
and creative in designing a cost-effective program while also considering the
scope of coverage to be afforded.
V. COVERAGES, PREMIUM, AND BILLING EVALUATION
A. Description of Audit and Billing Processes.
B. Description of underwriter access and communication procedure.
C. Description of how fees and commissions (if any) are determined, as well as
the amount of the fee and the percentage of the commission charge.
D. Indicate whether premiums can be guaranteed for more than one year. .
E. Indicate how long your firm's proposal is valid; minimum 60 days required.
F. Availability of loss control services, frequency of visits, and ability to assist
the City in reducing loss exposures.
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RFP Available to Vendors
07/12/04
Deadline for Receipts of Proposals
08/19/04
Evaluation of Proposals
08/19/04 — 09/03/04
Complete Negotiations with Selected Firm
09/04/04 — 09/13/04
Anticipated Award by Commission
09/22/04
Anticipated Effective Date of Implementation
1 10/1/04
All dates tentative. City reserves the right to change scheduled dates.
VII. SELECTION/NEGOTIATION PROCESS
A Selection/Negotiation Committee has been appointed by the City Manager and will be
responsible for selecting the most qualified firm and negotiating a contract. The vendors
with the top scoring proposals may be asked to make a detailed presentation of their
product to the evaluation team. The top -scoring vendor in this process will be selected to
implement their product. No work on this project shall proceed without written authorization
from the City of Tamarac.
The City reserves the right to enter into contract negotiations with the selected Proposer. If
the City and the selected Proposer cannot negotiate a successful contract, the City may
terminate such negotiations and begin negotiations with the next selected Proposer. No
Proposer shall have any rights against the City arising from such negotiations.
Each firm should submit documents that provide evidence of capability to provide the
services required for the Committee's review, for short listing purposes. The short listed
firms will then be contacted via telephone and a follow-up letter to prepare for a
presentation to the committee so that a final firm can be selected. The committee will then
attempt to negotiate an agreement, which can be recommended to the Tamarac City
Commission for award.
VIII. INSURANCE REQUIREMENTS
Proposer agrees to, in the performance of work and services under this Agreement, comply
with all federal, state, and local laws and regulations now in effect, or hereinafter enacted
during the term of this agreement that are applicable to Contractor, its employees, agents, or
subcontractors, if any, with respect to the work and services described herein.
Proposer shall obtain at Proposer's expense all necessary insurance in such form and amount
as required by the City's Risk & Safety Officer before beginning work under this Agreement.
Proposer shall maintain such insurance in full force and effect during the life of this Agreement.
Proposer shall provide to the City's Risk & Safety Officer certificates of all insurance required
under this section prior to beginning any work under this Agreement. Proposer shall indemnify
and save the City harmless from any damage resulting to it for failure of either Proposer or any
subcontractor to obtain or maintain such insurance.
The following are required types and minimum limits of insurance coverage, which the
Proposer agrees to maintain during the term of this contract:
City of Tawlarac'
Line of Business/ Coverage
Commercial General Liability
Including:
Premises/Operations
Contractual Liability
Personal Injury
Explosion, Collapse, Underground Hazard
Limits
Occurrence Aggregate
$1,000,000 $1,000,000
Products/Completed Operations
Broad Form Property Damage
Cross Liability and Severability of Interest Clause
Automobile Liability $1,000,000 $1,000,000
Workers' Compensation & Employer's Liability Statutory
The City reserves the right to require higher limits depending upon the scope of work under
this Agreement.
Neither Proposer nor any subcontractor shall commence work under this contract until they
have obtained all insurance required under this section and have supplied the City with
evidence of such coverage in the form of an insurance certificate and endorsement. The
Proposer will ensure that all subcontractors will comply with the above guidelines and will
maintain the necessary coverages throughout the term of this Agreement.
All insurance carriers shall be rated at least A-VII per Best's Key Rating Guide and be licensed
to do business in Florida. Policies shall be "Occurrence" form. Each carrier will give the City
sixty (60) days notice prior to cancellation.
The Proposer's liability insurance policies shall be endorsed to add the City of Tamarac as an
"additional insured". The Proposer's Worker's Compensation carrier will provide a Waiver of
Subrogation to the City. The Proposer shall be responsible for the payment of all deductibles
and self -insured retentions. The City may require that the Proposer purchase a bond to cover
the full amount of the deductible or self -insured retention. If the Proposer is to provide
professional services under this Agreement, the Proposer must provide the City with evidence
of Professional Liability insurance with, at a minimum, a limit of $1,000,000 per occurrence and
in the aggregate. "Claims -Made" forms are acceptable for Professional Liability insurance.
IX. INDEMNIFICATION
The Proposer shall indemnify and hold harmless the City of Tamarac, its elected and
appointed officials and employees from any and all claims, suits, actions, damages, liability,
and expenses (including attorneys' fees) in connection with loss of life, bodily or personal
injury, or property damage, including loss of use thereof, directly or indirectly caused by,
resulting from, arising out of or occurring in connection with the operations of the Proposer or
his Subcontractors, agents, officers, employees or independent contractors, excepting only
such loss of life, bodily or personal injury, or property damage solely attributable to the gross
negligence or willful misconduct of the City of Tamarac or its elected or appointed officials and
employees.
City of
......... ..................• i7177::!/f)t, � ?i"t"�irtS,rr.r l a C>7:. ... .........
XI. PROPOSAL SELECTION
The City of Tamarac reserves the right to select the vendor proposal which represents the
best value to its citizens, and to accept or reject any proposal submitted in response to this
solicitation. The City's Evaluation and Selection Committee will act in what they consider to
be the best interest of the City. The City reserves the right to waive any irregularity found in
the Proposals during the evaluation and selection process. Additional questions may be
asked of vendors by Committee members during the evaluation and selection process to
clarify each firm's written proposal.
CONTACT WITH PERSONNEL OF THE CITY OF TAMARAC OTHER THAN THE
PURCHASING AND CONTRACTS MANAGER OR DESIGNATED REPRESENTATIVE
REGARDING THEIR REQUEST FOR PROPOSALS MAY BE GROUNDS FOR
ELIMINATION FROM THE SELECTION PROCESS.
XII. CRITERIA FOR SELECTION
The City will assemble an Evaluation and Selection Committee comprised of a cross-
section of City staff from various departments. This Committee will evaluate the proposals
and may "short-list" the highest -ranked firms who would then be notified to prepare a
detailed presentation to the Committee members. Proposals will be evaluated based upon
the following weighted criteria:
Mandatory Elements (no points assigned)
a. The organization is licensed to practice in Florida
b. The firm adheres to the instructions in this Request for Proposals in
preparing and submitting the proposal document
2. Technical Proposal (maximum points — 60)
a. Scope of coverage in adherence with specifications
b. Coverage enhancements
C. Underwriting creativity
d. Loss -sensitivity and structure of Workers' Compensation program
e. Loss Control Service Proposal
f. Financial strength of the carrier
g. Claims service capabilities and experience
3. Price Proposal (maximum points - 40)
Points for price will be tallied based on the following formula:
The responsive and responsible Proposer providing the lowest price shall automatically
receive the maximum number of points (40). The pricing points for all other Proposers shall
be calculated by dividing the lowest price by each succeeding price and multiplying the
result by 40. See example below:
Example: Proposer A price: $100.00 = 40 points
Proposer B price: $110.00
Formula: 100 (A)
110 (B) (or 100 - 110) _ .91
.91 x 40 = 36.4 points
Proposer B points = 36.4
City of rc911'?%}%]t; u���4yn p..............................................................................}.at!?i;i?Lssl7fC}..,.'; and CAL)l�tt"i.PCtM.._"""wf7on
XII1. ORAL PRESENTATIONS
The highest-ranking Proposers may be invited to give an oral presentation. This decision
will be based upon the findings of the Evaluation Committee during the initial proposal
evaluation. The Committee may prepare a short-list of the highest —ranked firms, who will
then be notified of the presentation requirement. Presentations will be evaluated by the
Committee based upon the same weighted criteria established in the Request for
Proposals. Final scoring and designation of the highest -ranked vendor will be determined
by the number of points awarded to each firm after the presentation phase.
XIV. RIGHT TO REJECT PROPOSALS
To the extent permitted by applicable state and federal laws and regulations, City reserves
the right to reject any and all Proposals, to waive any and all informalities not involving
price, time or changes in the work with the successful Proposer, and to disregard all non-
conforming, non -responsive, unbalanced or conditional proposals. The City reserves the
right to award the contract to the Proposer who will best serve the interest of the City. The
City also reserves the right to waive minor irregularities or variations to the proposal
requirements.
Submission of a Proposal indicates acceptance by the firm of the terms and conditions
contained in the Request for Proposal, unless clearly and specifically confirmed in the
written contract between the City of Tamarac and the successful Proposer.
XV. QUESTIONS ABOUT THE RFP
Questions regarding the proposal process or the scope of work shall be directed in writing
to Keith K. Glatz, CPPO, Purchasing and Contracts Manager, via fax to 954-724-2408 or by
email to keithgatamarac.orq. Answers will be provided via written addendum to all
Proposers, and no questions will be answered otherwise, except at the discretion of the
Purchasing and Contracts Manager.
Ss':;i_ j
�ry
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1,:163; 14M-to] C7J,
RFP 04-27R
WORKER'S COMPENSATION INSURANCE AND
CLAIMS ADMINISTRATION SERVICES
PROPOSAL SUBMISSION FORM
Company Name:
Address:
City State Zip
Telephone
Fax
Contact Person Name
Contact Person Email address
NOTE: To be considered eligible for award, one (1) original of the Proposal Form must
be submitted with your firm's proposal.
NO BID INDICATION (IF "NO BID" IS OFFERED):
Please indicate reason(s) why a Proposal is not being submitted at this time. Return this
Form to avoid removal from the City of Tamarac's vendor database.
cit r,;� 1t�tarr;Pr.: r, �m Pu!;hosiog and Vicar%#a%�tln I'Xvishon
PROPOSAL FORM
(continued)
RFP 04-27R
WORKER'S COMPENSATION INSURANCE AND
CLAIMS ADMINISTRATION SERVICES
PROPOSAL PRICING FORM
1.
Premiums by Line of Coverage
$
2.
Claims Administration Service if any or separate)
$
3.
Loss Control Service if any or separate)
$
4.
Commissions and/or flat fees for broker if an
$
5.
Managed Care Network Fees if any or separate)
$
5.
Bill Review Fees if any or separate)
$
7.
Other
$
SUBMITTED BY:
Company Name:
Authorized Signature:
Print Name/Title of Authorized Signer:
Email address of Signer:
NOTE: To be considered eligible for award, one (1) original copy of this proposal form,
manually signed in ink by an authorized signer of the firm, must be submitted with the
Proposal.
}:,F.-, a
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................:.���,................. .................................................................................................... \....................................................... ............ .............................................. .......................................................................................
PROPOSALFORM
(continued)
WORKER'S COMPENSATION INSURANCE AND
CLAIMS ADMINISTRATION SERVICES
20612•19_l MIL63 4;411Ia C•3=`7 C•T►`T�•T:7�1
The undersigned hereby confirms that:
He/she is a duly authorized agent of the Company submitting the proposal; and
2. He/she has read the General Terms and Conditions, the Instructions to Offerors,
and all other terms and conditions which were made available to the Proposer in
conjunction with the RFP, and fully understands and accepts these terms unless
specific variations have been expressly listed on the Proposal Form; and
3. The Proposer will accept any awards made to it as a result of this Request for
Proposals for a minimum of sixty (60) calendar days following the date and time of
the proposal opening.
SIGNATURE OF AUTHORIZED SIGNER
DATE
TYPE/PRINT NAME
TITLE
EMAIL ADDRESS
NOTE: Proposals without the manual signature of an authorized signer of the
Proposer, with authority to bind the proposing company in contract matters, shall be
deemed non -responsive and ineligible for award.
C'ii
ia? r:;??c3!;tt:+C7 t: t7C1 (.;r;)Wra,^,i;�' (.)t#%f.`„ion
ATTACHMENT "A"
PROPOSAL FORM
(continued)
RFP 04-27R
WORKER'S COMPENSATION INSURANCE AND
CLAIMS ADMINISTRATION SERVICES
Qualification Form for Workers' Compensation
Give a description of your firm, the carrier and the claims -handling entity, and include
information regarding the following:
1. Names of principal owners, partners and officers.
2. Length of time the firm has been in business.
3. Number of offices and locations that will service the City.
4. Toll free number for use by the City and Claimants for contact and reporting of claim
information.
5. Hours of operation and availability of reporting service 24/7.
6. Type of Claims Handling System for claims reporting. Include samples of loss run
reports and analysis.
7. Indication of proposed number of personnel including supervisors and managers
who would be assigned to administer the City's program. Give details regarding the
position of each, their experience, education, experience with public entities, and
length of time with the firm.
8. License(s) to practice in the State of Florida.
9. Describe the claims handling process including your procedures for making initial
and follow-up contact with claimants, physicians, and the City.
10. Describe your philosophy and procedures for the establishment of case reserves.
11. Explain detail of claims reviews, meetings and frequency.
12. Explain details of your procedures for follow-up investigations.
13. Explain the carrier's philosophy and communication with the employer and claimant
regarding denied and contested claims.
14. Explain in detail the bill review and payment process.
15. Indicate if the vendor participates in a Managed Care arrangement and attach a
current list of providers for Central and South Florida (specifically including Broward,
Palm Beach, Dade, and Volusia Counties).
:"7a•
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16. Produce the results of any claims, underwriting, or other audits by the State of
Florida and indicate any corrective actions pending.
17. Financial strength of carriers and reinsurance companies should also be included in
the proposal (acceptable forms of information on this include annual reports or
documents that highlight the financial solvency of the carrier),
18. List of any legal action filed and/or pending against your company in the last two
years and the outcome. If the Proposer has merged with, purchased or joined with
another company within the past three years, the Proposal must include any legal
action filed against those entities.
19. Define the procedures for assignment of outside legal counsel and the ability for the
City to appoint designate their own counsel representation.
20. Provide references of similar or related programs performed in Broward County or
the State of Florida for accounts similar in size to the City of Tamarac. Include
organization names, addresses, names of contact persons, telephone numbers and
email addresses for each reference. A minimum of three references should be
furnished, if possible. The City may contact other current or past accounts in
addition to, or instead of, the references provided to inquire about Proposer's
service and performance.
C:i t,, o! ", <„ a;ara c PurchDsing & Contracts Division
CERTIFICATION
THIS DOCUMENT MUST BE SUBMITTED WITH THE BID
We (1), the undersigned, hereby agree to furnish the item(s)/service(s) described in the
Invitation to Bid. We (1) certify that we(1) have read the entire document, including the
Specifications, Additional Requirements, Supplemental Attachments, Instructions to
Bidders, Terms and Conditions, and any addenda issued. We agree to comply with all of
the requirements of the entire Invitation To Bid.
Indicate which type of organization below:
INDIVIDUAL 1-1 PARTNERSHIP11 CORPORATION OTHER❑
If "Other", Explain:
Authorized Signature
Title
Company Name
Address
City/State/Zip
Contact Email address
Name (Printed Or Typed)
Federal Employer I.D./Social Security No.
Telephone
Fax Number
Contact Person
Page i of I
(,("raification
ZO-1.
city i117i.:' <XL :xt.rYT it..ksa!',C+ & E.;c.'i%ti "iC.M
CERTIFIED RESOLUTION
I, (Name), the duly elected Secretary of
(Name of Corp.), a corporation organized and existing under the laws of
the State of , do hereby certify that the following Resolution was
unanimously adopted and passed by a quorum of the Board of Directors of the said corporation at
a meeting held in accordance with law and the by-laws of the said corporation.
"IT IS HEREBY RESOLVED THAT (Name)", the
duly elected (Title of Officer) of
(Name of Corp.) be and is hereby authorized to execute
and submit a Bid and/or Bid Bond, if such bond is required, to the City of Tamarac and such other
instruments in writing as may be necessary on behalf of the said corporation; and that the
Bid, Bid Bond, and other such instruments signed by him/her shall be binding upon the said
corporation as its own acts and deeds. The secretary shall certify the names and signatures of
those authorized to act by the foregoing resolution.
The City of Tamarac shall be fully protected in relying upon such certification of the secretary and
shall be indemnified and saved harmless from any and all claims, demands, expenses, loss or
damage resulting from or growing out of honoring, the signature of any person so certified or for
refusing to honor any signature not so certified.
I further certify that the above resolution is in force and effect and has not been revised, revoked or
rescinded.
I further certify that the following are the name, titles and official signatures of those persons
authorized to act by the foregoing resolution.
NAME TITLE SIGNATURE
Given under my hand and the Seal of the said corporation this day of , 20
(SEAL)
By:
Secretary
Corporate Title
NOTE:
The above is a suggested form of the type of Corporate Resolution desired. Such form need
not be followed explicitly, but the Certified Resolution submitted must clearly show to the
satisfaction of the City of Tamarac that the person signing the Bid and Bid Bond for the
corporation has been properly empowered by the corporation to do so in its behalf.
Page 1 of Z Ceif fied h'esoi(i'iv) ,,
City of Tetnar2:1c � F'ttn�hasing & C:at�frkaGts D ision
............................. ............................
OFFEROWS QUALIFICATION STATEMENT
The undersigned certifies under oath the truth and correctness of all statements and of
all answers to questions made hereinafter:
SUBMITTED TO: City of Tamarac
Purchasing and Contracts Manager
7525 NW $$`h Avenue
Tamarac, Florida 33321
Company:
Contact Name:
Address:
City, State, Zip
Telephone No.
Fax No.
Is] IT44:t*IT
Corporation
Partnership
❑ Individual
00ther
1. State the true, exact, correct and complete name of the partnership, corporation,
trade or fictitious name under which you do business and the address of the place
of business.
The correct name of the Offeror is:
The address of the principal place of business is:
2. If Offeror is a corporation, answer the following:
a)
Date of Incorporation: w......................
b)
State of Incorporation:
c)
President's name:
d)
Vice President's name:.,,_
e)
Secretary's name:
f)
Treasurer's name:
g)
Name and address of Resident Agent:
Page i of 5 of"'e or's Qualifwarion st€3tealf M
:'tv eel T"tam�l7,a ,w Purchasing t,e sir,t; t or frc��,t; f ib'1si tr
�v
3. If Offeror is an individual or a partnership, answer the following:
a) Date of organization:
b) Name, address and ownership units of all partners:
c) State whether general or limited partnership:
4. If Offeror is other than an individual, corporation or partnership, describe the
organization and give the name and address of principals:
5. If Offeror is operating under a fictitious name, submit evidence of compliance with
the Florida Fictitious Name Statute.
6. How many years has your organization been in business under its present
business name?
a) Under what other former names has your organization operated?
7. Indicate registration, license numbers or certificate numbers for the businesses or
professions, which are the subject of this Bid. Please attach certificate of
competency and/or state registration.
8. Have you personally inspected the site of the proposed work?
FIYES ❑ NO
9. Do you have a complete set of documents, including drawings and addenda?
1:1 YES [:] NO
10. Did you attend the Pre -Proposal Conference if any such conference was held?
F-1
YES [:] NO
Page 2 of 5 ....... Offeror"s Quutrfic atron st;ate.m'.' riff
City of 7"e,owm � P!irchasi»q c� Cont acts Division
11. Have you ever failed to complete any work awarded to you? If so, state when,
where and why:
12. State the names, telephone numbers and last known addresses of three (3)
owners, individuals or representatives of owners with the most knowledge of work
which you have performed and to which you refer (government owners are
preferred as references).
Name Address Telephone
13. List the pertinent experience of the key individuals of your organization (continue
on insert sheet, if necessary).
14. State the name of the individual who will have personal supervision of the work:
15. State the name and address of attorney, if any, for the business of the Offeror:
16. State the names and addresses of all businesses and/or individuals who own an
interest of more than five percent (5%) of the Offeror's business and indicate the
percentage owned of each such business and/or individual:
17. State the names, addresses and the type of business of all firms that are partially
or wholly owned by Offeror:
r't'ge 3 of 5 Off'€wlor's Que.:Iiificatrr, "" stat w"wi!
City of Tamarac
(..s.; � <art�� �, "rt'ri r"ri :s:'t:; .,tr.S b"r
18. State the name of Surety Company which will be providing the bond, and name
and address of agent:
19. Bank References:
Bank Address Telephone
20. Attach a financial statement including Offeror's latest balance sheet and income
statement showing the following items:
a) Current Assets (e.g., cash, joint venture accounts, accounts receivable, notes
receivable, accrued income, deposits, materials, real estate, stocks and
bonds, equipment, furniture and fixtures, inventory and prepaid expenses):
b) Net Fixed Assets
c) Other Assets
d) Current Liabilities (e.g., accounts payable, notes payable, accrued
expenses, provision for income taxes, advances, accrued salaries, real
estate encumbrances and accrued payroll taxes).
e) Other Liabilities (e.g., capital, capital stock, authorized and outstanding
shares par values, earned surplus, and retained earnings):
21. State the name of the firm preparing the financial statement and date thereof:
22. Is this financial statement for the identical organization named on page one?
YES[—] NO
23. If not, explain the relationship and financial responsibility of the organization whose
financial statement is provided (e.g., parent -subsidiary).
f'r;ge 4 of 5 �:lffevr'<7r'.., Qu a%rfic"'War.:
C;,,+tV i� Tr1"f7Cc�fl; tatT Pi: sl!? Cot;tmcl5 �)!S/wsion
The Offeror acknowledges and understands that the information contained in response
to this Qualification Statement shall be relied upon by owner in awarding the contract
and such information is warranted by Offeror to be true. The discovery of any omission
or misstatement that materially affects the Offeror's qualifications to perform under the
contract shall cause the owner to reject the proposal, and if after the award, to cancel
and terminate the award and/or contract.
Signature
ACKNOWLEDGEMENT
OFFEROR'S QUALIFICATION STATEMENT
State of
County of
On this the day of , 20 _,,,,, , before me,
the undersigned Notary Public of the State of Florida, personally appeared
Vq
(Name(s) of individual(s) who appeared before notary)
whose name(s) is/are Subscribed to within the instrument, and he/she/they
acknowledge that he/she/they executed it.
WITNESS my hand and official seal.
NOTARY PUBLIC
SEAL OF OFFICE:
NOTARY PUBLIC, STATE OF FLORIDA
(Name of Notary Public: Print,
Stamp, or Type as Commissioned)
❑ Personally known to me, or
❑ Produced identification:
(Type of Identification Produced)
❑ DID take an oath, or
❑ DID NOT take an oath
P)yes ,'5 cif Of,Ff rOe`S C UdiffiU410,1l itOteM,9nt
.ti
f.:f!,y of r l77ldlr C
L.s�.I1T,P7.J.i.... �.;(,?Ps/1c7Gi"' (:tV:S;(.,rt
Y
VENDOR DRUG -FREE WORKPLACE
Preference may be given to vendors submitting a certification with their bid/proposal
certifying they have a drug -free workplace in accordance with Section 287.087, Florida
Statutes. This requirement affects all public entities of the State and becomes effective
January 1, 1991. The special condition is as follows:
IDENTICAL TIE BIDS - Preference may be given to businesses with drug -free
workplace programs. Whenever two or more bids that are equal with respect to price,
quality, and service are received by the State or by any political subdivision for the
procurement of commodities or contractual services, a bid received from a business that
certifies that it has implemented a drug -free workplace program shall be given
preference in the award process. Established procedures for processing tie bids will be
followed if none of the tied vendors have a drug -free workplace program. In order to have
a drug -free workplace program, a business shall:
Publish a statement notifying employees that the unlawful manufacture,
distribution, dispensing, possession, or use of a controlled substance is
prohibited in the workplace and specifying the actions that will be taken against
employees for violations of such prohibition.
2. Inform employees about the dangers of drug abuse in the workplace, the
business's policy of maintaining a drug -free workplace, any available drug
counseling, rehabilitation, and employee assistance programs, and the penalties
that may be imposed upon employees for drug abuse violations.
3. Give each employee engaged in providing the commodities or contractual
services that are under bid a copy of the statement specified in subsection (1).
4. In the statement specified in subsection (1), notify the employees that, as a
condition of working on the commodities or contractual services that are under
bid, the employee will abide by the terms of the statement and will notify the
employer of any conviction of, or plea of guilty or nolo contendere to, any
violation of chapter 893 or of any controlled substance law of the United States or
any state, for a violation occurring in the workplace no later that five (5) days
after each conviction.
5. Impose a section on, or require the satisfactory participation in a drug abuse
assistance or rehabilitation program if such is available in the employee's
community, by any employee who is so convicted.
6. Make a good faith effort to continue to maintain a drug -free workplace through
implementation of this section. As the person authorized to sign the statement, I
certify that this form complies fully with the above requirements.
Authorized Signature
Company Name
of T,,,niarv:; Purch a ir,,g & Contracts Div,siurr
....................................................................................................... ......................................................
NON -COLLUSIVE AFFIDAVIT
State of
)ss.
County of
being first duly sworn,
deposes and says that:
1. He/she is the , (Owner, Partner, Officer,
Representative or Agent) of the Offeror
that has submitted the attached Proposal;
2. He/she is fully informed respecting the preparation and contents of the attached
Proposal and of all pertinent circumstances respecting such Proposal;
3. Such Proposal is genuine and is not a collusive or sham Proposal;
4. Neither the said Offeror nor any of its officers, partners, owners, agents,
representatives, employees or parties in interest, including this afFant, have in any
way colluded, conspired, connived or agreed, directly or indirectly, with any other
Offeror, firm, or person to submit a collusive or sham Proposal in connection with
the Work for which the attached Proposal has been submitted; or to refrain from
bidding in connection with such Work; or have in any manner, directly or indirectly,
sought by agreement or collusion, or communication, or conference with any
Offeror, firm, or person to fix the price or prices in the attached Proposal or of any
other Offeror, or to fix any overhead, profit, or cost elements of the Proposal price
or the Proposal price of any other Offeror, or to secure through any collusion,
conspiracy, connivance, or unlawful agreement any advantage against (Recipient),
or any person interested in the proposed Work;
5. The price or prices quoted in the attached Proposal are fair and proper and are not
tainted by any collusion, conspiracy, connivance, or unlawful agreement on the
part of the Offeror or any other of its agents, representatives, owners, employees
or parties in interest, including this affiant.
Signed, sealed and delivered in the presence of:
By
Witness
Witness Printed Name
Title
Page ? of 2 Non-Gollusivo Affidavit
�;
City' of Tc"9�"7?iftc;3i; ; "urchvsin g & Co;?t`lact, �lVf:y1:)13
ACKNOWLEDGMENT
NON -COLLUSIVE AFFIDAVIT
State of Florida
County of
On this the day of , 20 , before me, the undersigned Notary Public
of the State of Florida, personally appeared
and
(Name(s) of individual(s) who appeared before notary)
whose name(s) is/are Subscribed to within the instrument, and he/she/they
acknowledge that he/she/they executed it.
WITNESS my hand
and official seal.
NOTARY PUBLIC
SEAL OF OFFICE:
NOTARY PUBLIC, STATE OF FLORIDA
(Name of Notary Public: Print,
Stamp, or Type as Commissioned)
❑ Personally known to me, or
❑ Produced identification:
(Type of Identification Produced)
❑ DID take an oath, or ❑ DID NOT take an oath
..... ... z
REQUEST FOR PROPOSALS
RFP 04-27R
WORKERS' COMPENSATION INSURANCE AND
CLAIMS ADMINISTRATION SERVICE
Index to Exhibits
A. "Application for Employer Workplace Safety Program Premium Credit"
B. "Application for Drug Free Workplace Premium Credit Program"
C. "Workers' Compensation and Employers Liability Coverage Agreement
Declarations" for the Fiscal Year beginning 10/01/2003 and ending 09/30/2004
D. "Workers' Compensation FY2005 Payroll Projection for 10/1/2004 to 10/1/2005
Premium Calculations"
E. "Workers' Compensation Experience Rating" - Worksheet for the last three years.
F. City of Tamarac "Florida Municipal Insurance Trust Members Loss Report" —for the
period 10/01/1999 to 09/30/2004, as of 05/26/2004
G. City of Tamarac "Supplemental Florida Municipal Insurance Trust Loss Run Detail
with Description, Causation, and Status for the past 5 years"
H. City of Tamarac Organizational Chart
Purchasing and
Contracts Division
C1 ity of Tamarac
"Committed to Excellence... Always"
ADDENDUM NO. 1
REQUEST FOR PROPOSALS
0:11 &W Z:
WORKERS' COMPENSATION INSURANCE AND
CLAIMS ADMINISTRATION SERVICE
DATE OF ADDENDUM: July 27, 2004
ALL POTENTIAL PROPOSERS:
=>1,161W
Please note the following responses to questions and clarifications that have been
received.
1. Question: Does the City do pre -employment and post -employment physicals
for all employees?
Answer: The City does pre -employment physicals (post -offer) on all
employees. The City does post -employment physicals (fitness for duty physicals)
subject to the .terms and conditions of City Policy and the applicable collective
bargaining agreement.
2. Question: How many volunteers does the City utilize and what do they do for
the City?
Answer: Total of 128 volunteers. 98 volunteers are on boards and
committees and attend 1 one hour meeting a month (excluding July) to participate
on the following committees or boards: Code Enforcement Board, Consumer Affairs
Committee, Economic Development Advisory Committee, Insurance Advisory Board;
Investment Advisory Committee, Parks and Recreation Board, 3 Pension Boards,
Planning Board, Public Information Committee, Social Services Board, and the
Veterans Affairs Committee.
7525 NW 88th Avenue ■ Tamarac, Florida 33321-2401 a (954) 724-2450 ■ Fox (954) 724-2408 0
www.tomarac.org
Equal Opportunity Employer
30 Volunteers in Parks and Recreation for Social Service Programs. All duties are
clerical in nature. Scheduling meetings, helping at the front counter, handing out
programs at events, etc.
3. Question: Are you allowing brokers exclusivity to the markets?
Answer: No, we are not assigning markets.
4. Question: What is the City's FEIN?
Answer: 59-1039552
All other terms and conditions remain the same as of this date.
This addendum should be signed and returned with your Proposal.
NAME OF PROPOSER:
SIGNATURE:
F97_r1:l
2
EXHIBIT 2
❑ Administration/
Marketing
❑ Risk Control
Ili Underwriting
Property & Casualty
Health
Post Office Box 530065
125 East Colonial Drive
Orlando, FL 32853-0065
800-445-6248
407-425-9142
Suncom 344-0725
Fax 407-425-9378
❑ Health Claims
Post Office Box 538140
Orlando, FL 32853-8140
800-756-3042
407-245-0725
Suncom 344-0725
Fax 407-425-9378
❑ Workers'
Compensation Claims
Post Office Box 538135
Orlando, FL 32853-8135
800-756-3042
407-245-0725
Suncom 344-0725
Fax 407-425-9378
❑ Property & Liability
Claims
Post Office Box 538135
Orlando, FL 32853-8135
800-756-3042
407-245-0725
Suncom 344-0725
Fax 407-425-9378
FLORIDA LEAGUE OF CITIES, INC.
PUBLIC RISK SERVICES
ugust 17, 2004
'ity of Tamarac
urchasing and Contracts Division
525 NW 88d Avenue
amarac, FL 33321
Florida Municipal insurance Trust Proposal
e appreciate the opportunity to present you with our response to your recent insurance
quest. We welcome the occasion to meet with you to discuss this matter.
The Florida League of Cities Insurance Program was established in 1977 to provide affordable
Workers' Compensation coverage and service to governmental entities. Liability, property and
group health programs followed shortly thereafter and propelled the League into the recognized
leader of such services in the state of Florida. In 1992 the programs were merged under the
name of the Florida Municipal Insurance Trust.
The Trust, governed by a board of elected officials, is a non -assessable, non-profit, tax-exempt
risk sharing pool. It has superior financial stability presently highlighted by $255 million in
assets, $90 million in annualized premium, and over $38 million in allocated surplus with
approximately 500+ members. The FMIT offers a packaging of comprehensive general and
automobile liability and property coverages including professional liability and remains on the
broadest claims payment basis (occurrence) with no annual payment limitation
(aggregate).
When examining other insurance markets, it is obvious that our self -insured group concept is a
most attractive insurance alternative. To be certain, the FMIT is highly qualified to meet all
your risk management needs. Our expertise in the areas of governmental coverages, coupled
with our outstanding claims, loss control and fraud (SRD departments translates to considerable
service and savings over that of traditional markets.
Thank you for your time and consideration. We look forward to the chance to meet with you
sometime in the near future.
Sincerely
A. ,
G
Chuck Wilde
Account Executive
CH/vb
Enclosure
Florida Municipal Insurance Trust
5,
Cfty of Tamarac
< , P "Committed to Excellence... Always"
Purchasing and
Contracts Division
ADDENDUM NO. 1
REQUEST FOR PROPOSALS
RFP 04-27R
WORKERS' COMPENSATION INSURANCE AND
CLAIMS ADMINISTRATION SERVICE
DATE OF ADDENDUM: July 27, 2004
ALL POTENTIAL PROPOSERS:
PLEASE NOTE:
Please note the following responses to questions and clarifications that have been
received.
1. Question: Does the City do pre -employment and post -employment physicals
for all employees?
Answer: The City does pre -employment physicals (post -offer) on all
employees, The City does post -employment physicals (fitness for duty physicals)
subject to the terms and conditions of City Policy and the applicable collective
bargaining agreement.
2. uestion: How many volunteers does the City utilize and what do they do for
the City?
Answer: Total of 128 volunteers. 98 volunteers are on boards and
committees and attend 1 one hour meeting a month (excluding July) to participate
on the following committees or boards: Code Enforcement Board, Consumer Affairs
Committee, Economic Development Advisory Committee, Insurance Advisory Board;
Investment Advisory Committee, Parks and Recreation Board, 3 Pension Boards,
Planning Board, Public Information Committee, Social Services Board, and the
Veterans Affairs Committee.
7525 NW 88th Avenue ■ Tamarac, Florida 33321-2401 ■ (954) 724-2450 ■ Fax (954) 724-2408 ■
www.tamarac.org
Equal Opportunity Employer
30 Volunteers in Parks and Recreation for Social Service Programs. All duties are
clerical in nature. Scheduling meetings, helping at the front counter, handing out
programs at events, etc.
3. Question: Are you allowing brokers exclusivity to the markets?
Answer: No, we are not assigning markets.
4. Question: What is the City's FEIN?
Answer: 59-1039552
All other terms and conditions remain the same as of this date.
This addendum should be signed and returned with your Proposal.
NAME OF PROPOSER: H. Chuck Wi Ide
SIGNATURE: 44 rL, 4 DATE: 8/18/2004
2
SUBMIT PROPOSAL TO:
CITY OF TAMARAC
PURCHASING AND CONTRACTS DIVISION
7525 NW 88T" AVENUE
TAMARAC, FL 33321
954-724-2450
REQUEST FOR PROPOSALS
Pro oser Acknowledgement
RFP NO.: 04-27R
RFP TITLE: Worker's Compensation, Employer's Liability and Claims Administration
PROPOSAL OPENING DATE/TIME: August 19, 2004, 4:00 PM local time
BUYER NAME: Keith K. Glatz, CPPO
BUYER PHONE: 954-724-1322
BUYER EMAIL: keithg@tamarac.org
PRE -PROPOSAL CONFERENCE/SITE INSPECTION: N/A
BONDING: N/A
GENERAL CONDITIONS
THESE INSTRUCTIONS ARE STANDARD FOR ALL PROPOSALS FOR SERVICES ISSUED BY THE CITY OF TAMARAC. THE CITY OF
TAMARAC MAY DELETE, SUPERSEDE OR MODIFY ANY OF THESE STANDARD INSTRUCTIONS FOR A PARTICULAR PROPOSAL
BY iNDICATING SUCH CHANGE IN THE INSTRUCTIONS TO OFFERORS OR IN THE SPECIAL CONDITIONS OF THE PROPOSAL,
ANY AND ALL SPECIAL CONDITIONS THAT MAY VARY FROM THESE GENERAL CONDITIONS SHALL PREVAIL OVER ANY
CONFLICTING PROVISION WITHIN ANY VENDOR'S STANDARD TERMS AND CONDITIONS REGARDLESS OF ANY LANGUAGE IN
VENDOR'S DOCUMENTATION TO THE CONTRARY.
SEALED PROPOSALS
THIS FORM SHOULD BE EXECUTED AND SUBMITTED WITH ALL PROPOSAL FORMS IN A SEALED ENVELOPE. THE FACE OF THE
ENVELOPE SHALL CONTAIN THE ABOVE ADDRESS, THE RFP NUMBER AND THE RFP TITLE. PROPOSALS NOT SUBMITTED ON
THE ATTACHED PROPOSAL FORM MAY BE DEEMED NON -RESPONSIVE. ALL PROPOSALS ARE SUBJECT TO THE TERMS AND
CONDITIONS SPECIFIED HEREIN. THOSE PROPOSALS THAT DO NOT COMPLY WITH THESE CONDITIONS MAY BE DEEMED NON-
RESPONSIVE.
PROPOSER COMPANY NAME: Florida eau f
COMPANY ADDRESS: Post Uffi ce Box 530065 Orlando FL 328537
COMPANY PHONE: _ (407) 425-9142
NAME OF AUTHORIZED AGENT: H. Chuck Wilde
TITLE OF AUTHORIZED AGENT: Account E4=tive
AUTHORIZED AGENT EMAIL ADDRESS: cwi 1 de@f 1 ci t i e
PROPOSER TAXPAYER ID OR SOCIAL SEC;r,
NUMBER: 9-6001124
SIGNATURE OF AUTHORIZED AGENT: �
Icertify that this Proposal Acknowledgement is made without prior understanding, agreement or connection with any
corporation, firm or person submitting a Proposal for the same commodities and/or services and is in all respects fair and
without collusion or fraud. I agree to abide by all conditions of this Proposal and certify that I am authorized to sign this
Proposal as an agent for the Proposer.
GTC. I
City of Tamarac ti' Purchasing and Contracts Division
PROPOSAL FORM
RFP 04-27R
WORKER'S COMPENSATION INSURANCE AND
CLAIMS ADMINISTRATION SERVICES
PROPOSAL SUBMISSION FORM
SUBMITTED BY:
-Company Name:
Florida League of Cities, lnc.
Address:
Post office Box 530065
City State Z
Orlando, FL 32853-0065
Telephone
407-425-9142
Fax
407-425-9378
Contact Person Name
H. Chuck Wilde
Contact Person Email address
cwilde@flcities.com
NOTE: To be considered eligible for award, one (1) original of the Proposal Form must
be submitted with your firm's proposal.
NO BID INDICATION (IF "NO BID" IS OFFERED):
Please indicate reason(s) why a Proposal is not being submitted at this time. Return this
Form to avoid removal from the City of Tamarac's vendor database.
of Tamarac l Purchasing and Contracts Division
PROPOSAL FORM
(continued)
RFP 04-27R
WORKER'S COMPENSATION INSURANCE AND
CLAIMS ADMINISTRATION SERVICES
PROPOSAL PRICING FORM
1.
Premiumsby Line of Coverage
$ 459,476
2.
Claims Administration Service if any or se crate
$
Included
3.
Loss Control Service if an or separate)
$
Included
4.
Commissions and/or flat fees for broker if an
$
N/A
5.
Managed Care Network Fees if any or separate)
$
A
6.
Bill Review Fees if an or se arate
$
N/A
7.
Other
$
N/A
SUBMITTED BY:
Company Name: Florida League of Cities, Inc.
W.
Authorized Signature: 4
Print Name/Title of Authorized Signer: H. Chuck Wilde
Email address of Signer:
cwilde@flcities.com
NOTE: To be considered eligible for award, one (1) original copy of this proposal form,
manually signed in Ink by an authorized signer of the firm, must be submitted with the
Proposal.
Pr-2
of Tamarac + 1
Purchasing and Contracts Division
PROPOSAL FORM
(continued)
RFP 04-27R
WORKER'S COMPENSATION INSURANCE AND
CLAIMS ADMINISTRATION SERVICES
PROPOSAL CERTIFICATION FORM
The undersigned hereby confirms that:
1. He/she is a duly authorized agent of the Company submitting the proposal; and
2. He/she has read the General Terms and Conditions, the Instructions to Offerors,
and all other terms and conditions which were made available to the Proposer in
conjunction with the RFP, and fully understands and accepts these terms unless
specific variations have been expressly listed on the Proposal Form; and
3. The Proposer will accept any awards made to it as a result of this Request for
Proposals for a minimum of sixty (60) calendar days following the date and time of
the proposal opening.
/7/—/.= cLi- k....,._
SIGNATURE OF AUTHORIZED SIGNER
s 1s 2004
DATE
H. Chuck Wilde
TYPE/PRINT NAME
Account Executive
TITLE
cwilde@flcities.com
EMAIL ADDRESS
NOTE: Proposals without the manual signature of an authorized signer of the
Proposer, with authority to bind the proposing company in contract matters, shall be
deemed non -responsive and ineligible for award.
PF-3
CITY OF TAMARAC
RFP NO. 04-27R
ATTACHMENT "A"
l . Executive Director: Michael Sittig
2. Since 1922
3. Orlando, FL
4. Toll free number to report claims: 1-877-676-3890 24/7.
5. Office hours are 9-5pm daily, toll free number is a 24/7 service.
6. Attached.
7. Adjusters assigned to Broward County: Adjuster Kristine Sujka-Lost time (4 yrs), Adjuster Sharon White-
Med Only (2 yrs), & Wilma Mosley -Claims Supervisor (12 yrs), Linda Smith RN, CRRN-Managed Care
Supervisor (20 yrs), Katherine Weng RN (7yrs) and Michael Coefield (10 yrs).
8. Attached.
9, 12, & 13. Upon receipt of a claim the adjuster is to conduct a thorough investigation (employer
investigation, employee investigation, provider investigation, witness investigation, ect.). Outside
investigation is required as needed on complex, catastrophic, and questionable claims. A decision
on compensability is to be made in a timely manor according to the statute/law, and supported by
case facts as they relate to the application of statutory obligation and case law. Direct personal
contact is necessary on catastrophic, complex and other cases where it is advantageous to provide
on -site case/medical management. Personal contact with the injured worker is sometimes
important when investigation complex, catastrophic or questionable claims.
;C-
10. Initial and subsequent reserves should be factually based and reflect the total probable total payment
obligations. Reserve updates should b e made when the known facts cause changes to the probable total
payment obligations. The adjusters have the responsibility of evaluating reserves during each review of the
file.
11. Claims reviews, meetings and frequency, can be scheduled upon request once a quarter, with a two- week
notice of the scheduled date.
14. Choice Managed Care Network is utilized for bill review and payment; the adjusters approve the bills and
forward to Choice for application of fee schedule and payment.
15. Attached are the current Managed Care provider lists as requested.
16. N/A
17. FMIT — Attached. Reinsurer - National Union Ins. Co. A++ XV.
18. None.
19. Legal counsel is selected from an approved list of attorneys, and selected based on the geographical
location of the case.
20. Previously listed..
01r of Tamarac Purchasing & Contracts Division
CERTIFICATION
THIS DOCUMENT MUST BE SUBMITTED WITH THE BID
We (1), the undersigned, hereby agree to furnish the item(s)/service(s) described in the
Invitation to Bid. We (1) certify that we(I) have read the entire document, including the
Specifications, Additional Requirements, Supplemental Attachments, Instructions to
Bidders, Terms and Conditions, and any addenda issued. We agree to comply with all of
the requirements of the entire Invitation To Bid.
Indicate which type of organization below:
INDIVIDUAL PARTNERSHIPO
CORPORATION FX� OTHERE]
If "Other', Explain:
H. Chuck Wilde
Authorized Signature
Name (Printed Or Typed)
Account Executive
59-6001124
Title
Federal Employer I.D./Social. Security No.
Florida League of Cities, Inc.
407-425-9142
Company Name
Telephone
Post Office Box 530065
407-425-9378
Address
Fax Number
Orlando, FL 32853-0065
H. Chuck Wilde
City/State/Zip
Contact fton
cwilde@flcities.com
Contact Email address
Page 1 of 1 Certification
City of Tamarac
& Contracts Division
A4;111IJ1401 T*_T0IW"_I7:
N/A
I, (Name), the duly elected Secretary of
(Name of Corp.), a corporation organized and existing under the laws of
the State of , do hereby certify that the following Resolution was
unanimously adopted and passed by a quorum of the Board of Directors of the said corporation at
a meeting held in accordance with law and the by-laws of the said corporation.
"IT IS HEREBY RESOLVED THAT (Name)", the
duly elected (Title of Officer) of
(Name of Corp.) be and is hereby authorized to execute
and submit a Bid and/or Bid Bond, if such bond is required, to the City of Tamarac and such other
instruments in writing as may be necessary on behalf of the said corporation; and that the
Bid, Bid Bond, and other such instruments signed by him/her shall be binding upon the said
corporation as its own acts and deeds. The secretary shall certify the names and signatures of
those authorized to act by the foregoing resolution.
The City of Tamarac shall be fully protected in relying upon such certification of the secretary and
shall be indemnified and saved harmless from any and all claims, demands, expenses, loss or
damage resulting from or growing out of honoring, the signature of any person so certified or for
refusing to honor any signature not so certified.
I further certify that the above resolution is in force and effect and has not been revised, revoked or
rescinded.
I further certify that the following are the name, titles and official signatures of those persons
authorized to act by the foregoing resolution.
NAME TITLE SIGNATURE
Given under my hand and the Seal of the said corporation this day of , 20
(SEAL) By:
Secretary
Corporate Title
NOTE:
The above is a suggested form of the type of Corporate Resolution desired. Such form need
not be followed explicitly, but the Certified Resolution submitted must clearly show to the
satisfaction of the City of Tamarac that the person signing the Bid and Bid Bond for the
corporation has been properly empowered by the corporation to do so in its behalf.
Page i of 1 Certified Resolution
of Tamarac :' ; a . �� Purchasing & Contracts Division
OFFEROR'S QUALIFICATION STATEMENT
The undersigned certifies under oath the truth and correctness of all statements and of
all answers to questions made hereinafter:
SUBMITTED TO: City of Tamarac
Purchasing and Contracts Manager
7525 NW 881h Avenue
Tamarac, Florida 33321
Company: Florida League of Cities, Inc.
Contact Name: H • Chuck Wilde
Address:
City, State, Zip
Telephone No.
Fax No.
Post Office Box 530065
Urlando, FL 32853-0065
407-425-9142
407-425-9378
Check One
DCorporation
FlPartnership
1:1 Individual
F-10ther
1. State the true, exact, correct and complete name of the partnership, corporation,
trade or fictitious name under which you do business and the address of the place
of business.
The correct name of the Offeror is:
Florida League of Cities, Inc.
The address of the principal place of business is:
Orlando
2. If Offeror is a corporation, answer the following:
a) Date of Incorporation: 1922
b) State of Incorporation. Florida
c)
d)
e)
Executive Director
Pfeskk--nt's name:
Michael Sittig
Vice President's name: N/A
Secretary's name: N/A
0 Treasurer's name: N/A
g) Name and address of Resident Agent: H. chuck i d
Page 1 of 5 Offeror's Qualification Statement
of Tamarac
Purchasing & Contracts Division.
3. If Offeror is an individual or a partnership, answer the following:
a) Date of organization:
b) Name, address and ownership units of all partners:
4.
5.
7.
8
E61
c) State whether general or limited partnership:
If Offeror is other than an individual, corporation or partnership, describe the
organization and give the name and address of principals:
If Offeror is operating under a fictitious name, submit evidence of compliance with
the Florida Fictitious Name Statute. N/A
How many years has your organization been in business under its present
business name? 82
a) Under what other former names has.your organization operated?
N/A
Indicate registration, license numbers or certificate numbers for the businesses or
professions, which are the subject of this Bid. Please attach certificate of
competency and/or state registration.
A-284526
Have you personally inspected the site of the proposed work?
FIYES ❑ NO N/A
Do you have a complete set of documents, including drawings and addenda?
❑ YES F-] NO N/A
10. Did you attend the Pre -Proposal Conference if any such conference was held?
F-1
YES ❑❑ NO N/A
Page 2 of 5 Offeror's Qualification Statement
City of Tamarac 0 Purchasing & Contracts Division
`\
11. Have you ever failed to complete any work awarded to you? If so, state when,
where and why:
NO
12. State the names, telephone numbers and last known addresses of three (3)
owners, individuals or representatives of owners with the most knowledge of work
which you have performed and to which you refer (government owners are
preferred as references).
Name
City of Sunrise - Bill Mason
City of Plantation - John Mc
Address
10770 West Oakland Pk Blvd
Sunrise. FL 333!31
Telephone
954-572-2496
54-797-2
rianation, I-L 333I
City of Oakland Park- AlvarezGail h _
6250
Oakl nd Park, FL 33434 -
13. List the pertinent experience of the Key individuals oT your organization (continue
on insert sheet, if necessary).
van
Chuck Wilde - 20 years Byron Beard - 35 years
Valerie Burns - 18 Years
Crosby Coleman - 25 _years
14. State the name of the individual who will have personal supervision of the work:
Byron Beard
15. State the name and address of attorney, if any, for the business of the Offeror:
General Counsel - Harry Morrison, FLC - Tallahassee
16. State the names and addresses of all businesses and/or individuals who own an
interest of more than five percent (5%) of the Offeror's business and indicate the
percentage owned of each such business and/or individual:
N/A
17. State the names, addresses and the type of business of all firms that are partially
or wholly owned by Offeror:
Page 3 of 5 Offerors Qualification Statement
City of Tamarac
Purchasing & Contracts LOMSiOn
18. State the name of Surety Company which will be providing the bond, and name
and address of agent:
19. Bank References:
Bank
--- _ _ .. ...,.,.. ._.,� AddressTelephone„ ,_..,. ...,._
Capital City Bank of Tallahassee
20. Attach a financial statement including Offeror's latest balance sheet and income
statement showing the following items:
a) Current Assets (e.g., cash, joint venture accounts, accounts receivable, notes
receivable, accrued income, deposits, materials, real estate, stocks and
bonds, equipment, furniture and fixtures, inventory and prepaid expenses):
b) Net Fixed Assets
c) Other Assets
d) Current Liabilities (e.g., accounts payable, notes payable, accrued
expenses, provision for income taxes, advances, accrued salaries, real
estate encumbrances and accrued payroll taxes).
e) Other Liabilities (e.g., capital, capital stock, authorized and outstanding
shares par values, earned surplus, and retained earnings):
21. State the name of the firm preparing the financial statement and date thereof:
Shorsten and Shorstein
22. Is this financial statement for the identical organization named on page one?
EIYES E NO
23. If not, explain the relationship and financial responsibility of the organization whose
financial statement is provided (e.g., parent -subsidiary).
Financial statement is for the FLC sponsored insurance trust.
Page 4 of 5 Offeror's Qualif<cation Statement
Citv of Tamarac `��
Sly
Purchasing & Contracts Division
The Offeror acknowledges and understands that the information contained in response
to this Qualification Statement shall be relied upon by owner in awarding the contract
and such information is warranted by Offeror to be true. The discovery of any omission
or misstatement that materially affects the Offeror's qualifications to perform under the
contract shall cause the owner to reject the proposal, and if after the award, to cancel
an terminate the award and/or contract.
re
ACKNOWLEDGEMENT
OFFEROR'S QUALIFICATION STATEMENT
State of
County of
On this the ILL*' day of _._„j. � , 20 �LLL , before me,
the undersigned Notary Public of the State of Florida, personally appeared
(Name(s) oHndividual(s) who appeared before notary)
whose name(s) is/are Subscribed to within the instrument, and he/she/they
acknowledge that he/she/they executed it.
WITNESS my hand and official seal.
NOTARY PUBLIC
SEAL OF OFFICE:
9arbprO b Mathewson
MY Ilan DD033241
a ExPkas July 20, 2005
(3/
NOTARY PUBLIC, STATE OF FLORIDA
aA�.6P-R b����
(Name of Notary Public: Print,
Stamp, or Type as Commissioned)
1!6 Personally known to me, or
❑ Produced identification:
(Type of Identification Produced)
5f DID take an oath, or
❑ DID NOT take an oath
Page 5 of 5
Offerors Qualification Statement
FLORIDA LEAGUE OF CITIES, INC.
UNLAWFUL SUBSTANCE POLICY STATEMENT
The Florida League of Cities, Inc. does not condone, support or encourage the use,
possession, distribution, manufacture or dispensing of unlawful drug substances.
The Florida League of Cities, Inc. has an established policy regarding employee
assistance and will provide its employees with the help and assistance deemed necessary under
the circumstances.
Florida League of Cities, Inc. -
Authorized Signature
.Tune 29, 2004
Date
of Tamarac.
Purchasing & Contracts Division
State of
County of
NON -COLLUSIVE AFFIDAVIT
)ss.
N/A
being first duly sworn,
deposes and says that:
1. He/she is the , (Owner, Partner, Officer,
Representative or Agent) of , the Offeror
that has submitted the attached Proposal;
2. He/she is fully informed respecting the preparation and contents of the attached
Proposal and of all pertinent circumstances respecting such Proposal;
3. Such Proposal is genuine and is not a collusive or sham Proposal;
4. Neither the said Offeror nor any of its officers, partners, owners, agents,
representatives, employees or parties in interest, including this affiant, have in any
way colluded, conspired, connived or agreed, directly or indirectly, with any other
Offeror, firm, or person to submit a collusive or sham Proposal in connection with
the Work for which the attached Proposal has been submitted; or to refrain from
bidding in connection with such Work; or have in any manner, directly or indirectly,
sought by agreement or collusion, or communication, or conference with any
Offeror, firm, or person to fix the price or prices in the attached Proposal or of any
other Offeror, or to fix any overhead, profit, or cost elements of the Proposal price
or the Proposal price of any other Offeror, or to secure through any collusion,
conspiracy, connivance, or unlawful agreement any advantage against (Recipient),
or any person interested in the proposed Work;
5. The price or prices quoted in the attached Proposal are fair and proper and are not
tainted by any collusion, conspiracy, connivance, or unlawful agreement on the
part of the Offeror or any other of its agents, representatives, owners, employees
or parties in interest, including this affiant.
Signed, sealed and delivered in the presence of:
Witness By
Witness Printed Name
Title
Page 9 of 2 Nan -Collusive Affidavit
City of Tamarac
& Contracts Division
State of Florida
County of
ACKNOWLEDGMENT
NON -COLLUSIVE AFFIDAVIT
N/A
On this the day of , 20 , before me, the undersigned Notary Public
of the State of Florida, personally appeared
and
(Name(s) of individual(s) who appeared before notary)
whose name(s) is/are Subscribed to within the instrument, and he/she/they
acknowledge that he/she/they executed it.
WITNESS my hand
and official seal.
NOTARY PUBLIC
SEAL OF OFFICE:
NOTARY PUBLIC, STATE OF FLORIDA
(Name of Notary Public: Print,
Stamp, or Type as Commissioned)
❑ Personally known to me, or
❑ Produced identification:
(Type of Identification Produced)
❑ DID take an oath, or ❑ DID NOT take an oath
Page 2 of 2 Non -Collusive Affidavit
FLORIDA MUNICIPAL INSURANCE TRUST
COVERAGE PROPOSAL
� me;
CITY OF TAMARAC
PROPOSED EFFECTIVE DATE: October 1, 2004
ADMINISTERED AND PREPARED BY:
PUBLIC RISK SERVICES
OF THE
FLORIDA LEAGUE OF CITIES, INC.
P.O. BOX 530065
ORLANDO, FL 32853-0065
August 17, 2004
FLORIDA MUNICIPAL INSURANCE TRUST
WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY
2004-2005
LIMIT OF LIABILITY:
Workers' Compensation: Statutory
Employers' Liability:
Total Payroll:
City of Tamarac
FMIT 0584
$1,000,000 Each Accident
$1,000,000 By Disease
$1,000,000 Aggregate by Disease
Deductible Stoploss
Drug Free Workplace Credit (5%)
Safety Credit (2%)
Experience Modification
NET PREMIUM:
$25,000
$19,526,900
Yes
Yes
10/1 /04 0.69
$459,476
WORKERS' COMPEN ATION PAYROLLS
CODE DESCRIPTION PAYROLL
0251
Irrigation Works Operation & Drivers
183,062
5190
Electrical Wiring - Within Buildings & Drivers
41,372
6403
Carpentry NOC
46,712
5509
Street or Road Maintenance or Beautification & Drivers
976,623
7380
Chauffeurs Drivers & their helpers NOC - Commercial
303,040
7520
Waterworks Operation & Drivers
2,137,071
7580
Sewage Disposal Plant Operation & Drivers
372,318
7704
Firefighters & Drivers
6,145,259
8380
Automobile Service or Repair Center & Drivers
238,201
8810
Clerical Office Employees NOC
5.180,055
8820
Attorney - All Employees & Clerical, Messengers, Drivers
392,561
9015
Buildings - Operation by Owner or Lessee
211,283
9102
Park NOC - All Employees & Drivers
1,377,104
9410
Municipal, Township, County or State Employee NOC
1,922,239
TOTAL PAYROLL
19,526,900
PLEASE READ THIS PAGE CAREFULLY
NO COVERAGES, TERMS OR CONDITIONS ARE TO BE ASSUMED.
All Trust Programs are Non -Assessable
Terms of this Agreement:
Premiums shown are subject to year-end audit adjustments.
All coverages provided by the Florida Municipal Insurance Trust are on an occurrence format. The Florida Municipal
Insurance Trust does not automatically included prior acts (tail) coverage.
2004/2005 PREMIUM INSTALLMENT PLAN
First Installment Second Installment Third Installment Fourth Installment
25% minimum due 25% minimum due 25% minimum due 25% minimum due
October 1, 2004 January 1, 2005 April 1, 2005 July 1, 2005
Payment will be forward to the League Office in Tallahassee
For any other coverages, the premium is billed by the Florida League of Cities
and due in full at inception, regardless of the size of premium
Forty-five (45) Days Notice of Cancellation and Non -Renewal
Ten (10) Days Notice of Cancellation for Non -Payment of Premium
FLORIDA LEAGUE OF CITIE§ PUBLIC RISK SERVICES
Public Risk Services is a full service operation formed to administer the Florida League of Cities' sponsored Trust.
This office is located in Orlando, Florida and includes four primary departments.
,, POLICYHOLDER RELATIONS
Policyholder Relations/service is pU-d d forthe Florida League of Cities' sponsored insurance Trust. Service is
provided throughout the state withrepresentatives in geographically defined territories. The North portion of
Florida is serviced by Tom Conleyd in Tallahassee; the Central portion is serviced by John Ligon in Orlando; and the
South portion is serviced by Chuck Wilde in Vero Beach.
UNDERWRITING
Functions of this department include evaluating insurance exposures for prospective and current members; computing
premiums for proposals, renewals and audits; and issuing policies. Department personnel are divided into four teams
including a separate health unit along with territorial teams to work with each marketing representative. Additionally,
premium billing and collection is coordinated between the Tallahassee and Orlando office.
CLAIM ADJUSTING/MONITORING
An integral part of the service is both the claims adjusting and the monitoring functions. All claims are handled "in house"
by League personnel.
RISK CONTROL
The Florida League of Cities Risk Control services provides resources to address property, liability and workers'
compensation losses. This includes implementation of a formal loss control program, field consultation, risk management/
safety training programs, field inspection and custom designed programs for specialized operations. In addition, the
department provides risk bulletins and a monthly "Safety Update" newsletter for public entities. There is no cost
to members associated with any of these resources.
OVERVIEW OF THE FLORIDA
LEAGUE OF CITIES SAFETY SERVICES
The problems contributing to accidents, injuries and lawsuits involving public entities are understood to be much more
complex than ever before. With your cooperation and our loss prevention expertise, success in loss avoidance/reduction
is an achievable goal. Take advantage of our services.
SYSTEM 7
This safety management program assists you in the implementation of a formal "measurable" loss control
program. The League provides an orientation and all materials necessary to implement the program immediately. The
success of cities on this program has been excellent. This program is the cornerstone for all of our other services.
2 FIELD SURVEYS
We assist you in making and understanding "how to" conduct a proper jobsite inspection to uncover unsafe workplace
or worksite conditions that could result in loss.
3 FIELD CONSULTATION
The field consultation program provides members with advice regarding the development and implementation of
meaningful policies and procedures that could assist the entity on managing their operations for success in loss
avoidance. This service also includes a complete assessment of your present loss control efforts. Written
recommendations accompany all field consultations.
4 SAFETY TRAINING
Workshops, seminars and other training formats are available to support your program. Examples of programs:
(1) How to make accident investigations
(2) Job hazard analysis
(3) Accident investigation
(4) Proper lifting
(5) Proper hiring techniques
(6) Recreational safety
5 RISK BULLETINS & "LIFTING' PAMPHLETS
Risk bulletins on a variety of subjects are available to support your efforts. Listing provided on request.
6 CUSTOM SLIDE/VIDEO PROGRAMS
If your operation is unique or your problem is specific in nature, the League has the capability to develop an
in-house "custom" program on "any" topic.
i NEWSLETTER
Support your program with information developed for our Monthly Safety Newsletter.
THERE IS NO COST FOR ANY OF THE ABOVE SERVICES. THEY ARE PROVIDED AS A MEMBER SERVICE OF
THE FLORIDA LEAGUE OF CITIES.
ATTACHMENT A
#17
MUN� lA.
cE TR
Florida League of Cities, Inc., administrator for
the Florida Municipal Insurance Trust
125 East Colonial Drive
Orlando, FL 32801.
Toll Free: (800) 442-6248
Fax: (407) 425-9378
www.fleities.com/insurance
c
- 7
�ti� a MuNic
� .� CE '�R
FMIT Snapshot!
125 East Colonial Drive
Insurance Office
Orlando, FL 32801
Years in Service
27
Number of Insurance Profes-
90+ employees
sionals
$81 Million in premiums for our Property and
Book of Business
Casualty program
$15 Million in premiums for our Health program
$67 Million in Surplus as of 3/31/04
Financial Strength
$310 Million in Assets as of 3/31/04
Reinsurance
All A rated carriers
Includes: Workers' Compensation, Property, Auto
Property and Casualty Piro- ;
Liability, Auto Physical Damage, General Liabil-
gram
ity, Errors & Omissions, Law Enforcement, and
Miscellaneous Ancillary_Coverages
Includes: HMO, POS, Dental, Vision,
Health Program
Short -Term Disability, and Life
16 WC Licensed Adjusters
8 Property & Liability Licensed Adjusters
Claims Management Staff.
4 Nurses
5 Health Examiners
19 Su port Staff
Avers a Ad'ustin Experience
8+ years
26 arrests
Special Investigation. Unit
12 cases successfully prosecuted
$829,800.66 ordered in restitution
0
s
0
0
0
d
�
I
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►r
4
FLORIDA MUNICIPAL INSURANCE TRUST
COMPILED FINANCIAL STATEMENTS
MARCH 31, 2004
SHORSTEIN & SHORSTEIN, P.A.
CzPrn IzD rv■WC ACCOUNTANTS
8263 BAYBERRY RCUM
JACKSONVILLi, FLoRIDA 3?rZ�ii Q
JACK F- SHORUMN, G.P.A.
"mucL R. SHORREIN, c.r.A.
MAIeK J. SHORT m, c.P.A.
WALTZI! I. HUNr[R, C.P.A.
H. Dm Hoorm c.r.A.
MICHAEL K PARRISH, C.P.A.
SARI1AM J. HOUSTM, C.P.A.
J"N s. MOELI., C.P.A.
Tw-WHONIC
(SOL) 739.13I 1
FACSIMILE
(904) 729-2W9
YYR arm
V WW.iHQRlTE1NCrA.COM
May 13, 2004
r~
t� y
To the Trustees of the Florida
Municipal Insurance Trust: y'
We have compiled the accompanying balance sheet of the Florida
Municipal Insurance Trust as of March 31, 2004, and the related
statements of revenues, expenses and changes in fund equity and cash
flows for the six months then ended, in accordance with Statements
on Standards for Accounting and Review Services issued by the e American Institute of Certified Public Accountants.
m
A compilation is limited to presenting in the form of financial n statements information that is the representation of management. We n
have not audited or reviewed the accompanying financial statements
and, accordingly, do not express an opinion or any other form of
assurance on them.
Management has elected to omit substantially all of the
disclosures required by generally accepted accounting principles.
If the omitted disclosures were included in the financial
statements, they might influence the user's conclusions about the
Trust's financial position, results of operations, and cash flows.
Accordingly, these financial statements are not designed for those
who are not informed about such matters.
1
"pUO"M: A"vos,A„ Jr=rr+:= or C=! r11m rj,= C JNCCMJW-%N, Z . �yl y iftsvr rrs or ComFtlm l�uruc Amavrrrwrrrw
Florida Municipal Insurance Trust
*RALANCE SHEET
Cash and Cash Equivalents
Investments
$ 34,536,D85
Premiums Receivable
237,709,472
Reinsurance Recoveries Receivable
21,675,128
�+
Receivable from Florida Special Disability Trust Fund
758,577
7,301,834
Ow
Receivable for Members' Deductibles
Mortgage Note Receivable
933,896
Prepaid Reinsurance
3,707,244
='
Prepaid Service Fee
883,282
1,825,000
C�
�
Prepaid Expenses - Other
w.
638913
13
:r
08,822
W
Total Assets 121 0,D72,25D
ee
LIABILITIES &M,EM... tQ ilk
C
Liabilities:
Liability for Claims and Claim Expenses $207,393,714 ft
Premiums Collected in Advance 32,779,520 e
Accounts Payable 1,513,460
Accrued Fees - Administrator
_ , 381,.246, d
Total Liabilities 242,074,940
Fund Equity:
Restricted $ 2,357,250
Unrestricted _ 65,612,060 67,97,310
Total Liabilities and Fund Equity P.3 12, 072 2 0
*See Accountants' Compilation Report.
F.
Florida Municipal Insurance Trust
*STATEMENT OF RSVgMMS, EXPENSES AND
CHANGES IN FUND EQUITY
9= the .x o 2 0
br_ eUfin9 .Revenueg
Premium Income
Investment Income
Other Income
Total Operating.Revenues
gperati�9,.�xn, ens€@
Claims and Claim Expenses
Administrative Fee and Service Fee
Assessments - Florida Department of Labor and
Employment Security'
Sponsorship Fee
Fraud Unit Expense
Other Expenses
Total Operating Expenses
Operating Income
Fund Equity, Beginning of Period
Fund Equity, End of Period
*See Accountants, Compilation Report.
3
$ 37,226,84
9,038,73
N
22,672,39
4,577,75
1,050,45
988,19
�•
260,01
y
7d
15,993,42 �.
5.QQ388
n
rt
Florida Municipal Insurance Trust
*STATEMENT OF CASH FLOWS
FOr e
ash Z12YA fr.4M QDOratina_Activitj2q
Cash Received from Members for Premiums
Reinsurance Recoveries
Florida Special Disability Trust Fund Collections
Cash Received for Commissions
Cash Paid to Property Pool Members
Cash Payments for Claims
Cash Payments to Suppliers for Goods and Services
Cash Payments to Florida Special Disability Trust Fund
Net Cash Provided by Operating Activities
Cash_F „ows„.,.fm lZmasting Activities
Interest on Cash and Investments
Collections on Mortgage Note
Net Cash Provided by Investing Activities
S. - S • f •l . - S - - T.-T • . .
=. . MIT ..
*See Accountants' Compilation Report.
4
$ 52,478,333
1,677,030
3,498,999
220,855
(209,9821
(25, 904, 925)
(13,276,193)
_ 1,212,, 727)
232,380
18,723,401
15,812,684
"AI 536.085
EE
Florida Municipal Insurance Trust
*STATEMENT OF CASH FLOPS
-F!2r the� &JX_ X2nthp Spled Marcla 3,1, 2QQ$
_ . . AK KUe
T4��_ . - i • SS w
y•
•. . . r
• - _ • • ri • �j • . VP
Investment • wm
QWSSLin'1
Increase in Premiums Receivable
Decrease in Reinsurance Recoveries Receivable
Decrease in Receivable from Florida Special Disability
Trust Rind
Increase in Receivable for Members' Deductible
Increase in Prepaid Expenses - Other
Decrease in Prepaid Reinsurance
Increase in Deposits
Decrease in prepaid Service Fee
Decrease in Liability for Claims and Claim Expenses
Increase in Premiums Collected in Advance
Decrease in Accounts Payable
Increase in Accrued Expenses
see Accountants' Compilation Report.
$ 15,993,427
(9,038,733) 4
w
y
(17,828,759) OLI
251,732
m
2,683,818
�.
(152,759)
(551,923)
v'
2,019,407
(13,757)
75,000
(869,290)
26,213,981
c
(1,521,167)
1412
7 3 0 rn„
m
�s
FLORIDA MUNICIPAL INSURANCE TRUST
FINANCIAL STATEMENTS
SEPTEMBER 30, 2003
I
J
wj
Florida Municipal Insurance Trust
Financial Statements
September 30, 2003
TABLE OF CONTENTS
itle Pagg_ Number
INDEPENDENT AUDITORS' REPORT 1-2
MANAGEMENT'S DISCUSSION AND ANALYSIS 3_9
'BALANCE SHEET 10
STATEMENT OF REVENUES, EXPENSES AND
CHANGES IN FUND EQUITY. 11
STATEMENT OF CASH FLOWS 12-13
NOTES TO FINANCIAL STATEMENTS 14-23
SCHEDULE 1 - REQUIRED SUPPLEMENTARY INFORMATION
TEN-YEAR CLAIMS DEVELOPMENT INFORMATION 24-25
SCHEDULE 2 - REQUIRED SUPPLEMENTARY INFORMATION
CLAIMS LIABILITY BY TYPE•OF CONTRACT 26
JACK F. SHORSTEIN, G.P.A.
SAMUEL R. SHORSTEIN, C.P.A.
MARK J. SHORCTEIN, C.P.A.
WALTER L. HuNTER, G.P.A.
H. DAN HOOPER, C.P.A.
MICHAEL K. PARRISH, C.P.A.
BARSARA J. HouiToN, C.P.A.
JOAN S. MDELL, C.P.A.
SHORSTEIN & SHORSTEIN, P.A.
CERTIFIED PUBLIC ACCOUNTANT$
8268 BAYBERRY ROAD
JACKSONVILLE, FLORIDA 322SS
January 5, 2004
To the Trustees of the Florida
Municipal Insurance Trust:
TELEPHONE
(904) 739-1311
1rACSIMILE
(904) 739,20M
WEOSRE
WVV W.8 HO RSTKI NCPA.COM
_) We have audited the accompanying balance sheet of the Florida
Municipal Insurance Trust as of September 30, 2003, and the related
statements of revenues, expenses and changes in fund equity and cash
flows for the year then ended. These financial statements are the
responsibility of the Trust's management. Our responsibility is to
express an opinion on these financial statements based on our audit.
We conducted our audit in accordance with U.S. generally
accepted auditing standards. Those standards require that we plan
and perform the audit to obtain reasonable assurance about whether
the financial statements are free of material misstatement. An
audit includes examining, on a test basis, evidence supporting the
amounts and disclosures in the financial statements. An audit also
includes assessing the accounting principles used and significant
estimates made by management, as well as evaluating the overall
financial statement presentation. We believe that our audit
provides a reasonable basis for our opinion.
In'our opinion, the financial statements referred to above
present fairly, in all material respects, the financial position of
the Florida Municipal Insurance Trust as of September 30, 2003, and
the results of its operations and its cash flows for the year then
ended in conformity with U.S. generally accepted accounting
principles.
1
MEMBMS, AW CRICAN INJIMMITE OF CERTIFIED PUBLIC ACCOUNTANTS • FLORIDA INSTiME OF CERTIFIED PUBLIC ACCOUNTANTS
The Management's Discussion and Analysis on pages 3 through 9 is
not a required part of the basic financial statements but is
supplementary information required by accounting principles
generally accepted in the U.S. We have applied certain limited
procedures, which consisted principally of inquiries of.management
regarding the methods of measurement and presentation of the
required supplementary information. However, we did not audit the
information and express no opinion on it.
Schedules 1 and 2 are comprised of information derived from the
financial statements of the Florida Municipal Insurance Trust as
well as predecessor entities, the Florida Municipal Liability Self -
Insurers Program, the Florida Municipal Self -Insurers Fund, the
Florida Municipal Property Self Insurers Program and the Florida
Municipal Health Trust Fund. The respective financial statements
were previously audited by us -in accordance with U.S. generally
accepted auditing standards,'and'we expressed unqualified opinions
on those financial statements.
In our opinion, the information set forth in Schedules 1 and 2,
as required by the Governmental Accounting Standards Soard, is
fairly stated in all material respects in relation to the financial
statements from which it has been derived.
J
2
Florida Municipal Insurance Trust
MANAGEMENT'S DISCUSSION & ANALYSTS
or the Ygar Ended t
The following discussion and analysis will provide an overview
of the financial activities of the Florida Municipal Insurance Trust
(the Trust) for the fiscal year ended September 30, 2003. Please
read this in addition to the financial statements, notes to the
financial statements, and other supplementary information provided
herein.
?UmagijLl High1jalats
• Assets exceeded Trust Liabilities at September 30, 2003,
by $52,003,883. Of this amount, $2,357,250 is being held
as collateral for surety bonds that have been issued to
the Florida Municipal Loan Council and is considered
restricted. The Trust's governing Board of Trustees
determines if, how much, and when Fund Equity
distributions are to be made, based on the Trust's long-
term financial needs.
• Fund Equity increased by $18,207,431 in 2002-2003 due
primarily to favorable past year loss development in the
Workers Compensation and General Liability lines of
coverage and base premium rate increases.
• The Trust invests more than $228,000;Q00 primarily in the
various portfolios of the Florida Municipal Investment
Trust (FMIvT), an external investment pool, as allowed
under the Trust's investment policy. Income derived from
these investments is used to fund incentive credits and
offset certain administrative expenses. Given the nature
of the Trust's operations and the integral part
investment income plays in those operations, it would be
inappropriate for the Trust to exclude investment income
from operating activities.
Florida Municipal Insurance Trust
MANAGEMENT'S DISCUSSION & ANALYSIS
Year Ended September 30, 200
Basic Financial Statem .
? The Trust is an independent reporting entity accounted for as
an enterprise fund in accordance with U.S. generally accepted
accounting principles for governments as established by the
Governmental Accounting Standards Board (GASB). These governmental
accounting rules require the'Trust to prepare a series of financial
statements. The Balance Sheet provides information about the assets
and liabilities at a specific point in time, in this case, September
30, 2003. The Statement of Revenues, Expenses, and Changes in Fund
Equity provides information about revenues (additions to.fund
equity) and expenses (deductions from fund equity) recorded during
the entire fiscal period from October 2002 through September 2003.
The Trust uses the flow of economic resources measurement focus and
"> the accrual basis of accounting. Under this method, revenues are
recorded when earned and expenses are recorded at the time the
liabilities are incurred.
Notes to the financial statements. The footnotes provide additional
information essential to the understanding of the financial
statements. .
supplemental information. In addition to the basic financial
statements and accompanying notes, this report also presents certain
supplementary information regarding the Trust's ten-year claims
development history. Setting member premium rates today to cover
the assumed risk of possible future loss occurrences is largely
guided by claims development. Analysis of trends in claims
development indicates whether losses are increasing, decreasing or
static.
Income and expenses. The majority of the Trust's operating income
and expenses are contained within a relatively small number of
accounts. Following is a brief description of the major accounts..
Premium Income. The Trust provides insurance to members in
much the same way as.insurance companies provide insurance
Protection for customers. Coverages are rated for each
individual member based on established rates, adjusted by
experience modifiers and discounts to reflect the actual loss
experience of the member. The experience modifier is based on
prior experience adjusted by certain factors. Member premium.
rating is accomplished by the Trust's Underwriting Department,
which has assigned each member to one of its staff
�J underwriters.
4
Florida Municipal Insurance Trust
MANAGEMENT'S DISCUSSION & ANALYSIS
r the Year Ended Se2tgmber 30 QQ
Investment income. The Trust has a highly diversified
investment portfolio. The target allocations established under
1 the Trust's investment policy are 20* equity and 80* fixed
income. The Trust's investments are managed primarily through
the equity and bond portfolios of the FMIvT. The Trust
complies with the provisions of GASB Statement 31 by including
in investment income the change in fair value of its
investments.
Claim payments and reserves. The Trust pays for covered losses
experienced by its members as well as related claims expenses.
The Florida League of Cities, Inc. has a contractual agreement
with the Trust to function as its administrator. All claims
are processed and managed in-house by the administrator.
Outside claims adjusters, attorneys, medical experts., and other
professionals are contracted on an as needed basis. Between
the time a claim is reported and the time it is resolved,
reserves are established for the estimated amount that will
have to be paid at some future date to settle the loss.
Reserves are also established for claims that have occurred,
.J but are not yet known to the Trust. This recognizes losses in
the current year for claims that will be paid in future
periods. This process allows a matching of current year
premiums with.estimated total losses that will be incurred as
the result of, current fiscal year coverages.
;) Administrative expenses and contract service fees. In
providing coverage and other member services, the Trust incurs
administrative expenses and contract service fees with both the
administrator and outside vendors. All of these expenses'a.re
budgeted and monitored on a regular basis for compliance with
budgetary limits. The administrator assesses their fees based
on member premiums and no change in this contractual
arrangement is anticipated in the near future.
1
5
Florida Municipal Insurance Trust
MANAGEMENT'S DISCUSSION & ANALYSIS
For the Year Ended S ember 0 2003
29Marative„..Financial Information
Table 1
Balance Sheet
ssets•
Cash and Cash Equivalents
Investments
Premiums Receivable
Reinsurance Recoveries Receivable
Receivable from%Florida.Special
Disability Trust .
Receivable for Members' Deductibles
;} Prepaid Reinsurance
Prepaid Service Fee
Prepaid Expenses - Other
Mortgage Note Receivable
Deposits
Total Assets
Liabitties:
Liability for Claims and Claim
Expenses
Premiums Collected in Advance
Accounts Payable
Accrued Expenses:
Administrative Fee
Sponsorship Fee
Total Liabilities
Euit
Y
Fund Equity
Total Liabilities
and Fund Equity
6
$ 15,012,684
228,903,119
3,846,369
1,010,309
9,985,652
781,137
3,902,689
900,000
86,990
4,863,875
89,062
g272,181,88f
$208,263,004
6,565,539
3,034,627
240,515
74,318
218,178,003
2 00 86
270 1F-L 8B
2Q1-2002
$ 6,942,078
215,733,417
3,679,527
3,683,699
10,685,370
948,960
2,987,825-
1,050,000
36,054
5,090,540
.89,062
$25Q, ElLf 532
$210,054,775
4,118,985
2,681,3.62
205,188
69,770
217,130,080
33,796,452
50 2fi 32
i
Florida Municipal Insurance Trust
MANAGEMENT'S DISCUSSION & ANALYSIS
FOZ t Y a 30, 2QQa
Table 2
Statement of Revenues, Expenses and
Changes in Fund Equity
B2vQ" es
Premium income
Investment Income
Other Income
Total Operating Revenues
Exnenses-
Claims and Claim Expenses
Administrative and Service Fees
Assessments - Florida Department of
Labor and Employment Security
Sponsorship Fee
Coverage Litigation Costs
Fraud Unit Expense
Other Expenses
$ 71,676,492
13,665,893
335.13B
85 23
51,396,565
8,609,123
2,172,376
2,039,706
-0-
337,965
2,914,357
Total Operating Expenses 67.470.Q92
Operating Income (Loss) 18,207,432
Fund Equity, Beginning of Year _33,726,, 452
Fund Equity, End of Year 52,003,113
2001-2002
$ 63,020,147
5,102,963
222 7
69,345,227
53,873,519
7,684,318
eo
1,976,275
C
1,750,468
1,272,587
339,586
m
1,610,622.n
68,5Q.L75
■s
(162,148)
33,999.1600 .
A 23.7
The Trust implemented GASS Statement 34 for financial statement
reporting purposes. Premium income is now presented net of
incentive credits which were previously presented as a separate
expense on the financial statements. In addition, expenses for
vision and life reinsurance were previously included in other
expenses. These are now netted against premium income. For
comparative purposes premium income in Table 2 for fiscal year 200.1-
2002 is presented net of incentive credits in the amount of
$10.658,895 and additional ceded reinsurance in the amount of
$230,006.
7
Florida Municipal Insurance Trust
MANAGEMENT'S DISCUSSION & ANALYSIS
FQr the Year, Ended_§_t=m_ber 1g,200
Some of the more important fund transactions during 2002-2003 are:
• The improving overall economic environment has
contributed to the increase in investment income. The
Pool earned $13,665,693 in investment income for 2002-
2003, which was greater than the $5,102,963 earned in the
previous year.
0 Improving loss development in previous claims years for
Workers Compensation -and General Liability has decreased
the overall Claims Expense to $51,396,565 for 2002-2003,
which is down from $53,873,519 in 2001-2002.
• For the fiscal year ended September 30, 2003 the Trust
reported earned premium of $71,676,492 compared to
$63,020,147 in the previous year. The primary reasons ee
for the increase in premiums are due to a combination of 5'
increased base rates for 2002-03 and new business.
C
Capital Asset and Long -Term Debt Activity
e�
The Trust has no capital assets or any long-term debt.
rt
Economic Factors .
The general outlook for the Trust continues to be favorable and
the major economic factors. influencing its performance have not
changed dramatically. The major internal challenges facing the
Trust are.to control administrative expenses and claims, while
pricing their products sufficient to cover unfavorable developments
in industry trends.
According to recent actuarial reports, expense ratios as a
percentage of premiums for the various lines remain under control.
Furthermore, there are no indications of any adverse developments
with regards to ultimate reserves on prior years.
During the 2003 session Florida lawmakers passed legislation to
reform key aspects of the Workers Compensation law. The bill was
primarily designed to limit the permanent total disability
eligibility, reduce attorney involvement and make adjustments to
medical fees paid to providers and hospitals. The effective date of
this legislation was October 1, 2003 and is anticipated to constrain
claims costs on claims filed after the effective date.
8
Florida Municipal Insurance Trust
MANAGEMENT'S DISCUSSION & ANALYSIS
FQr the Year Ended geRtgMher
At renewal the Trust was able to add $2.8 million in normal
premium net of cancelled business for workers compensation and
liability premiums while increasing rates pursuant to actuarial
recommendations. The overall retention for the Trust was 98t.
Rpmests for InggmatiQj;
This financial report is designed to provide a general overview
of the Trust's finances. Questions concerning the information
provided in this report or requests for additional financial
information should be addressed to the Director, Florida
Municipal Insurance Trust, P.O. Box $381.35, Orlando, FL 32853.
E
�j
Florida Municipal Insurance Trust
*BALANCE SHEET
September 30 2003
ASSETS
Cash and Cash Equivalents $ 15,812,684
Investments 228,903,119
Premiums Receivable 3,846,369
Reinsurance Recoveries Receivable 1,010,309
Receivable from Florida Special Disability Trust Fund 9,985,652
i Receivable for Members' Deductibles 781,137
Prepaid Reinsurance 3,902,689
Prepaid Service -.Fee 900,000
Prepaid Expenses - Other 86,990
Mortgage Note Receivable 4,863,875
Deposits 89,062
Total Assets $270,181.886
1
Liabilities:
Liability for Claims and Claim Expenses $208,263,004
Premiums Collected in Advance 6,565,539
Accounts Payable 3,034,627
Accrued Expenses:
:) Administrative Fee 240,515
Sponsorship Fee .74,318
Total Liabilities 218,178,003
Fund Equity:
„1 Restricted $ 2,357,250
Unrestricted 49,646,633
Total Fund Equity — .2,003,883
Total Liabilities and Fund Equity $270r181,886
i
i
*The accompanying notes are an integral part of these financial statements.
10
i
Florida Municipal Insurance Trust
*STATEMENT OF REVENUES, EXPENSES AND
CHANGES IN FUND EQUITY
For the ar Ended2003
Q=ratinq Revenues
Premium Income
'7 Investment Income
Other Income
Total Operating Revenues
era n E
Claims and Claim Expenses
l Administrative and Service Fees
Assessments - Florida Department of Labor and
Employment Security
Sponsorship Fee
Fraud Unit Expense
Other Expenses
") Total Operating Expenses
Operating Income
Fund Equity, Beginning of Year
Fund Equity, End of Year
r
3
$ 71,676,492
13,665,893
325_138
85-67"23
51,396,565
8,609,123
2,172,376
2,039,706
337,965
2.914.3„§77
--E7-470.092,
18,207,431
33,796.452
*The accompanying notes are an integral part of these financial statements.
11
I ,
i
i Florida Municipal Insurance Trust
*STATEMENT OF CASH FLOWS
For the Ended September 30. 2003
Cas FIow f om Operating Activities
Cash Received from Members for Premiums
$ 86,247,408
-� Reinsurance Recoveries
5,434,825
Florida Special Disability Trust Fund Collections
2,158,267
Cash Received for Commissions
335,138
Cash Collected for Property Pool Members
104,909
Cash Payments for Claims
(58,104,456)
Cash Payments to Suppliers for Goods and Services
(25,806,309)
Cash Payments to Florida Special Disability Trust Fund
(2,222,032)
Net Cash Provided by Operating Activities
8,.147.750
Cash F jows from Investing Activities
Interest on Cash and Investments.
603,793
Proceeds from Sale of Investments
5,205,601
_) Purchase of Investments
(5,31.3,203)
Collections on Mortgage Note
226,665
Net Cash Provided by Investing Activities
p
722,856
NNIlicrease in Caph„and Cash Equivalents
8,870,606
�I Cash and Cash ivalents, Be inn' of Year
1
6 942_,078
Cash and Cash Ecruivalents, End ear
15 812,684
I �
*The accompanying notes are an integral part of these financial statements.
i 12
Florida Municipal Insurance Trust
'
*STATEMENT OF CASH FLOWS
for_the Year Ended September -30, 2003
Reconciliation of Operating
Provided by Onerat;ina
Acttiy„;Lties
Operating Income
$ 18,207,431
Adlustments to
Reconci,leQperati_ng„..,Income to Net
gash Pgovided
by Q=atinOA—rtiy=ps
Investment
Income
(13,665,893)
i Change in Assets
and Lia§ilities
Increase in
Premiums Receivable
(166,842)
Decrease in
Reinsurance Recoveries Receivable
2,673,390
Decrease in
Receivable from Florida Special Disability
Trust Fund
699,718
)Decrease in
Receivable for Members' Deductible
167,823
Increase in
Prepaid Expenses - Other
(50,936)
i Increase in
Prepaid Reinsurance
(914,864)
Decrease in
Prepaid Service Fee
150,000
Decrease in
Liability for Claims and
i Claim Expenses •
(1,791,771)
Increase in
Premiums Collected in Advance
2,446,554
' Increase in
Accounts Payable
353,265
Increase in
Accrued Expenses
39,875
iN_et Cash PrQvide-d-by_Opgratina Activities _�,142,750
i
i
3
1
*The accompanying notes are an integral part of these financial statements.
I13
Reinsurance Program
Fro e
Tillinghast- Towers Perrin
Broker
Various Insured Entities
10 Pools
effective 4/1/04
see attached page for details
Trust Retention
$2 million per occurance in excess of members
deductibles
...- --I- - ■ A
rrvinyrs %+um en5aucin
Tillinghast -Towers Perrin
Broker
AIG/National Union Fire Ins. Company
Statutory x's $1,000,000
Trust Retention
$1, 000, 000
2003--2004
yasun
NLC Mutual Insurance Company
$10 Million in excess of $1 million
Trust Retention
$1,000, 000
Health
I American Stoploss
Broker
Reliastar
$900, 000 in excess of $100, 000
Trust Rentention
$100,000 Stoploss Cov
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