REQUEST FOR PROPOSALS (“RFP”) – PART I

RFP Template Revised 02/10/25 Page 1 of 6

RFP #: 262840MM RFP TITLE: WORKERS' COMPENSATION THIRD PARTY

ADMINISTRATOR

1.0 PURPOSE

Sarasota County (“County”), a political subdivision of the State of Florida, will receive proposals on the date indicated in OpenGov Procurement (OpenGov), the County’s electronic procurement portal, for the purpose of selecting a qualified Proposer to provide administration of workers' compensation (“WC”) claims for the Sarasota County WC program. Proposers are required to comply with Part II, Scope of Services.

OpenGov is located at https://procurement.opengov.com/portal/scgov

2.0 PROPOSER

2.1 For the purpose of this RFP, the term “Proposer” is defined as the legal entity submitting a proposal.

2.2 Proposers intending to submit a bid as a joint venture with another company must provide documentation attesting to the formation of that joint venture with their submittal. For purposes of this solicitation, all vendors who make up the joint venture will be considered together as the Proposer.

3.0 QUALIFICATIONS

3.1 The Proposer must demonstrate workers’ compensation claims administration experience.

3.2 The Proposer must have a 6-20 Resident All Lines Adjuster License issued by the Florida Department of Financial Services Division of Worker’s Compensation.

3.3 Preferred Qualifications

3.3.1. Proposer’s project team has experience providing and

administering workers’ compensation programs for Florida public entity employer with a minimum of two thousand (2,000) employees, within the past five (5) years.

3.3.2. Proposer’s project team has experience providing and

administering workers’ compensation programs for Florida public entity employer subject to the “Heart & Lung” presumption for firefighters, law enforcement and correction officers, within the past five (5) years.

3.3.3. Proposer’s project team includes personnel with knowledge of public sector claims handling, experienced adjusters of lost time claims management, and personnel with experience in adjusting complex claims, including Presumption claims.

3.3.4. Proposer’s project team has experience with Pharmacy Benefit Management.

https://procurement.opengov.com/portal/scgov

RFP Template Revised 02/10/25 Page 2 of 6

3.3.5. Proposer’s project team has experience with Pain Management options.

4.0 MEETINGS & SCHEDULE

An anticipated schedule is provided in the Timeline posted in OpenGov. All meetings will take place at the time, date, and location specified in the solicitation Timeline. Short-listed Proposers should be prepared to attend presentations and/or interviews either in Sarasota, Florida or virtually, at the County’s discretion.

5.0 SUBMITTAL INSTRUCTIONS

Refer to Submittal Instructions section in OpenGov for instructions on how to submit a proposal. Proposers are advised to review the General Terms and Conditions of Solicitations which are available in OpenGov.

6.0 VENDOR QUESTIONNAIRE

All proposers must complete the required forms and information included in the Vendor Questionnaire section of OpenGov. Completed forms and other requested documents must be uploaded with proposer’s submittal in OpenGov. Proposers who fail to complete and upload required forms and documents or fail to provide responses to questions in the Vendor Questionnaire section of OpenGov may be found non-responsive.

7.0 WRITTEN PROPOSALS

The information requested in each section below will be used by the evaluation committee to evaluate and score written proposals. All proposal documents must be submitted in the Vendor Questionnaire section in OpenGov in the format requested.

7.1 Qualifications

7.1.1. Single page Letter of Interest summarizing Proposer’s

qualifications.

7.1.2. Required and preferred Licenses and Certifications.

7.1.3. Resumes of key personnel, including subcontractors, demonstrating individual qualifications and experience

7.2 Experience

7.2.1. Narrative – Provide a narrative that describes the Proposer’s experience, including, but not limited to the number of years in business, pertinent capabilities, and evidence of experience and resources necessary to successfully provide the requested services.

7.2.2. Customer List - Provide a list of customers who have been provided services similar to the services described in this RFP in the last five

(5) years. Customer list should include contact information for a minimum of 1 and a maximum of 10 customers. At a minimum, include customer name, a brief description of services provided, contract start and end dates, and the name, email, and telephone number of a contact person who can verify information. When

RFP Template Revised 02/10/25 Page 3 of 6 possible, include the dollar value of the contract. If unable to provide detailed information regarding private sector customers due to confidentiality concerns, provide as much information as possible for those customers.

7.3 Approach

7.3.1. Project Approach - Provide a detailed project approach, including the proposed strategy for providing the requested services.

Anticipated resources, including, but not limited to, staffing levels, technology and equipment should be provided. Proposals should specifically address the following:

1. Project Team / Staffing Levels:

Clearly outline the staffing which will be provided, including the following information:

a. Define caseload of recommended adjusters and provide the average caseload per adjuster within your organization

b. Provide an outline of a dedicated unit based upon the historical information contained herein

c. Provide details regarding any adjuster caseload maximums which will be applied

7.3.2. Schedule/Timeline – Provide a graphical representation of the proposed schedule/timeline indicating major milestones and deliverables.

7.3.3. Organization – Provide an organizational chart identifying all key personnel and their role in the providing the requested services.

7.4 Compensation

Provide proposed fees using the pricing table provided in OpenGov.

7.5 Audit Report

Provide a copy of the most recent SAS (70) or similar audit report undergone by the Proposer within the last 24 months.

8.0 SELECTION PROCESS

8.1 Written Proposals

8.1.1. All timely responses meeting the criteria set forth in this RFP shall be considered by the County.

8.1.2. Written proposals will be evaluated and scored using the evaluation criteria in the Evaluation Criteria section of OpenGov.

8.1.3. Only proposers who submit required documentation will be eligible to receive Local and American Preference points.

8.1.4. When evaluating written proposals, the evaluation committee will use the scale below to score each criterion. Only whole numbers are to be used when scoring. Scores will be given weight as indicated in the evaluation criteria in OpenGov.

RFP Template Revised 02/10/25 Page 4 of 6

Score Description

5 Excellent

4 Very Good

3 Good

2 Satisfactory

1 Unsatisfactory

0 N/A

8.2 Presentations

8.2.1. If any member of the evaluation committee requests presentations, presentations shall be scheduled.

8.2.2. If presentations are requested or required, the evaluation committee shall determine the number of Proposers to be short-listed for presentations prior to scoring. The format of presentation will be determined by the County and may consist of presentations, interviews, or a combination of presentations and interviews.

Presentations will be required from no fewer than the three highest scoring Proposers (or all responsive and responsible Proposers if there are 3 or fewer) under the following circumstances.

1. The estimated costs of services are in excess of $350,000 (either annually or for the total project); or

2. Scoring results in 5 points or less between the highest scoring proposer and the 2nd highest scoring proposer; or

3. The solicitation documents specify that presentations or interviews will be required.

4. The Procurement Official has determined that presentations are required for this solicitation.

If this box is checked, the Procurement Official has determined that presentations are required for this solicitation

8.3 Ranking

Following presentations, the evaluation committee will rank the short-listed proposers. The ranking shall be based on the written proposals, clarifications (if any), and information presented during presentations.

8.4 Evaluation Committee Recommendation of Award

8.4.1. If presentations are not requested or required, the evaluation committee will recommend the highest scoring Proposer for award.

RFP Template Revised 02/10/25 Page 5 of 6

8.4.2. If presentations are requested or required, following presentations the evaluation committee will rank the short-listed Proposers, and recommend the first ranked Proposer for award.

9.0 AWARD

9.1 It is the intent of the County to award a contract to the Proposer(s) who, in the sole opinion of the evaluation committee is most qualified to provide the scope of services required and will provide the best value to the County.

9.2 The County reserves the right to contract for a term less than or greater than the duration indicated in OpenGov.

9.3 The successful Proposer(s) shall be required to submit proof of licenses or certifications as required by the County.

9.4 In the event of a tie, the RFP tie-breaking procedures identified in the Sarasota County Procurement Manual will apply. To be considered, tied Proposers will be required to provide documentation certifying they have implemented a drug-free workplace program meeting the requirements stipulated in Section 287.087, Florida Statutes. Documentation must be provided within the time specified by the County at the time of request.

9.5 Preferences

Proposers wishing to be considered for Local Business Preference or American Business Preference must complete and submit a Local & American Business Certification Form with their submittal. The Local & American Business Certification Form can be found in the Vendor Questionnaire section of OpenGov.

In awarding this RFP, preference shall be given to local businesses and American businesses in accordance with Section 2-215 of the Sarasota County Procurement Code.

Local and American business preferences do not apply to the award of this RFP, due to Grant funding requirements

9.6 Contract

A draft of the contract that the successful Proposer(s) will be expected to sign (a Term Contract) is posted on the Procurement website, shown below.

The County may, in its sole discretion, select a different contract type or make revisions to the one referenced above following the recommended award of this solicitation.

https://www.scgov.net/government/procurement/contract-templates

10.0 CHANGES IN KEY PERSONNEL

10.1 A change in the key personnel of a short-listed firm after the submission of the response to this RFP could result in reconsideration of the scoring of applicable evaluation criteria, at the sole discretion of the County.

10.2 Any changes in the key personnel of a short-listed firm should be brought to the attention of the County as soon as possible after the change is made.

https://www.scgov.net/government/procurement/contract-templates

RFP Template Revised 02/10/25 Page 6 of 6

The changes, the reasons for the changes, and resumes for the individuals being substituted for an individual identified in the response, must be submitted, prior to oral presentations, to the Procurement Analyst identified on the Solicitation Summary.

10.3 Decreases in scoring may result from the reconsideration of changes in the key personnel of a short-listed firm. No increases in scoring will result from the reconsideration of changes in the key personnel of a short-listed firm.

10.4 After award of a contract, the successful Proposer shall not be allowed to substitute key personnel named in this response, including subcontractors, without the prior written permission of the County. Substitution may, in the sole opinion of the County, be grounds for cancellation of selection, or termination of contract.

PART II

SCOPE OF SERVICES

Revised 10/07/20 Part II - Page 1 of 6 Prepared by Human Resources Department

1. OVERVIEW

A. The Sarasota County’s workers’ compensation (“WC”) program includes all departments and the Elected Official offices: Clerk of Courts, Property Appraiser, Supervisor of Elections and Board of County Commissioners. The program does not include the Tax Collector and the Sheriff’s Office.

B. The County has self-insured its WC program for more than thirty

(30) years. The County maintains excess WC insurance with a $1,000,000.00 per occurrence retention.

C. The County’s current program is focused on supporting criteria-based medicine, supporting treatment to achieve the best possible medical outcomes, and facilitating the County’s Stay at Work Program.

D. Consultant shall assume the complete handling of all new and existing claims, including pending claims, and incurred but not yet reported (IBNR) claims being handled by the County’s current claims administrator. A copy of claims data, and all other documentation associated with claims occurring prior to the effective date of this Contract, shall be transferred into Consultant’s Risk Management Information System (RMIS) to maintain a consistent, comprehensive history of all claim years.

The transfer of all data shall be completed no later than the commencement date of services under the contract.

2. ADMININSTRATIVE SERVICES

Consultant shall:

A. In accordance with any required time frames, prepare (with the County’s assistance) and file with the appropriate state agencies all applications, bonds, documentation, and data required (if any) for implementation and continuance of the program.

B. In accordance with any required time frames, prepare, maintain, and file all records and reports as may be required by legal authorities (state, local, and federal).

C. Prepare and follow service instructions that have been approved by the County in the handling of the County’s claims. The service instructions shall outline the details of the expected tasks, timeframes for completion and authority levels for all claim activity.

D. Provide monthly and annual reports summarizing claims and shall recap each year’s experience, including prior years, to date. The reports shall be on a fiscal year basis, with an October 1 anniversary. Reports shall be provided within 30 days of the end of the period for which each report applies.

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E. Prepare, maintain, and file statistical or other records and reports as required by the County’s excess insurers. Report claims to the County’s excess insurer(s) in accordance with the requirements of the excess insurer(s) and include a copy to the County.

F. Comply fully with all rules, regulations, guidelines or procedures established by the County and the State of Florida, including Electronic Data Interchange (EDI), and Medicare Secondary Payer requirements.

G. In accordance with any required time frames, prepare, maintain, and file statistical information required by Workers' Compensation Rating Bureaus, Medicare Secondary Payer, and other appropriate state agencies as applicable, including Electronic Data Interchange (EDI) and data necessary for the promulgation of experience modifications.

H. Prepare and distribute all required 1099 forms.

I. Annually, provide the County with Consultant’s SOC-1 report and Bridge letter.

J. Provide the County with Consultant’s procedures for response to emergencies, including the name(s) and/or office and telephone number(s) of Consultant’s emergency contact(s).

K. Have a business continuity plan for ensuring that in the event of an emergency, e.g., hurricane preparedness, how Consultant’s services will continue, how the County’s employees will be paid indemnity, and how they will be instructed on obtaining medical care.

L. Regularly keep the County informed of any significant regulatory or industry changes that may impact the County or its workers’ compensation program.

M. Meet with County staff monthly to address any administrative items and meet quarterly for claim reviews to review any claims or overall program performance.

N. Provide an annual stewardship meeting with Program results and benchmarking information comparing the Program with state and national data.

O. Audits

i. During the contract term, the County may audit its electronic claim files at any time without notice.

ii. Not more than once annually and upon at least thirty (30) days written notice to Consultant, County may request an audit, at County’s cost, relating to Consultant’s records.

Consultant shall cooperate with such audits. The County shall have the right to audit during the contract term and

Revised 10/07/20 Part II - Page 3 of 6 for five (5) years following the termination of the contract.

No additional fees shall be due the Consultant for cooperation with such audits.

iii. If the County secures a third party auditor, the County will request the auditor to sign and comply with any confidentiality agreement required by the Consultant.

P. Reimburse County for payment of any fines, penalties, or assessments assigned by the State of Florida for failure to comply with rules and regulations, including but not limited to EDI reporting, associated with the performance or responsibility of the Consultant.

3. CLAIMS HANDLING

Consultant shall:

A. Provide the County with Consultant’s reporting procedures, such as but not limited to 24-hour telephonic or internet-based claim reporting and intake capabilities. Send First Notice of Injury to the State of Florida in a timely manner and accept responsibility for penalties for late notice to the State of Florida unless the delay was caused by the County.

B. Receive and examine on behalf of the County all reports of employee injury claims timely and in accordance with state regulations and guidelines. Refer injured workers to appropriate medical services, and as appropriate and based upon pre-established criteria agreed upon by the County, provide immediate referral to specialty medical providers for injuries.

C. Complete 3-point contacts: Contact injured worker, supervisor, and medical provider, either in writing or orally, within 24 hours of Consultant’s receipt of claim report and when assuming an already existing claim.

D. Use its best judgment in settling or denying claims and in setting reserves for future payment, and perform the following functions regarding claims:

i. Comply with all applicable laws and regulations regarding workers’ compensation benefits.

ii. Perform necessary investigations and other measures to assure claim validity.

iii. Establish and maintain complete claims files on each claim.

iv. Maintain communication with injured workers, supervisors and medical providers at appropriate intervals (after medical appointments and claim milestones related to the plan of action) throughout the claim to determine status and next steps toward recovery and claim conclusion.

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v. Assist the County with its ongoing efforts to maintain a Stay at Work program, including the creation and offer of light duty positions. Claim Management throughout the light duty assignment, with regular reporting of status outcomes, in line with the requirements of the County light duty program is required.

vi. Properly review, process, and pay claims on a timely basis.

vii. Establish and update claim reserves. Obtain prior approval from the County’s Risk Manager or its designee on claim reserve increases in excess of $25,000.00.

viii. Provide copies of all pertinent medical, legal and investigative reports.

ix. Prepare and maintain files necessary for legal defense of claims and/or other litigation or other proceedings, such as actions for subrogation, contribution, or indemnity.

x. Attend hearings, depositions, mediations, and other proceedings as necessary. Prior to any scheduled proceedings, prepare status reports for County Risk Management staff outlining the case details, status, and plan of action to resolve the claim.

xi. Provide for timely notification of excess insurers, as required by excess insurance policies.

xii. Pursue all second injury funds, subrogation and other recovery opportunities.

xiii. Consult with the County on the selection of and referral to outside professionals such as surveillance personnel, expert witnesses, and attorneys, to assist in the investigation, adjustment, and defense of claims.

4. BANKING/RECONCILIATION SERVICES

A. The County’s claim funding account will be maintained at a financial institution chosen by the County.

B. Consultant shall assist County in establishing a zero-balance loss fund account at a financial institution chosen by the County (the Loss Fund Account). Consultant shall debit from the County’s designated account, via daily ACH transfers, an amount sufficient to meet all claims payment obligations that were issued by Consultant the prior day, and such amount shall be deposited into the Loss Fund Account.

C. The County reserves the right to direct Consultant in writing regarding payment of claims. The County reserves the right to establish a limit on the amount of payment that can be made by Consultant without County authorization; this will be outlined in

Revised 10/07/20 Part II - Page 5 of 6 the special instructions.

D. All claims or expense payments shall be made by Consultant on checks drawn on the County’s claim funding account. All funds in this account are the County’s funds and shall be returned to the County upon request or termination of the contract. No payments due to Consultant for administrative fees or reimbursable expenses shall be deducted from these funds.

E. Consultant shall provide the County with a monthly list of all checks issued for the prior month and outstanding checks by the 10th of the following month. All bank charges, if any, shall be incurred by and paid by Consultant.

F. Consultant shall cooperate fully with any audit of the County’s claim funding account by either the County or County-authorized independent auditor.

5. DATA ACCESS/REPORTING SERVICES

A. Consultant shall provide all reports, including unit statistical reports, required by the State of Florida.

B. Consultant shall provide the County access to their RMIS System, which shall provide comprehensive, real-time, online electronic claim information, and financial and reporting data. Within the RMIS, the County shall have real-time, online access to all claim files, including adjuster notes, supervisory notes, case management notes, diary items, payment records, medical bills, and expense bills, in an electronic format with internet-based access. The County will be provided with a minimum of five (5) free licenses to access Consultant’s RMIS.

C. Consultant shall provide County with data and reports to comply with its annual audit and actuarial requirements no later than October 10th of each calendar year.

D. Consultant shall provide County with a daily download to the County’s system, Origami.

6. OTHER REQUIREMENTS

A. Staffing Requirements

i. Consultant shall maintain a dedicated staffing unit with adjusting, supervisory, and support staff, preferably at a claims office within a radius of 100 miles of Sarasota County.

ii. Upon written notice to Consultant, the County shall have the right to request a change of any member of Consultant’s staff due to performance reasons or lack of following service standards. Consultant shall promptly remove such staff from the Program and work diligently to

Revised 10/07/20 Part II - Page 6 of 6 promptly find a replacement.

B. Obligations Not Terminated by Contract Period

i. Consultant shall be required to provide continuing services for all claims occurring during the contract period until three (3) months after the termination of the contract.

Continuing services shall include provision of all required reports for the contract period rendered, and all required reports to appropriate agencies. Consultant’s fees shall include consideration for such continuing obligations and, except as noted herein, no additional compensation shall be due for obligations which extend beyond the contract period.

C. Ownership of Claims Files

i. The County shall have all rights, title, interest, and ownership to all loss statistics and claim files, in electronic and hard copy form, created as a result of the services to be provided by Consultant. At the sole option of the County and upon ten (10) days written notice, Consultant shall deliver such files to County.

ii. At the termination of the contract, at the sole expense of the Consultant, Consultant shall provide County with electronic files or other data feeds acceptable to the County containing all of the claim data. Such data shall be made available in a format generally importable into a commonly recognized database for claims administration.

PART III – INSURANCE REQUIREMENTS

Insurance Template 1 Revised 05/13/16 Page 1 of 2

CONTRACTOR’S INSURANCE

Contractor shall, on a primary basis and at its sole expense, maintain in full force and effect, at all times during the life of this Contract, insurance coverage (including endorsements) and limits as described herein. These requirements, as well as the County’s review or acceptance of insurance maintained by Contractor, are not intended to and shall not in any manner limit or qualify the liabilities or obligations assumed by Contractor under this Contract.

Insurance requirements itemized in this Contract and required of the Contractor shall extend to all subcontractors to cover their operations performed under this Contract.

The Contractor shall be responsible for any modifications, deviations, or omissions in these insurance requirements as they apply to subcontractors.

Insurance carriers providing coverage required herein must be licensed to conduct business in the State of Florida and must possess a current A.M. Best’s Financial Strength Rating of A- Class VII or better.

Each insurance policy required by this Contract shall apply separately to each insured against whom claim is made and suit is brought, except with respect to limits of the insurer’s liability.

The Contractor shall be solely responsible for payment of all premiums for insurance contributing to the satisfaction of this Contract and shall be solely responsible for the payment of all deductibles and retentions to which such policies are subject.

Contractor shall furnish Certificates of Insurance to the County Administrative Agent evidencing the types and amounts of coverage, including endorsements, required by this Contract prior to commencement of work and prior to expiration of the insurance contract, when applicable. Such Certificate(s) of Insurance shall, to the extent allowable by the insurer, include a minimum thirty (30) day notice of cancellation (10 days for non-payment of premium) or non-renewal of coverage. Notwithstanding these notification requirements, the Contractor will be required to provide County with 5-day prior written notice of any policy cancellation or non-renewal.

The County reserves the right to review, modify, reject, or accept any required policies of insurance, including limits, coverage, or endorsements, herein from time to time throughout the term of this Contract. County reserves the right, but not the obligation, to review and reject any insurer providing coverage due to its poor financial condition or failure to operate legally.

A. WORKERS’ COMPENSATION: Contractor agrees to maintain Workers’ Compensation insurance in accordance with Florida Statutes, Chapter 440.

Employers Liability to be included with a minimum limit of $500,000.00 per accident/per disease/per employee. If work is to be performed over or adjacent to navigable water and involves maritime exposure, applicable LHWCA, Jones Act, or other maritime law coverage shall be included.

PART III – INSURANCE REQUIREMENTS

Insurance Template 1 Revised 05/13/16 Page 2 of 2

In the event the Contractor has “leased” employees, the Contractor or the employee leasing company must provide evidence of a Workers’ Compensation policy for all personnel on the worksite.

Contractors who are exempt from Florida’s Workers’ Compensation law must provide proof of such exemption issued by the Florida Department of Financial Services, Bureau of Workers’ Compensation.

B. COMMERCIAL GENERAL LIABILITY: Contractor agrees to maintain Commercial General Liability per ISO form CG0001 or its equivalent, including but not limited to coverage for premises and operations, personal injury, products & completed operations, liability assumed under an insured contract, and independent contractors with limits of not less than $1,000,000.00 each occurrence, $2,000,000.00 aggregate covering all work performed under this Contract.

Contractor agrees to endorse Sarasota County Government as an additional insured on the Commercial General Liability coverage.

C. PROFESSIONAL LIABILITY: Consultant agrees to maintain Professional Liability insurance, or equivalent Errors & Omissions Liability insurance, with limits not less than $1,000,000 per claim/occurrence and in the aggregate for professional services rendered under this contract. If coverage is written on a claims-made basis: a. Any retroactive date shall precede the effective date of this contract; b. Consultant shall provide certificates of insurance evidencing the required coverage for a period of two years after final payment under this contract is made, or provide evidence showing Consultant has obtained a two year extended reporting period endorsement.

Part III