F883897933_04Attachment2SOW.pdf

2122-01 ITN RM, Statewide Claims and Investigation Services

DEPARTMENT OF FINANCIAL SERVICES

2122-01 ITN RM, Statewide Claims and Investigation Services

Statement of Work

Attachment 2

1. Statement of Work (SOW).

The Contractor shall provide Statewide Claims and Investigation Services to the Florida Department of Financial Services’ Division of Risk Management. The Contractor is responsible to the Department for the work of any subcontractor. All Deliverables and all tasks required by this Contract are the responsibility of the Contractor and shall be performed in compliance with all applicable statutes, rules, policies, and procedures.

2. Definitions.

In this Contract, the following terms shall be defined as set forth below:

a. Business Days – Monday through Friday, inclusive, except for the days State holidays are observed in accordance with section 110.117, Florida Statutes (F.S.), and emergencies as designated by the Department’s Contract Manager.

b. Business Hours – 8:00 a.m. until 5:00 p.m. Eastern Standard Time on all Business Days.

c. Calendar Days – All days, including weekends and holidays. With respect to due dates and deliverables, if the last day counted falls on a weekend or holiday, the due date will be the next Business Day thereafter.

d. Claimant – Property, Liability, or Workers’ Compensation claimant.

e. Contract – The agreement that results from Invitation to Negotiate #2122-01 ITN

RM between the Department and the selected Respondent.

f. Department – The Department of Financial Services.

g. Division of Risk Management (Division) – A part of the Department of Financial

Services.

h. EDI – Electronic Data Interchange.

i. Level 2 Criminal Background Screening – A background screening pursuant to

Chapter 435, F.S., which is used to identify criminal history.

j. SSAE 18 (SOC 1) Type II Audit – The Statement on Standards for Attestation

Engagements audit standard that focuses on the internal controls covering financial reporting.

k. SSAE 18 (SOC 2) Type II Audit – The Statement on Standards for Attestation Engagements audit standard that focuses on the internal controls related to security, data availability, confidentiality, privacy, and processing integrity.

l. State –The state of Florida.

m. State Liability and Property Claims – These types of claims involve general liability, automobile liability, federal civil rights, employment discrimination, and property damage to State and university buildings and contents.

n. Statewide – All counties in the state of Florida.

o. Workers’ Compensation Claims – These types of claims involve State employees, volunteers working for State agencies and universities, and other persons considered State employees under Florida Statutes.

3. Duration.

a. Term.

The term of the Contract is four (4) years to begin on the Effective Date as indicated in the Contract Signature Page. The Department shall have the right to terminate or suspend the Contract by providing the Contractor with nine (9) months written notice.

b. Renewals.

The Contract may be renewed, by mutual agreement, in accordance with section 287.057(14), F.S., for a period not to exceed four (4) years from the end of the original Contract term. Renewal pricing, to which the Contractor shall be bound, will be paid in accordance with Attachment 3, Price Response; however, the Department may negotiate for lower pricing. Renewals are contingent upon satisfactory performance evaluations by the Department, and subject to the availability of funds.

4. Services to be Provided by the Division.

The Division will:

a. assign claims to the Contractor, identifying the type of assignment and what information is being requested;

b. review and approve reports and other documentation submitted by the Contractor;

c. provide clarification to the Contractor, as needed, regarding Division operations and liability, property and Workers’ Compensation policies;

d. provide the Contractor access to the Division’s claims management system;

e. provide Division claims management system training to the Contractor’s staff; and

f. provide office space and network access for the Contractor’s On-site Coordinator as described in Section 5.2.3., 7., Type III: Investigation of Possible Insurance Fraud for Workers’ Compensation and State Liability and Property Claims.

5. Services to be Provided by the Contractor.

The Contractor shall provide claims processing and investigation services for Workers’ Compensation, general liability, automobile liability, federal civil rights, employment discrimination, and property damage to State buildings, when assigned by the Division, to assist the Division’s in-house claims staff in bringing claims to closure.

5.1 Administrative Set-Up.

The Contractor shall begin performing the requirements for Administrative Set- Up, described in this SOW, upon execution of the Contract. The Contractor shall, within sixty (60) Calendar Days of the effective date of the Contract, complete the following Administrative Set-Up requirements:

a. Implementation Plan.

The Contractor shall develop an Implementation Plan to support the services required under this Contract.

b. Implementation Schedule.

The Contractor shall develop an Implementation Schedule. At a minimum, the Implementation Schedule will include:

i. required work broken into tasks;

ii. specific durations for each task;

iii. task start and end dates;

iv. dependencies; and

v. assigned resources.

c. Policies and Procedures.

The Contractor shall submit policies and procedures for all of Section 5.2, Statewide Claims and Investigation Services, as applicable, by a mutually agreed upon date, prior to services commencing.

d. Division Approval Required.

The Contractor shall, during Administrative Set-Up outlined in Section 5.1, submit to the Division all written documents that require approval by the Division, as provided by this SOW, prior to commencing the delivery of Statewide Claims and Investigation Services.

e. Disaster Recovery Plan.

The Contractor shall provide a Disaster Recovery Plan for Division approval, by a mutually agreed upon date, prior to services commencing.

f. Training.

i. The Contractor shall ensure that adjusters are available to receive the

Division’s claims management system training, which at the discretion of the Division, shall be in-person at the Division’s facilities or remotely, prior to services commencing.

ii. The Contractor shall, upon written request by the Division, provide the Division training on any Contractor system(s) that is required to be used by the Division, prior to services commencing. The Contractor will provide access to all users requested by the Division.

g. Weekly Status Report.

The Contractor shall provide a Weekly Status Report until the requirements of Section 5.1, Administrative Set-Up, are completed.

5.2 Statewide Claims and Investigation Services.

The Contractor shall, when requested in writing by the Division, begin performing the services specified in this Section 5.2, Statewide Claims and Investigation Services.

5.2.1 Type I: Special Investigation/Field Contact.

A. Workers’ Compensation Claims.

1. Type I Workers’ Compensation Claim assignments involve State employees, volunteers working for State agencies, and other persons considered State employees as defined in Chapter 440, F.S.

2. The Contractor shall, for Type I Workers’ Compensation Claim assignments, provide the services for a special investigation/field contact to include, but not be limited to the following:

a. obtaining recorded statements, in person, from the injured employee, witnesses, and the injured employee’s employer. Since recorded statements may not always be appropriate or required, interviews may be conducted in lieu of recorded statements, as directed by the Division;

b. inspecting the accident scene, including taking photographs;

c. obtaining accident reports, medical reports, court records, death certificates, and similar documents;

d. determining possible subrogation claims which would include obtaining affidavits for Special Disability Trust Fund claims; and

e. verifying continued disability or dependency, as defined in Chapter

440, F.S.

3. The Contractor shall, within one (1) Business Day after receipt of a Type

I Workers’ Compensation Claim assignment from the Division, provide written acknowledgement of the assignment to the Division. Such written acknowledgement shall include, at a minimum, the name of the Contractor’s investigator assigned to the claim file, the assigned investigator’s telephone number, and email address.

4. The Contractor shall complete Type I Workers’ Compensation Claim assignments within twenty-one (21) Calendar Days from assignment acknowledgement, unless an extension is provided in writing to the Contractor by the Division.

B. State Liability and Property Claims.

1. Type I State Liability and Property Claim assignments of this type include:

a. automobile accidents involving State employee drivers;

b. general liability claims (including professional malpractice) alleging negligence of State employees in conducting State program operations or maintenance of State premises;

c. claims alleging federal civil rights violations by State employees acting under color of State law;

d. employment discrimination claims filed against State agencies; and

e. property damage claims filed by State agencies for damage to State owned buildings and contents due to covered perils including, but not limited to, fire, wind, flood, or lightning.

2. Services required by the Contractor for Type I State Liability and Property Claim assignments include, but are not limited to:

a. assessing the extent and nature of injuries or damages sustained;

b. investigating accident/incident factors leading to establishment of the degree of liability, if any, on the part of State government;

c. interviewing involved persons or witnesses;

d. taking photographs or statements;

e. obtaining accident reports, medical records, photographs, court records, and similar documents; and

f. conducting other claims activities as required to bring the claim to conclusion.

3. For Type I State Liability and Property Claim assignments, the Contractor shall adhere to the communications requirements set forth below:

a. The Contractor shall, within one (1) Business Day after receipt of

Type I, State Liability and Property Claim assignment, provide written acknowledgement to the Division. Such written acknowledgement shall include, at a minimum, the name of the Contractor’s investigator assigned to the claim file, the assigned investigator’s telephone number, and email address.

b. The Contractor shall contact the parties involved in the Type I State Liability and Property Claim investigation assignment within two (2) Business Days after receipt of the assignment from the Division.

c. The Contractor shall complete Type I State Liability and Property Claim assignments within twenty-one (21) Calendar Days from assignment acknowledgement, unless an extension is provided in writing to the Contractor by the Division.

5.2.2 Type II: External Full Handling and Processing of a Claim.

Claims assigned for external full handling and processing may include permanent assignments, such as in the case of out-of-State claims; temporary assignments for a finite or specific period of time; and/or special assignments for which the Division may require additional assistance. Claims assigned for external full handling and processing shall be the responsibility of the Contractor, except for the following responsibilities, which shall be retained by the Division:

• findings of permanent total disability;

• attorney assignments; and

• settlement authority.

A. Workers’ Compensation Claims.

1. Workers’ Compensation Claims may be either existing or new claims and will be assigned to the Contractor for full handling and processing. This includes, but is not limited to:

a. determining compensability;

b. coordinating, paying, and reviewing medical benefits in collaboration with the Division’s medical case management Contractor;

c. coordinating, paying, and reviewing indemnity benefits;

d. requesting assignment of defense counsel if a claim becomes litigated and assisting the defense attorney as needed;

e. completing any required EDI forms;

f. referring claims for investigation and/or surveillance to maintain efficiency and identify potentially fraudulent claims upon prior written approval of the Division; and

g. requesting settlement authority and taking action to settle and close claims when appropriate and/or handling a claim until a Claimant is no longer eligible for benefits.

2. The Division will assign Type II Workers’ Compensation Claims to the Contractor for full handling and claims processing, which shall include a full and comprehensive investigation.

3. The Contractor shall submit to the Division a summary of the claim ten

(10) Calendar Days prior to mediation. This summary shall include a completed authorization request form, and a recommended settlement amount. For claims that are not settled, the Contractor shall assist legal counsel during the legal process as necessary.

4. The Contractor shall submit a Quarterly Status Update of Workers’ Compensation claims ten (10) Calendar Days following completion of the previous quarter.

5. The Contractor shall process all claims related bills and payment requests through the Division’s claims management system. The Division will issue checks for all approved payment requests. All processed bills and payment requests shall be in accordance with Division policies and procedures. The Contractor shall ensure all associated invoices and supporting documentation are uploaded to each associated claim within the Division’s claims management system.

B. State Liability and Property Claims.

1. State Liability and Property Claims may be existing or new claims and will be assigned to the Contractor for full handling and processing. This includes, but is not limited to:

a. Interviewing witnesses, photographing the scene of an accident, and collecting medical bills and documentation of wage losses and other damages;

b. determining liability of the insured agency;

c. drafting and submitting a request for authority from the appropriate

Division program administrator;

d. contacting the counsel representing the claimant and negotiating a settlement when possible;

e. requesting assignment of defense counsel if plaintiff files a lawsuit and assisting the defense attorney as needed once litigation commences; and

f. requesting settlement checks as needed and closing the file after litigation is concluded.

2. The Division will assign Type II State Liability and Property Claims to the Contractor for full handling and claims processing, which shall include a full and comprehensive investigation.

3. The Contractor shall submit to the Division a summary of the claim ten

(10) Calendar Days prior to mediation. This summary shall include a completed authorization request form, and a recommended settlement amount. For claims that are not settled, the Contractor shall assist legal counsel during the legal process as necessary.

4. The Contractor shall submit a Quarterly Status Update of State Liability and Property claims ten (10) Calendar Days following completion of the previous quarter.

5. The Contractor shall process all claims related bills and payment requests through the Division’s claims management system. The Division will issue checks for all approved payment requests. All processed bills and payment requests shall be in accordance with Division’s policies and procedures. The Contractor shall ensure all associated invoices and supporting documentation are uploaded to each associated claim within the Division’s claims management system.

5.2.3 Type III: Investigation of Possible Insurance Fraud for Workers’ Compensation and State Liability and Property Claims.

1. The Contractor shall, for Type III claim assignments, investigate possible fraudulent claims involving Workers’ Compensation and State Property and Liability claimants, as well as vendors providing goods or services related to a claim, or any other person or organizations associated with a claim.

Services billed under Type III should include, but not be limited to, preparing a referral to Division of Investigative and Forensic Services (DIFS), communicating with DIFS, State attorney offices, and defense counsel, and assist in the preparation of the case for prosecution.

2. The Contractor shall possess expertise in the investigation of insurance claims for potential fraud and be qualified and capable to function as the Division’s Special Investigations Unit (SIU), as required by section 626.9891, F.S.

3. The Contractor shall, at no additional cost to the Division, dedicate one (1) qualified Florida-licensed investigator, for Type III and Type IV service coordination and close consultation with Division staff. This coordinator (hereinafter referred to as “On-site Coordinator”) shall work onsite within the Division in Tallahassee, Florida, at least two (2) Business Days per week, or more as deemed necessary and requested in writing by the Division.

4. The Contractor’s On-site Coordinator shall be approved by the Division and shall be prepared to begin work, on-site within the Division no later than fourteen (14) Calendar Days from the date services commence.

5. Prior to Division approval of the Contractor’s proposed On-site Coordinator, the Contractor shall obtain a background check, including fingerprinting, through the Florida Department of Law Enforcement on the proposed individual. The Division reserves the right to reject proposed staff based on background check results. The Contractor shall be responsible for payment of, and retaining records relating to, employee background and security checks, which records are exempt from Chapter 119, F.S.

6. The Contractor shall submit to the Division a Quarterly Fraud Investigation Report by the fifteenth (15th) day of the month following the quarter in which services were rendered.

7. The Division will provide office space and network access for the Contractor’s Division-approved On-site Coordinator.

5.2.4 Type IV: Surveillance.

1. Type IV claim assignments require surveillance investigation on Workers’ Compensation and State Liability and Property Claims. The Division retains discretion regarding Contractor assignment for observational activities on claims in litigation and may elect to use the Contractor for specific claims.

Surveillance may include, but is not limited to, observation of the claimant’s daily activities to substantiate or invalidate alleged losses, verification of claim details, internet and social media data mining, and other claims investigation activities as directed by the Division.

2. The Contractor shall, within one (1) Business Day after receipt of a Type IV surveillance assignment, provide acknowledgement of the assignment to the Division. Such written acknowledgement of the assignment shall include, at a minimum, the name of the investigator assigned to the file, their telephone number, and email address.

3. The Contractor shall submit to the Division an Assignment Summary Report within three (3) Calendar Days following the completion of each assignment.

5.2.5 Type V: Appraisals.

1. Automobile Property Damage Appraisal.

Automobile property damage appraisal assignments shall require the

Contractor to determine and document the reasonable cost to repair the damage to a passenger type automobile or a single unit truck. If the damaged vehicle is determined to be a total loss, the Contractor’s appraiser is to notify Division staff, prepare a vehicle condition report, and order a vehicle total loss evaluation report. These claims shall also include those for third party automobile total loss. For these claims, the Contractor shall settle the claim within the authority received from Division staff and arrange for the sale of the salvage.

2. Heavy Equipment and Structural Property Damage Appraisal.

Heavy equipment and structural property damage assignments shall require the Contractor to determine and document the reasonable cost to repair the damage to heavy equipment or structural property. If the vehicle or structural property is determined to be a total loss, the appraiser is to immediately notify Division staff, prepare a condition report, and where applicable, order a total loss evaluation report. This type of assignment may also include structural damage appraisals required in claims being processed by the Division’s property insurance program that provides coverage for State and university owned and leased buildings, and contents damaged by covered perils including, but not limited to, fire, wind, flood, or lightning.

3. Marine Surveys.

Marine survey assignments shall require the Contractor to determine the reasonable cost to repair or replace damaged marine property or equipment.

4. For Type V appraisal assignments listed above the Contractor shall:

a. Submit to the Division within one (1) Business Day after the receipt of a

Type V appraisal assignment, written acknowledgement of the assignment. Such written acknowledgement shall include, at a minimum, the name of the Contractor’s staff assigned to the appraisal, the assigned staff’s telephone number, and email address.

b. Contact the owner of the equipment or facility where the equipment is located within two (2) Business Days from the receipt of the assignment from the Division. The Contractor shall notify the Division within three

(3) Business Days of assignment when the inspection is scheduled.

c. Submit appraisal to the Division within seven (7) Business Days from the receipt of the assignment from the Division, unless a mutually agreeable alternative timeline is established.

d. Ensure all appraisals provided to the Division are accompanied by photos that clearly show the area(s) of damage.

e. Notify Division staff if a supplement is requested in order to obtain the Division’s approval. If the supplement is approved by the Division, the Contractor shall submit it to the Division within one (1) Business Day after completion, including a copy of the repair facility’s W-9.

5.2.6 Type VI: Temporary Catastrophe Adjusters.

1. Type VI, temporary catastrophe adjusters will appraise and adjust property damage claims to State and university property (buildings and contents) following a catastrophic event.

2. The Contractor shall guarantee the availability of a minimum of ten (10) temporary catastrophe adjusters, for which the Division will pay an annual retainer fixed fee.

3. The Contractor shall, when requested in writing by the Division following a catastrophic event, provide a minimum of ten (10) claims adjusters to deploy and provide full claims handling of property damage claims within two (2) Business Days of the Division’s written request.

4. The Contractor shall have the ability to provide additional adjusters to assist in the event of a catastrophic event, within ten (10) Business Days of the Division’s written request.

5. The Contractor shall ensure that all Type VI, temporary catastrophe adjusters, have the equipment needed to appraise and adjust property damage claims.

6. Adjusters shall not be employees or agents of the State and shall remain employees of the Contractor.

7. The Contractor shall submit a Monthly Summary Report for each adjuster deployed detailing the number of hours, tasks, and details of services provided for the prior month.

5.2.7 Reporting.

1. General Reporting Requirements.

a. The Contractor shall develop reports using formats approved in advance by the Division and that comply with the requirements established by the Division. When reporting requirements are not established in this SOW, the Division will provide the Contractor with instructions and submission timeframes. The Division reserves the right to modify established reporting formats resulting from changing priorities or management direction.

b. Report due dates specified in the Contract may be modified, if approved in advance and in writing by the Division.

c. The Contractor shall develop and submit to the Division all Contract reports at no additional cost to the Division.

2. Assignment Summary Reports.

For Types I, II, III, and IV assignments as specified in Section 5.2, the

Contractor shall submit to the Division written Assignment Summary Reports as specified in Table 1.

Table 1

ASSIGNMENT SUMMARY REPORTS AND DUE DATES

Assignment Type Workers’

Compensation Claims State Liability and Property Claims

Type I: Special Investigation/Field Contact

Fifteen (15) Calendar Days following completion of assignment.

Ten (10) Calendar Days following completion of assignment.

Type II: External Full Handling and Processing of Claim

Quarterly Status Update ten (10) Calendar Days following completion of the previous quarter.

Quarterly Status Update ten (10) Calendar Days following completion of the previous quarter.

Type III: Investigation of Possible Insurance Fraud

Ten (10) Calendar Days following completion of the assignment.

Type IV: Surveillance Three (3) Calendar Days following completion of the assignment.

3. Unless otherwise specified in the Contract or requested in writing by the Division, all Assignment Summary Reports specified in Table 1, Assignment Summary Reports and Due Dates, shall include, but not be limited to:

a. The date on which the assignment was issued to the Contractor by the

Division.

b. A brief description of the assignment, including the assignment type.

c. The name, address, telephone number, and email address of the

Contractor’s assigned adjuster/investigator.

d. The Claimant’s name, the Division’s claim number, the date of the accident, and the Claimant’s employer.

e. Summary of the Contractor’s findings in accordance with specific information requested by the Division for that assignment.

f. A summary of any written statement(s), if applicable, and the electronically recorded statement(s), if requested by the Division. If recorded statements are obtained, the Contractor shall not transcribe the entire statement unless requested to do so by the Division.

4. Type III Quarterly Fraud Investigation Report.

a. For Type III assignments, as specified in Section 5.2.3, the Contractor shall submit to the Division at no additional charge, a written Quarterly Fraud Investigation Report by the fifteenth (15th) day of the month following the quarter in which services were rendered.

b. Quarters shall be based on the calendar year (January 1 – March 31, April 1 – June 30, July 1 – September 30, and October 1 – December 31).

c. The format of the Quarterly Fraud Investigation Report shall be agreed upon by the Division and the Contractor and shall include a thorough summary of the Contractor’s referrals, activities, and findings. Report content shall include information such as:

i. total new Special Investigation Unit (SIU) referrals made during the last quarter;

ii. total SIU referrals to date;

iii. open SIU files;

iv. open surveillance files;

v. savings for fraud investigations;

vi. total DIFS referrals to date;

vii. total arrests;

viii. total warrants issued;

ix. total convictions;

x. total restitution awarded;

xi. Physical Therapy (PT) files reviewed/investigated;

xii. PT files with additional reviews;

xiii. Temporary Total Disability (TTD) files reviewed/investigated;

xiv. TTD files with additional reviews;

xv. Temporary Partial Disability (TPD) files reviewed/investigated;

xvi. TPD files with additional reviews;

xvii. medical only files reviewed/investigated;

xviii. medical only files with additional reviews;

xix. litigated files reviewed/investigated;

xx. litigated files with additional reviews;

xxi. impairment rating files reviewed; and

xxii. undetermined status files reviewed/investigated.

d. Ad Hoc Reporting.

The Division reserves the right to request the Contractor to conduct ad hoc analyses and provide ad hoc reports, such as utilization assessments, costs and total spending. In such instances, the Division will make the request in writing to the Contactor and will establish a deadline for submission. The Contractor shall provide ad hoc analyses and ad hoc reports to the Division at no additional cost to the Division.

5.2.8 Internal Quality Assurance Plan.

1. At no additional charge, the Contractor shall develop, finalize, and maintain a written, up-to-date Internal Quality Assurance Plan to ensure its appropriate administration of all responsibilities specified in this SOW. The Contractor shall submit its Final Internal Quality Assurance Plan to the Department’s Contract Manager within thirty (30) Calendar Days after Contract execution.

The Division reserves the right to direct the Contractor to modify its Final Internal Quality Assurance Plan as needed.

2. At a minimum, the Contractor’s Final Internal Quality Assurance Plan shall include how the Contractor shall meet the performance standards and requirements specified in this SOW, including but not limited to:

a. Ensuring adequate, qualified adjusters will be available to respond to the

Division’s assignments and complete the services specified in the Contract.

b. Ensuring detailed policies and procedures are in place to provide high quality service delivery.

c. Conducting orientation and training of new employees (including any subcontractors), subsequent monitoring of employee and subcontractor performance, and interventions to be used when Contract functions are not adequately performed by employees or subcontractors.

d. Escalating within its own organization technical problems, staffing shortages or other issues that threaten to, or prevent, the Contractor from meeting the terms and conditions of the Contract.

e. Ensuring timely dissemination of required Contract reports as specified in the Contract.

f. Adhering to response requirements specified in the Contract.

g. Adhering to information technology and data submission requirements specified in the Contract.

h. Ensuring confidentiality and protection of Claimant and other confidential information.

5.2.9 Information Technology (IT) Requirements.

1. The Contractor shall access the Division’s claims management system in order to perform the services specified in this SOW.

2. The Contractor shall ensure that all Contractor staff that have access to the Department’s network complete the Department’s Security Awareness Training within ten (10) Business Days from the date the Contract is executed, or a mutually agreed upon timeframe.

3. All electronic transmission of reports and supporting documentation containing Personally Identifiable Information (PII) and Personal Health Information (PHI) as defined by the Health Insurance Portability and Accountability Act (HIPAA) must be encrypted to meet privacy standards.

The Contractor shall ensure that the operation of all of its systems is performed in accordance with State regulations and guidelines related to security and confidentiality and meet all privacy and security requirements of PII, and PHI as defined by HIPAA regulations. The Contractor shall immediately inform the Department’s Contract Manager of any incidents whereby PII and/or PHI data may have been released inappropriately.

5.2.10 Staffing Requirements.

1. General Staffing Requirements.

a. The Contractor shall assign work under this Contract to adjusters who possess the requisite licensure, knowledge, skills, and abilities required to perform the services in this SOW.

b. The Contractor shall assign work under this Contract to adjusters who have more than three (3) years of claims adjusting experience, unless approved in writing by the Division.

c. The Contractor shall maintain staffing levels, strategically located throughout the state of Florida, that is sufficient to perform the services and meet the requirements specified in this SOW.

d. All adjusters provided to perform the services required for this Contract must possess and maintain a Florida adjuster license.

e. The Contractor shall recruit qualified staff as needed to implement all aspects of the services required in this SOW.

f. The Contractor shall, when requested in writing from the Division, provide temporary adjusters to replace or assist Division adjusters with Workers’ Compensation, property, and liability claims and/or claims related special projects.

g. The Contractor shall, within five (5) Business Days of the Division’s request, provide the proposed temporary adjusters, which shall be approved in advance by the Division.

h. The Contractor shall, within five (5) Business Days of the Division’s request, ensure that approved temporary adjusters are available to receive the Division claims management system training, which at the discretion of the Division, shall be in person at the Division’s facilities or remotely.

i. The Contractor shall ensure that adjusting staff utilize the Division’s claims management system to process claims, maintain notes regarding claims, and indicate when claims are closed.

j. The Contractor shall submit, along with a monthly invoice, a Monthly Summary Report for each temporary adjuster which includes the number of hours, tasks, and details of services provided for the prior month.

k. The Contractor shall invoice the Division within thirty (30) Calendar Days after the end of each month in which temporary adjusting services were provided.

l. The Contractor shall, throughout the term of this Contract, have the ability to provide at least three (3) temporary Workers’ Compensation adjusters, three (3) property, and three (3) liability claims adjusters. The number of adjusters shall be determined by the Division. If the Division determines that additional adjusters are needed beyond the required minimum of three (3) in each area, the Contractor will be notified and shall use its best efforts to provide additional adjusters.

m. In the event the Division determines that the Contractor’s staff or staffing levels are not sufficient to complete the services specified in this SOW, it may advise the Contractor in writing and the Contractor shall have thirty (30) Calendar Days to remedy the identified staffing deficiencies to the satisfaction of the Division. The Contractor shall reassign any staff whose continued presence would be detrimental to the completion of the services in this SOW.

n. The Contractor shall have the ability to accommodate non-English speaking persons (including, but not limited to, Spanish and Creole), as well as the hearing impaired and/or others who require special assistance.

2. Background Checks.

The Contractor’s staff provided to perform the work described herein must undergo a background check at the expense of the Contractor. Review and approval of this background check, which, at a minimum, is the equivalent of a Level 2 Criminal Background Screening including fingerprinting as described in section 435.04, F.S., is required for the Contractor’s staff before he or she will be allowed to perform work under the Contract. The Contractor must advise the Contractor’s staff that: 1) the fingerprints will be used to check the criminal history records of the FBI, and 2) procedures for obtaining a change, correction, or update of an FBI identification record are described in 28 C.F.R. 16.34. Results will be used to determine the Contractor’s staff eligibility for access to the Department’s systems. The Department will provide detailed instructions for fingerprinting upon Contract execution.

3. Key Staff.

At a minimum, the Contractor shall assign the following Key Staff to the Contract:

a. Contract/Account Manager.

The Contractor shall designate a primary contract/account manager to work directly with the Department’s Contract Manager and the Division’s program staff in providing the services specified in this SOW. The Contractor’s contract/account manager shall have authority to revise processes and procedures, and assign additional resources, as needed, to maximize the efficiency and effectiveness of services provided under the Contract. The Contractor’s contract/account manager shall be available to meet with Division staff in person, or by telephone during Business Hours at the request of the Division, to discuss any aspect of the Contract, such as the status of the Contract activities or assignments, Contractor performance, Contractor payment, outstanding issues, reports, and deliverables.

b. Temporary Claims Adjusters.

As specified in Section 5.2.10, l., the Contractor shall commit and guarantee a minimum of three (3) qualified workers’ compensation adjusters, three (3) qualified property claims adjusters, and three (3) liability claims adjusters to work within the Division to temporarily replace or assist Division adjusters or claims processors, requested by the Division. All assigned temporary adjusters shall be subject to prior Division written approval.

c. On-site Coordinator.

As specified in Section 5.2.3, 3., the Contractor shall dedicate one (1) qualified Florida-licensed investigator, who shall work on-site within the Division in Tallahassee, Florida, a minimum of two (2) Business Days, or more as needed and directed by the Division, for Type III and Type IV investigation assignments and close consultation with Division staff.

d. Removal of Key Staff.

The Contractor shall provide written notification to the Department’s Contract Manager of any vacancies in its Division-approved Key Staff within two (2) Business Days of the position(s) becoming vacant, or when the Contractor becomes aware that the position will be vacated, whichever is sooner.

e. The Contractor shall not remove any Division-approved temporary adjusters or the Division-approved On-site Coordinator without the prior written consent of the Department’s Contract Manager. If a Division-approved temporary adjuster or On-site Coordinator must be replaced for reasons beyond the reasonable control of the Contractor, including illness, disability, resignation, or for-cause termination, prior written consent of the Division shall not be required, but the Contractor shall provide written notification to the Department’s Contract Manager within one (1) Business Day of the position(s) becoming vacant. If applicable and requested by the Division, the Contractor shall fill the vacant position within ten (10) Calendar Days of the Division’s written request.

f. Availability of Contractor Staff.

The Contractor shall be available to provide assistance to the Division during Business Hours.

5.2.11 SSAE 18 (SOC 1 & 2) Type II Audit and Contractor’s Self-Assessment Tool.

1. The Contractor shall have an SSAE 18 (SOC 1 & 2) Type II Audit conducted at no cost to the Division, annually by an independent Certified Public Accounting (CPA) firm (Auditor) in accordance with the professional standards established by the American Institute of Certified Public Accountants (AICPA), unless an alternative audit is mutually agreed upon.

The Contractor shall complete the Contractor’s Self-Assessment Tool annually with each SSAE 18 (SOC 1 & 2) Type II Audit.

2. The Contractor shall electronically submit the SOC report, within fifteen

(15) Business Days of the issuance of the report, to the Department in Adobe Acrobat Portable Document Format (.pdf).

3. The Contractor shall submit a bridge letter, addressing the gap between the report date and the Contractor’s year-end, with the SOC report in the event the audit report covers less than a twelve (12) month period.

4. The Contractor shall electronically submit to the Division, within fifteen

(15) Business Days of receipt from the Division, a completed Contractor’s self-assessment tool.

5. The Contractor shall provide electronically, within ten (10) Business Days, written responses and supporting documentation to the Division for all Division requested audit follow-up review inquiries or requests for additional information.

5.2.12 Contractor Performance.

1. Performance Standards and Financial Consequences.

The Contractor shall notify the Division upon becoming aware of any circumstances that may reasonably be expected to jeopardize the timely and successful completion (or delivery) of any services. The Contractor shall use reasonable efforts to avoid or minimize any delays in performance and shall inform the Division of the steps the Contractor is taking or will take to do so, and the projected actual completion (or delivery) time. If the Contractor believes a delay in performance by the Division has caused or will cause the Contractor to be unable to perform its Contract obligations on time, the Contractor shall notify the Division and use reasonable efforts to perform its Contract obligations on time notwithstanding the Division’s delay.

2. The Department’s Contract Manager and Division program staff will ensure regular monitoring of the Contractor’s performance in accordance with the requirements of the Contract and may determine the need for a financial consequence based upon an evaluation of the severity of a deficiency. Failure by the Contractor to meet the established minimum performance standards may result in the Division, at its sole discretion, finding the Contractor to be out of Contract compliance, and all remedies specified in this SOW, in the resulting Contract, and under law, shall become available to the Division.

3. The Division reserves the right to impose financial consequences upon the Contractor for failure to comply with the performance standards set forth below in Table 2, Deliverables, Performance Standards, and Financial Consequences.

4. Contractor Performance Reporting.

At no additional charge, the Contractor shall submit a quarterly performance report to the Department’s Contract Manager that summarizes the Contractor’s adherence to each of the performance standards in Table 2, Deliverables, Performance Standards, and Financial Consequences. The report shall be in a format approved by the Division. Quarterly performance reports shall be submitted to the Division by the fifteenth (15th) day of the month following the quarterly reporting period, and in addition to the reporting on each performance standard in Table 2, Deliverables, Performance Standards, and Financial Consequences, and shall include a list of all claims assignments generated by the Division during the reporting period, and the date on which the assignment was received by the Contractor. For each assignment and performance standard, the Contractor shall measure its level of performance in adhering to each of the relevant performance standards provided in Table 2, Deliverables, Performance Standards, and Financial Consequences as follows:

i. Exceeded Contract Requirements

ii. Met Contract Requirements

iii. Did Not Meet Contract Requirements

5. Corrective Action Plan.

a. If the Division determines that the Contractor is out of compliance with any of the provisions of the Contract, the Division may require the Contractor to submit a Corrective Action Plan (CAP) within a specified timeframe. The CAP shall provide an opportunity for the Contractor to resolve deficiencies without the Division invoking financial consequences or more serious remedies, up to and including Contract termination.

b. In the event the Division identifies a violation of the Contract, or other non-compliance with the Contract, the Division shall notify the Contractor of the occurrence in writing. The Division shall provide the Contractor with a timeframe for corrections to be made.

c. The Contractor shall submit a CAP to the Division within the timeframe specified by the Division and in a format specified by the Division. The Division may require changes to the CAP and provide a specific deadline.

d. The Contractor shall implement the approved CAP, within three (3) Business Days of the Division’s approval of the CAP.

e. If the Contractor does not meet the standards established in the CAP within the agreed upon timeframe, the Contractor shall be in violation of the provision of the Contract and shall be subject to financial consequences.

5.2.13 Method of Payment.

1. Payment for Services Rendered.

The Contract shall be a fixed price and fixed rate Contract. The Division will pay the Contractor in arrears for service hours completed in accordance with the terms of the Contract at the hourly rates provided in the Contract.

2. The Division will pay the Contractor in arrears for appraisals completed in accordance with the terms of the Contract at the fixed price specified in the Contract. No administrative fees, surcharges, processing charges, or any other kind of fee shall be invoiced.

3. There may be occasional claims filed outside of the state of Florida for which the Contractor shall be required to provide claims adjusting services. The Contractor’s hourly service rates for services provided out of the state of Florida shall be the same as Division authorized hourly rates for in-State services.

4. Reimbursement for Expenses Incurred.

The Division will only reimburse the Contractor for expenses incurred for out-of-county travel. “Out-of-county” is defined as any county beyond the county where the Contractor’s place of business is located, or the Contractor’s assigned staff work location, and from which the Contractor’s assigned staff is working. Any travel for which reimbursement will be requested by the Contractor must be authorized in writing by the Division in advance. Division-authorized, out-of-county travel expenses will be reimbursed to the Contractor pursuant to the provisions of section 112.061, F.S. The Contractor shall submit invoices for reimbursement of travel expenses incurred to the Division, as instructed by the Department’s Contract Manager with all supporting documentation as specified in section 112.061, F.S. For the purpose of computing travel expenses, the Contractor’s place of business where the Contractor’s assigned staff is assigned to work shall be the site by which all travel expenses shall be computed.

5. Expenses incurred by the Contractor to obtain accident reports, medical reports, photographs, birth certificates, death certificates, court records, or other documents needed to complete an assignment will only be reimbursed by the Division if such expenses are approved in advance by the Division. The Contractor shall submit invoices for reimbursement of such expenses incurred to the Division with original receipts to support the expenses, a description of the assignment and need for the expense, and the associated claim number.

6. Retainer for Temporary Catastrophe Adjusters.

The Division will pay an annual retainer to the Contractor in a fixed amount for the guaranteed availability of at least ten (10) temporary catastrophe adjusters as specified in Section 5.2.6., 2.

7. Invoice Submission.

The Contractor shall submit all invoices and supporting documentation to the Division as specified by the Department’s Contract Manager following the month in which services were rendered, and as specified below. The Division may require electronic invoices or files to be submitted in a format specified by the Division.

8. For Type I, II, III, and IV assignments, the Contractor shall submit monthly invoices and shall submit a separate invoice for each assignment which shall include, at a minimum, the service hours rendered, service(s) provided, and supporting documentation.

9. For Type V assignments, the Contractor shall submit invoices to the Department’s Contract Manager upon the completion of each appraisal.

Invoices shall include, at a minimum, a copy of the appraisal, photos, and supplement, if applicable.

10. For Type VI assignments, the Contractor shall submit monthly invoices and shall submit a separate invoice for each assignment, which shall include at a minimum, service hours rendered, service(s) provided, and supporting documentation.

11. All invoices must have sufficient supporting documentation to allow for a proper audit of the items or services being billed. In addition to information specified above, all invoices shall include, at a minimum:

a. invoice date;

b. Contractor’s invoice number;

c. Division’s Contract number;

d. State FLAIR Contract number;

e. Division’s claim number;

f. Claimant name;

g. description of services rendered, or expenses incurred;

h. date(s) services were rendered, or expenses incurred;

i. required supporting documentation;

j. Contractor’s remittance address; and

k. Contractor’s Federal Employer Identification Number.

12. Invoices must be submitted to the Division within ninety (90) Calendar Days from the date services were performed.

13. The Contractor shall, within fifteen (15) Business Days of Contract execution, ensure a current Electronic Substitute W-9 Form is on file with the State of Florida Vendor website at:

https://flvendor.myfloridacfo.com/.

14. The Contractor shall maintain current remittance information in the Vendor Information Portal at:

https://flvendor.myfloridacfo.com/.

https://flvendor.myfloridacfo.com/ https://flvendor.myfloridacfo.com/

5.2.14 Deliverables, Performance Standards, Acceptance Criteria, and Financial Consequences.

The Contractor shall provide the Deliverables, meet the performance standards, and be liable for the financial consequences described in Table 2, Deliverables, Performance Standards, and Financial Consequences. All Deliverables must be provided or performed to the satisfaction of the Division to be accepted.

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TABLE 2

DELIVERABLES, PERFORMANCE STANDARDS, AND FINANCIAL

CONSEQUENCES

Deliverable and Performance Standard Due Date or Time Period Financial Consequence

1. Administrative Set-Up

1.1 Administrative Set-Up

(as required by Section 5, 5.1, Administrative Set-Up.)

The Contractor shall complete the Administrative Set-up within sixty (60) Calendar Days after the Effective Date of the Contract, unless a mutually agreeable alternative timeline is established and agreed to, in writing, by the Department’s Contract Manager.

Failure to submit an acceptable Deliverable and/or meet the specified time criteria shall result in the Contractor being assessed for the Division’s actual costs that result from the Contractor’s failure to begin providing Statewide Claims and Investigation Services when required, plus one thousand dollars ($1,000.00) for each Calendar Day…