RFP Workers Comp 20261.pdf

The City of Troy, New York

Request for Proposal

Administration of the City of Troy’s

Worker’s Compensation and Section 207A & 207C

Programs

Due Date: November 3, 2025, at 12PM http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjY89yws6DLAhWMcz4KHagZDfMQjRwIBw&url=http://wamc.org/post/troy-charter-change-review-process-underway&bvm=bv.115339255,d.cWw&psig=AFQjCNGggQ3Mz5dBsHkxHR4SnLHPVtT08Q&ust=1456953057484328

CITY OF TROY, NEW YORK

OFFICE OF THE CITY COMPTROLLER

BUREAU OF CONTRACTS & PROCUREMENT

CITY HALL – 433 River Street

TROY, NEW YORK 12180

(518) 279-7104

(518) 268-1682 FAX

NAME: Administration of the City of Troy’s Worker’s Compensation and Section 207A & 207C Program

OPEN DATE: November 3, 2025 TIME: 12:00 PM EST

RFP

NOTICE

LEGAL PUBLICATIONS FOR PROPOSALS – 2025

PLEASE BE ADVISED THAT FOR THE YEAR 2025 THE CITY OF TROY, NEW YORK, BUREAU OF

CONTRACTS & PROCUREMENT WILL PUBLISH ALL PUBLIC BIDS AND PROPOSALS IN THE

FOLLOWING:

THE RECORD

EMPIRE STATE PURCHASING GROUP (www.bidnetdirect.com/new-york)

IT IS THE RESPONSIBILITY OF THE PROSPECTIVE PROPOSERS TO READ THESE PUBLICATIONS

AND CONTACT THE CITY OF TROY, NEW YORK, BUREAU OF CONTRACTS & PROCUREMENT IF

THEY WISH TO RECEIVE A REQUEST FOR PROPOSAL.

http://www.bidnetdirect.com/

*****THIS IS A REQUEST FOR PROPOSALS*****

DATE: 10/7/25

FROM: Michael McNeff, City Comptroller

NOTICE IS HEREBY GIVEN THAT SEALED PROPOSALS ARE SOUGHT FOR THE

FOLLOWING:

PROPOSAL NAME: Administration of the City of Troy’s Worker’s Compensation and Section

207A & 207C Program

DATE OF OPENING: November 3, 2025, TIME OF OPENING: 12:00 PM EST

CONTACT PERSONS:

Bureau of Contracts & Procurement, Nancy Piskutz (518) 279-7104 purchasing@troyny.gov

City Comptroller Office, Gabrielle Mahoney (518) 279-7103 gabrielle.mahoney@troyny.gov

VENDORS MUST SUBMIT PROPOSAL IN A SEALED ENVELOPE. Each submission shall submit One (1) original copy and Four (4) copies.

PLEASE PRINT ON THE ENVELOPE: 1) NAME & ADDRESS OF PROPOSER

2) PROPOSAL NAME

It is the proposer’s responsibility to read the attached SPECIFICATIONS and GENERAL CONDITIONS which outlines rules of the City of Troy.

Subject to the right of the City of Troy to reject any and all proposals.

Facsimile or e-mail will not be accepted.

mailto:purchasing@troyny.gov

Request for Proposal

Worker’s Compensation and Section 207A & 207C Programs

General Conditions

Purpose

The City of Troy, New York (“the City”) hereby requests proposals from qualified agencies to provide services for the administration of the City’s Worker’s Compensation and Section 207A & 207C Programs.

General Information

The City of Troy is a municipality located within the County of Rensselaer, State of New York, employing approximately 600 full and part-time employees. The City is interested in soliciting proposals from agencies to administer the City’s Worker’s Compensation and Section 207A & 207C Programs to approximately 1,000 active and retired employees.

Scope

The City intends for this request to result in the selection of an agency that will assist in administering the

Worker’s Compensation and Section 207A & 207C Programs.

Contract Period

The terms of this contract will be from January 1, 2026 through December 31, 2029 with an option for one (1) additional two (2) year extension upon mutual agreement by both parties. All Proposal documents issued by the City of Troy shall be considered part of the executed contract that is issued.

Proposal Evaluation

• Proposals shall remain valid until the execution of a contract by the City.

• Proposal will be evaluated by a committee to determine whether the requirements of the RFP are met.

Proposals will be evaluated based upon several criteria. Award will be made to the qualified agency that submits the proposal that best meets the City’s needs. The proposals will be evaluated on the following criteria:

▪ Proposed Plan for Administering the Program

▪ Qualifications and Experience

▪ Proposed Methods to Deliver the Services Required

▪ Total Proposed Price/Fees

• If deemed necessary by the evaluation committee, interviews may be scheduled with selected prospective agencies. This will permit further evaluation and will allow the City to inquire further into the experience the agency has had on similar projects.

Proposal Content and Format

In order for the City to conduct a uniform review process of all proposals, proposals must be submitted in the format set forth below. Failure to follow this format may be cause for rejection of a proposal because adherence to this format is critical for the evaluation process.

I. General Information/Qualifications

Each proposal shall provide a statement of qualifications including:

▪ The full corporate name, address, telephone number, and contact person.

▪ A brief history and description of the agency submitting the proposal.

▪ Identification of the firm’s professional staff members who will be assigned to this engagement if the firm’s proposal is selected. Include a resume for each such professional staff member that details qualifications, years and types of experience, education, accomplishments, etc. Specify the extent of the availability and commitment of each such professional staff member who will be assigned to this engagement if the firm’s proposal is selected. If the firm will be subcontracting any work, describe the tasks to be subcontracted in this section and provide the proposed subcontractor’s name, address, telephone number, and qualifications. Who would be working directly with the City on cost saving options, administrative issues, questions or problem solving?

Please provide the roles and qualifications of each person. Also, include the number of clients each person is expected to handle.

▪ Provide references that include: name, address, phone number and length of time associated with your organization. Provide a number of three (3) references of clients that are of a similar size and scope to the City.

▪ A signed cover letter from a person within the firm who is authorized to make representations on behalf of the firm and to bind the firm including their name, title, phone number, address and email address.

▪ A summary of the firm’s general experience in providing employee health benefits consulting services, and a summary of the firm’s specific experience in providing group benefit consulting services to large public sector employers/plan sponsors. Proposer shall assign and designate a specific individual from the firm to the City’s account. Describe any other facets of your organization and your firm’s experience that are relevant to this proposal that have not been previously described and that you feel warrant consideration.

▪ Any additional information which would serve to distinguish the firm from other firms submitting proposals.

▪ The City may make such inquiries as it deems necessary to determine the ability of each proposer to perform the services contemplated by this RFP. Proposers shall promptly furnish all information and data for this purpose as may be subsequently requested.

▪ Describe the form of professional liability or errors and omissions insurance carried by your company and the amount of coverage (copies of current insurance coverage will suffice as well).

▪ Compliance with Laws, Licenses and Required Professional Designations: The Consultant and any of the services or supplies provided hereunder are contingent and expressly conditioned upon the ability of the Consultant to provide the specified services or supplies consistent with all federal, state and local laws and regulations. The Consultant agrees that he or she will fully comply with federal, state and local policies, procedures, standards, laws, rules and regulations. The Consultant and any subcontractors shall secure and maintain any necessary licenses, permits and professional designations as may be required to provide the services or supplies under the contract and pay all related charges. If, for any reason, the Consultant’s required licenses, permits or designations are terminated, suspended, revoked or in any manner modified from their status at the time the contract becomes effective, the Consultant shall notify the City immediately of such condition in writing.

II. Scope of Services

Each proposal shall state the methods to be used to provide the services required and documentation of any required licensing necessary to administer the program. Please refer to Appendix A and describe in detail how your agency intends to achieve successful management of the administration of the City’s

Worker’s Compensation and Section 207A & 207C Programs in the following format:

▪ Data Processing

▪ Benefit Consulting

▪ Benefit Management and Administration

III. Fees

Each proposal should detail all fees for services rendered as described in the Appendix A of this request. Clearly set forth in detail any and all additional expenses for which you expect to be reimbursed. The proposal must, however, provide a guarantee that no additional fees will be charged to the City without prior written consent by the City.

Expiration of Proposal

By submitting a proposal, the applicant offers to enter into a Contract, the form and content of which shall be agreed upon by both parties. The applicant’s proposal shall not be revocable for ninety (90) days following the response deadline indicated above. The City reserves the right to waive any defects in the offer of any proposer, to reject any or all offers, and to request additional information from any and all proposers.

Other Terms and Conditions

The selected firm will be expected to provide all necessary professional services as well as all necessary material, equipment and personnel required to complete the project and all post-project closeout services.

The selected firm will be expected to comply with the insurance and indemnification requirements of the City.

Proposers shall familiarize themselves with all provisions of this RFP and shall not at any time after submitting a proposal, dispute any of the specifications or assert that there was any misunderstanding regarding the furnishing and delivering of the items called for in the proposal.

Cancellation Clause

The City reserves the right to cancel the contract at any time during the contract term by written thirty (30) day notice mailed to the address of the vendor.

Non-Collusive Proposal Certificate and Acknowledgement

Each proposer shall complete and submit with its, his, or her proposal the “Non-Collusive Certificate” and the

“Resolution” listed under Appendix B of this RFP. The submission of this statement certifies that the prices in this proposal have been arrived at independently without collusion, consultation, communication, or arrangement for the purpose of restricting competition, as to any matter relating to such prices with any other bidder with any competitor.

Mandatory Requirements

The agency shall, at a minimum, provide the services as listed in the attached Appendix A.

Insurance

The selected proposer will be required to procure and maintain at their own expense the following insurance coverage:

1. Commercial general liability and contractual liability on an occurrence basis with the following limits of coverage: bodily injury, property damage and personal injury, One

Million Dollars ($1,000,000) each occurrence/Two Million Dollars ($2,000,000) general aggregate.

a. Liability Insurance policies will not be accepted that:

i. Remove or restrict blanket contractual liability located in the “insured contract” definition (as stated in Section V, Number 9, Item f in the ISO

CGL policy or equivalent) so as to limit coverage against claims that arise out of work; or

ii. Remove or modify the “insured Contract” exception to the employers liability exclusion; or

iii. Do not cover the additional insured for claims involving injury to employees of the named insured or subcontractors.

b. Contractor shall require any subcontractors hired, carry insurance with the same limits and provisions provided here in. The contractor will maintain certificates of insurance for all subcontractors hired as part of the contractor’s records.

2. Professional Liability/Errors & Omissions of at least One Million Dollars ($1,000,000) each occurrence/Two Million Dollars ($2,000,000) aggregate (If applicable)

3. Workers compensation insurance as required by law and including employer's liability insurance. Statutory disability benefits insurance as may be required by law.

4. Comprehensive Automobile Liability coverage on owned, hired, leased, or

Non-owned autos with limits not less than One Million Dollars ($1,000,000) combined for each accident because of bodily injury sickness, or disease, sustained by any person, caused by accident, and arising out of the ownership, maintenance or use of any automobile for damage because of injury to or destruction of property, including the loss of use thereof, caused by accident and arising out of the ownership, maintenance or use of any automobile.

5. Commercial umbrella insurance coverage at maximum policy limits with minimum coverage of Five Million Dollars ($5,000,000).

6. All Risk Property Coverage – Contractor shall secure, pay for at its sole cost and maintain whatever All Risk Property Coverage Insurance Contractor may deem necessary to protect

Contractor against loss of owned or rental capital equipment and tools. The requirement to secure and maintain such insurance is solely for the benefit of the Contractor. Contractor’s failure to secure such insurance and/or to maintain adequate levels of coverage shall not obligate the City of Troy, its agents or employees, for any losses. Any such insurance policy shall include a waiver of subrogation clause as follows: “It is agreed that in no event shall this insurance company have any right to recover against the City of Troy and the

City of Troy is to be held harmless by the Insured and this Insurance carrier.

7. Pollution/Environmental Coverages as required by Corporation Counsel. (If Applicable)

Each and every policy of insurance required by this Agreement shall be in form and content satisfactory to the

City of Troy Corporation Counsel, and shall provide:

1. Additional Insured. The City of Troy (including its officers, agents, and employees) shall be named Additional Insured on all coverage including premises operations and completed operations on a primary and non-contributing basis for all policies and coverages, including but not limited to the umbrella insurance coverage. The Additional Insured shall be held harmless and indemnified from any and all claims arising out of or in consequence of the

Contractor’s services, work, operations, or activities under this Agreement or in any way arising out of or in consequence of the Contractor’s acts or omissions.

2. Per Project Aggregate. The insurance policies shall cover premises operations and completed operations on a per project basis.

3. Waiver of Subrogation. As to every type and form of insurance coverage required from the

Contractor, there shall be no right of subrogation against the City of Troy, its officers, agents, or employees. If any of Contractor’s policies of insurance prohibit such a waiver of subrogation, Contractor shall secure the necessary authorization from its insurance carrier to make this waiver effective.

4. Waiver of Indemnities. The Contractor waives any right of action it and/or its insurance carrier might have against the City of Troy (including its officers, agents, or employees) to be indemnified for any type of loss that is required by this Agreement to be covered by a policy of insurance, whether or not such loss is insured.

5. The Certificate of Insurance shall be in form and content satisfactory to the City of Troy

Corporation Counsel. All referenced forms shall be provided with the Certificate. Additional information, including without limitation complete policies, shall be provided to the

Corporation Counsel upon request.

6. The insurance policies shall not be changed or cancelled until the expiration of thirty (30) days after written notice to the City of Troy Corporation Counsel’s Office.

7. The insurance policies shall be renewed upon expiration and continued in force unless the City of Troy Corporation Counsel's Office is given thirty (30) days written notice to the contrary.

No services, work, operations, or activities shall be commenced under this Agreement until the Contractor has delivered to the City proof of issuance of all policies of insurance required by the Agreement to be procured. If at any time, any of the insurance policies shall be or become unsatisfactory to the City, Contractor shall promptly obtain a satisfactory policy and submit proof of the same to the City for approval. Upon failure of

Contractor to furnish, deliver, and maintain satisfactory insurance as provided above, this Agreement may, at the election of the City, be suspended, discontinued, or terminated. Failure of Contractor to procure and maintain any required insurance shall not relieve the Contractor from any liability under the Agreement, nor shall the insurance requirements be construed to conflict with the obligations of the Contractor concerning defense and indemnification.

In the event any part of the services, work, operations, or activities described in this Agreement is performed by an approved subcontractor of the Contractor, all insurance requirements of this Agreement shall be incorporated into the subcontract agreement with no additional exclusions or exceptions from coverage whatsoever. Subcontractor insurance requirements shall include but not be limited to the requirements for

Workers’ Compensation, Commercial General Liability, Umbrella Liability, and as applicable, Commercial

Auto and/or Professional Liability. Contractor shall require each and every subcontractor to produce a

Certificate of Insurance meeting all of the requirements of the City and documenting the required insurance coverages. A subcontractor’s Certificate of Insurance in form acceptable to the City shall be provided to the

City before that subcontractor may commence performance.

The carrying of insurance as required by this Agreement shall in no way relieve the Contractor, or its subcontractors, of any other responsibility or liability under this Agreement.

The City of Troy Corporation Counsel, in his or her sole discretion, may approve in writing a variance from the insurance requirements herein for good and sufficient reason.

The City of Troy reserves the right to reject any bid/proposal from any bidder/proposer if their General Liability and/or Auto Liability Insurance has a deductible or Self-Insured retention greater than $10,000.00.

Indemnification

The promises in this section are separate from the insurance requirements of this contract and shall apply whether or not the insurance requirements are fulfilled.

Each and every Contractor (as used in this paragraph the term “Contractor” shall include any and all subcontractors) who shall agree to perform the Work, or any part of it, shall defend, indemnify, and save harmless the City of Troy, its agents and employees, from and against any and all liability, loss, or other claim for damages for death, bodily injury, or property damage, or of any other kind or nature, arising out of or in consequence of the performance of the Work by the Contractor or any agent, servant, employee, subcontractor, or supplier of the Contractor, or of any failure to perform the Work or this contract, or arising in any way as a result of the Contractor’s activities or omissions, all to the fullest extent allowed by law. Every Contractor shall defend, indemnify, and save harmless the City of Troy, its agents and employees from and against, without limitation, all losses, litigations, claims, actions, causes of action, proceedings, demands, damages, indemnities, suits, judgments, orders, rulings, appeals, costs, expenses, and all other elements of litigation

(including without limitation reasonable attorney’s fees and other costs of defense), arising out of or in consequence of the Contractor’s Work under this contract, or failure to perform the Work or this contract, or arising in any way as a result of the Contractor’s activities or omissions, all to the fullest extent allowed by law.

Every Contractor shall defend, indemnify, and save harmless the City of Troy, its agents and employees from and against any and all claims for injuries to the Contractor’s employees or the employees of any agent, servant, or subcontractor, and any and all claims made by any person or entity (including without limitation all officers, employees, agents, contractors, subcontractors, suppliers, guests, invitees, uninvited persons, survivors, and distributees) arising out of or in connection with Contractor’s operations and activities or omissions on property owned by the City of Troy, all to the fullest extent allowed by law.

The parties intend that the promises in this section shall be consistent with New York General Obligations Law

Section 5-322.1 and therefore the promises shall not be construed as purporting to indemnify or hold harmless the City of Troy against liability for damage arising out of bodily injury to persons or damage to property contributed to, caused by or resulting from the negligence of the City of Troy, its agents or employees, whether such negligence be in whole or in part.

Conflict of Interest

No director, officer, employee, agent, contractor, or subcontractor of the contractor shall be deemed to be an agent, servant, and/or employee of the City, past or present. The contractor shall not employ as a director, officer, employee, agent, contractor, or subcontractor, directly or indirectly in any capacity, any elected or appointed official of the City, the two school districts, or any member of their immediate family, past or present.

The contractor acknowledges and agrees that all of its directors, officers, employees, agents, contractors, or subcontractors shall be bound by and adhere to the Code of Ethics of the City (if interested, copies of the Code of Ethics may be obtained from the City’s Corporation’s Office). The contractor further acknowledges and agrees that all of its employees must comply with all applicable laws relating to this agreement, or the performance thereof, and that the refusal to supply such evidence and/or testimony shall be the cause for immediate termination of this agreement by the City.

Termination for Cause

The City of Troy reserves the right to terminate this contract at any time for cause. The violation of any provision or condition contained in this contract, or the refusal, failure, or inability to carry out any provisions of this contract shall constitute sufficient grounds to terminate this contract for cause. Should The City of Troy elect to terminate this contract for cause, The City of Troy will notify the Contractor ten (10) days prior to the termination date and shall specify the cause for termination as well as the date the termination shall be effective. This termination notice will be issued via a written letter sent by certified U.S. mail. Immediate dismissals may be executed if deemed necessary by The City of Troy.

Termination Without Cause

The City of Troy may terminate this contract without cause. Written notice of termination must be sent via certified U.S. mail no later than thirty (30) days prior to the termination date.

Iran Divestment Act

By submitting a bid/proposal in response to this solicitation or by assuming the responsibility of a

Contract awarded hereunder, Proposer/Contractor (or any assignee) certifies that it is not on the

"Entities Determined To Be Non-Responsive Bidders/Offerors Pursuant to The New York State Iran

Divestment Act of 2013" list ("Prohibited Entities List") posted on the OGS website at:

http://www.ogs.ny.gov/about/regs/docs/ListofEntities.pdf and further certifies that it will not utilize on such Contract any subcontractor that is identified on the Prohibited Entities List. Additionally, Bidder/Contractor is advised that should it seek to renew or extend a Contract awarded in response to this solicitation, it must provide the same certification at the time the Contract is renewed or extended.

During the term of any subsequent Contract, should the City of Troy receive information that a person

(as defined in State Finance Law § 165-a) is in violation of the above-referenced certifications, the

City of Troy will review such information and offer the person an opportunity to respond. If the person fails to demonstrate that it has ceased its engagement in the investment activity which is in violation of the Act within 90 days after the determination of such violation, then the City of Troy shall take such action as may be appropriate and provided for by law, vile, or contract, including, but not limited to, seeking compliance, recovering damages, or declaring the Contractor in default.

The City of Troy reserves the right to reject any proposal, bid, request for assignment, renewal or extension for an entity that appears on the Prohibited Entities List prior to the award, assignment, renewal or extension of a contract, and to pursue a responsibility review with respect to any entity that is awarded a contract and appears on the Prohibited Entities list after contract award.

Right to Reject

The City of Troy reserves the right to reject any and all proposals, to waive any informalities and technical irregularities in the proposals received, or to accept any proposal deemed to be for the best interest of the City of

Troy.

MWBE Promotion

It is the policy of the City of Troy that Minority-Owned Business Enterprises (MBE) and Women-Owned

Business Enterprises (WBE) are afforded the maximum opportunity to participate in the performance of contracts. It is also the City’s goal to award Procurement Contracts to those procurement contractors who have evidenced compliance with the laws of the State of New York prohibiting discrimination in employment.

Non-Discrimination Policy

In accordance with Article 15 of N.Y. Executive Law (also known as the Human Rights Law) and all other

State and Federal statutory and constitutional non-discrimination provisions, the Contractor agrees that neither it nor any of its subcontractors shall, by reason of age, race, creed, color, national origin, sexual orientation, military status, sex, disability, predisposing genetic characteristics or marital status refuse to hire or employ or to bar or to discharge from employment such individual or to discriminate against such individual in compensation or in terms, conditions or privileges of employment.

Submission of Proposal

Please submit your sealed proposal by Monday, November 3, 2025, by 12:00 p.m. Agency should submit

One (1) original copy and Four (4) Copies of their proposals to:

Office of the City Comptroller

City Hall

433 River Street, Suite 5001

Troy, New York 12180

• Facsimile or e-mail will not be accepted.

• Proposals received after the above noted time will not be accepted.

• All sealed envelopes should be clearly marked “Administration of the City of Troy’s Worker’s

Compensation and Section 207A & 207C Programs.”

• Those submitting proposals do so entirely at their own expense. There is no express or implied obligation by the City to reimburse any firm or individual for any costs incurred in preparing or submitting proposals, preparing or submitting additional information requested by the City, or participating in any selection interviews.

• The City reserves the right to accept or reject any and all proposals in whole or in part, to waive any and all informalities, and to disregard all non-conforming, non-responsive or conditional proposals.

• The City reserves the right to award the work, in whole or in part, to one or more firms and individuals.

Questions

Questions will be received until Tuesday, October 21, 2025, at 12:00 pm. All questions will be compiled and answered in the form of an Addendum. All agencies on record with the Purchasing Agent will receive a copy of the Addendum. Questions received after the date will not be answered. All questions and requests for information about this scope of work should be directed to the Purchasing Department in written form at:

Office of the City Comptroller

City Hall

433 River Street, Suite 5001

Troy, New York 12180

Or by e-mail at:

purchasing@troyny.gov

Appendix A

Workers’ Compensation Administration/Section 207A and 207C Program

The awarded agency will be responsible for advising and assisting the City in the administration of

Workers’ Compensation benefits and Section 207A and 207C Programs including:

Workers’ Compensation Claims Administration/Workers’ Compensation Case

Management

• The Agency contacts the employee within 24 hours of the injury to ascertain the nature of the injury, medical treatment sought (if any), and an estimated return to work date.

• Upon determination of the nature of the injury, the agency decides whether the case needs to be reported to the Worker’s Compensation Board.

• The Agency files a C-2 form with the Workers’ Compensation Board if the injury sustained results in lost workdays beyond the waiting period specified under the Workers’ Compensation Law (7 days), and/or will require medical treatment beyond ordinary first aid.

• The Agency is responsible for ensuring that the Workers’ Compensation Board has properly indexed files.

• The Agency makes requests to the City to obtain information necessary to file all appropriate forms with the Workers’ Compensation Board. These forms include but are not limited to:

▪ C-11 - Employer’s Report of Injured Employee’s Change in Employment Status Resulting

From Injury

▪ C-240 - Employer’s Statement of Wage Earnings

▪ Employer’s Request for Reimbursement

• The Agency determines the employee’s Workers’ Compensation wages based on the degree of disability and authorizes payment of such wages.

• The Agency processes bi-weekly payments to employees on the Workers’ Compensation payroll.

• The Agency reviews medical and prescription bills and reduces according to the New York State

Workers’ Compensation Medical Fee Schedule. The Agency processes bi-weekly payments to the providers on behalf of the City.

• The Agency authorizes medical procedures and diagnostic tests, additional specialist treatment and rehabilitation services (i.e. physical therapy, chiropractic), braces and other prosthesis items, and surgeries.

• The Agency initiates and authorizes all Independent Medical Examinations.

• The Agency takes necessary steps to investigate fully any questionable claims. All steps taken are to be communicated with the City as they progress. No case shall be controverted without communication with the City.

• The Agency responds directly to medical provider’s requests for payment status and other inquiries.

• The Agency reviews hearing notices, determines the most appropriate and cost effective legal representation, and forwards the complete case file to the legal representative to ensure proper analysis prior to the hearing.

• The Agency notifies the City of any anticipated awards from the Workers’ Compensation Board.

• The Agency reviews the “Notice of Decision(s)” from the Workers’ Compensation Board, processes award payable to the appropriate parties, and processes appeal paperwork as necessary.

• The Agency provides a monthly review of indemnity payments, medical payments, etc.

• The Agency provides the City with supporting detail on penalty notices, including the name of the injured employee, date of injury, explanation of penalty, and reason therefore.

• Performs other related tasks as necessary for proper case management.

• Bi-weekly conference calls between the Agency and the City on the status of ongoing claims.

Workers’ Compensation Report Submission

• The Agency compiles monthly reports regarding open claims and status, liability, potential award amounts, etc.

• The Agency compiles monthly reports regarding indemnity payments, medical payments, etc.

• The Agency compiles quarterly reports regarding Special Funds reimbursements. Reports should be separated by department, then status (medical only or indemnity).

Administration of Section 207A and 207C Programs

• The Agency Administers Section 207A and Section 207C Programs according to established procedures.

• The Agency authorizes medical procedures, diagnostic testing, surgeries, etc.

• The Agency recommends Independent Medical Examinations as deemed necessary.

• The Agency works within guidelines established for work related duties as described within the

General Municipal Law.

• The Agency, in conjunction with the City’s Personnel Department, Public Safety Commissioner, and/or Police and Fire Chiefs, ensures that necessary treatment and return to work policies are administered and adhered to.

Injury Prevention

• The Agency works with the City Personnel Office and City Management to reduce worksite hazards and work-related injuries by establishing safety awareness programs and ensuring safety policies and procedures are being conformed to accordingly.

• The Agency conducts an analysis regarding the source of injuries and establishes realistic safety standards to help prevent common injuries.

• Establish a body of statistical and qualitative information to be used to develop loss control and risk management programs designed to reduce loss and increase safety awareness.

Appendix B

NON-COLLUSIVE CERTIFICATION

Pursuant to Section 103-D of the General Municipal Law of the State of New York.

(a) By submission of this bid or proposal, each bidder or proposer and each person signing on behalf of any bidder or proposer certifies, and in the case of a joint bid or proposal each party thereto certifies as to its own organization, under the penalty of perjury, that to the best of knowledge and belief:

(1) The prices in this bid or proposal have been arrived at independently without collusion, consultation, communication or agreement, for the purposes of restricting competition, as to any matter relation to such prices with any other bidder or proposer or with any competitor.

(2) Unless otherwise required by law, the prices which have been quoted in this bid or proposal have not been knowingly disclosed by the bidder or proposer and will not knowingly be disclosed by the bidder or proposer prior to opening, directly or indirectly, to any bidder or proposer or to any competitor; and

(3) No attempt has been made or will be made by the bidder or proposer to induce any other persons, partnership or corporation to submit or not to submit a bid or proposal for the purpose of restricting competition.

(b) A bid or proposal shall not be considered for award nor shall any award be made where (a) (1) (2) or (3) above have not been complied with; provided however, that if any bidder or proposer cannot make the foregoing certification, the bidder or proposer shall so state and shall furnish with the bid or proposal a signed statement which sets forth in detail the reasons therefore. Where (a) (1) (2) and (3) above have not been complied with, the bid or proposal shall not be considered for award nor shall any award be made unless the head of the purchasing unit of the political subdivision, public department, agency or official thereof to which the bid or proposal is made or his designee, determines that such disclosure was not made for the purpose of restricting competition.

The fact that a bidder or proposer (a) has published price lists, rates, or tariffs covering items being procured, (b) has informed prospective customers of proposed or pending publications of new or revised price lists for such items or (c) has sold the same items to other customers at the same prices being bid or proposed, does not constitute, without more, a disclosure within the meaning of subparagraph one (1).

(c) Any bid or proposal hereafter made to any political subdivision of the state or any public department, agency, or official thereof by a corporation bidder or proposer for work or services performed or to be performed or goods sold or to be sold, where competitive bidding is required by statute, rule, regulations, or local law, and where such bid or proposal contains the certification referred to in the sub-division one of this section, shall be deemed to have been authorized by the Board of Directors or the bidder or proposer, and such authorization shall be deemed to include the signing and submission of the bid or proposal and the inclusion therein of the certificate as to non-collusion as the act and deed of the corporation.

(Signature)

(Title)

To The City of Troy, NY

Bureau of Contracts & Procurement

For

Health Insurance Program

By submission of this bid or proposal, the bidder or proposer certifies that; (a) This bid or proposal has been independently arrived at without collusion with any other bidder or proposer or with any competitor; (b) This bid or proposal has not been knowingly disclosed and will not be willingly disclosed, prior to the opening of bids or proposals for this project, to any other bidder, proposer, competitor; (c) No attempt has been or will be made to induce any other person, partnership or corporation to submit or not to submit a bid or proposal; (d) The person signing this bid or proposal certifies that he has fully informed himself regarding the accuracy of the statements contained in this certificate, and under the penalties of perjury, affirms the truth thereof, such penalties being applicable to the bidder or proposer as well as to the person signing in its behalf; (e) That attached hereto (if a corporate bidder or proposer) is a certified copy of resolution authorizing the execution of the certificate by the signator of this bid or proposal on behalf of the corporate bidder or proposer.

Resolved that be

Name of Corporation authorized to sign and submit the bid or proposal of this corporation for the following project and to include

Describe Project in such bid or proposal, the certificates as to non-collusion required by section one hundred three-d of the general municipal law as the act and deed of such corporation, and for any inaccuracies or misstatements in such certificate this corporate bidder or proposer shall be liable under the penalties of perjury.

The foregoing is a true and correct copy of the resolution adopted by

Corporation at a meeting of its board of directors held on the day of in the year .

(SEAL OF CORPORATION)

(The above form must be completed if the bidder is a corporation)

COMPLETE INFORMATION BELOW:

Name / Address of Company Submitting Bid or Proposal

Authorized Representative Submitting Bid or Proposal (name printed)

Authorized Representative Submitting Bid or Proposal (signature)

Authorized Representative Submitting Bid or Proposal – Title

Contact Numbers:

Telephone: __________________________________

Cellphone: __________________________________

Fax: __________________________________

E-mail Address: __________________________________

Address: __________________________________

Date: __________________________________