Third_Party_Administration_of_Workers'_Compensation_Benefits.pdf

REQUEST FOR PROPOSAL

27-014

THIRD PARTY ADMINISTRATION OF WORKERS' COMPENSATION

BENEFITS

City of Hayward

777 B Street

Hayward, CA 94541

RELEASE DATE: November 12, 2026

DEADLINE FOR QUESTIONS: November 19, 2026

RESPONSE DEADLINE: December 11, 2026, 4:00 pm

RESPONSES MUST BE SUBMITTED ELECTRONICALLY TO:

https://secure.procurenow.com/portal/hayward-ca https://secure.procurenow.com/portal/%7bproject.government.code%7d

City of Hayward

REQUEST FOR PROPOSAL

Third Party Administration of Workers' Compensation Benefits

I. Introduction II. Project Details

III. Scope of Work IV. Evaluation Criteria V. Vendor Submissions

Attachments:

A - City of Hayward Professional Services Agreement – EXAMPLE

B - General Provisions

C - Contract Bonds

D - Non-Collusion Affidavit

E - Nondiscriminatory Affirmative Action Cert Statement

F - Non-nuclear

G - PRISM_Addendum_A_Final_070119

Request For Proposal #27-014 Title: Third Party Administration of Workers' Compensation Benefits

1. Introduction

1.1. Summary

NOTICE IS HEREBY given that the City of Hayward invites sealed proposals for 27-014 Third Party

Administration of Workers' Compensation Benefits. Each proposal shall be in accordance with the general provisions for purchase of work and services on file in the office of the HR, 777 B Street, Hayward, CA 94541-5114. All proposals must be submitted to the City's eProcurement Portal by 4:00 pm on Friday, December 11, 2026 and clearly identified with RFP title, number, company name and due date. It is the sole responsibility of the proposing firm to ensure that proposals are received prior to the closing time, as late bids will not be accepted and deemed nonresponsive.

1.2. Background

The City of Hayward, California (the City) is located in Alameda County and is known as the “Heart of the

Bay” because of its central and convenient location to San Francisco, Oakland, and San Jose. It is served by an extensive network of freeways and bus lines and has two BART stations and an Amtrak station. Currently, it is estimated that there are 160,000 residents of the City of Hayward with the City growing by approximately three percent since 2000.

The City is governed by a City Council / City Manager form of government. The City Council is made up of six members plus a mayor that serves as the head of the City Council. The City Council appoints a City Manager to oversee the City’s twelve departments. Hayward is known as the “Heart of the Bay” because of its central and convenient location in Alameda County – 25 miles southeast of San Francisco, 14 miles south of Oakland, 26 miles north of San Jose and 10 miles west of the valley communities surrounding Pleasanton. Serviced by an extensive network of freeways and bus lines, Hayward has two BART stations (Hayward and South

Hayward), an Amtrak station, and the Hayward Executive Airport, with easy access to San Francisco, Oakland, and San Jose airports.

Background Summary

• Population: 162,954

• Number of Employees: 844

• Annual City Operating Budget (including General Fund) FY 2027: $504,291 M

• Annual General Fund Budget: $123,524 M

• Annual City Capital Budget: $106 M

• Fiscal Year: July 1 – June 30

• Number of Departments:14

• Governance Structure: City Council / City Manager

• Utility Customers: 34,000

• MOUs: 7 https://procurement.opengov.com/portal/hayward-ca

• Housing Units: 48,000

The City is a “full service city” and provides a wide range of services. These services include: police and fire protection; animal control; wastewater treatment; building safety regulation and inspection; land use planning and zoning; maintenance and improvement of streets and related structures; traffic safety maintenance and improvement. The City employs 844 employees. The City’s worker’s compensation program is self-insured for $500,000 per occurrence with a total budget of $6.6 million. The City’s claims history, as shown in its annual reports submitted to the Department of Industrial Relations is as follows:

CITY OF HAYWARD FY 25-26 FY 24-25 FY 23-24 FY 22-23

Number of Medical-Only Cases

Reported in FY

55 49 58 50

Number of Indemnity Cases

Reported in FY

44 36 50 55

Total Number of Indemnity Cases

From All Years

Open In FY

211 195 209 216

Number of Cases in Which Notices of Legal

Representation Received in FY

17 18 16 22

Additional information regarding the City of Hayward may be obtained at: http://www.hayward-ca.gov

1.3. Contact Information

Any administrative questions regarding bidding procedures should be directed to:

Project Contact:

July Cole

Human Resources Manager

777 B Street

Hayward, CA 94541

Email: july.cole@hayward-ca.gov

Phone: (510) 583-8575

Procurement Contact:

Rita Perez

Purchasing Manager

777 B Street

Hayward, CA 94541-5114

Email: rita.perez@hayward-ca.gov

Phone: (510) 583-4801 http://www.hayward-ca.gov/about.shtm mailto:july.cole@hayward-ca.gov tel:(510)583-8575 mailto:rita.perez@hayward-ca.gov tel:(510)583-4801

Department:

HR

Department Head:

Candi Jackson

HR Administrative Assistant

1.4. Timeline

Release Project Date November 12, 2026

Question Submission Deadline November 19, 2026, 4:00pm

Question Response Deadline December 1, 2026, 4:00pm

Submission Deadline December 11, 2026, 4:00pm

Interview (finalist) January 11, 2027

2. Project Details

2.1. Important Instructions for Electronic Submittal

The City of Hayward is accepting electronic bid submissions. Bidders shall create a FREE account with

OpenGov Procurement by signing up at https://procurement.opengov.com/signup. Once you have completed account registration, browse back to this page, click on "Submit Response", and follow the instructions to submit the electronic bid.

2.2. Communication Regarding this RFP

All communication from prospective proposers regarding this RFP must be submitted in the Question &

Answer portal within the City's project posting. Please submit each question SEPARATELY. Questions not submitted separately will be rejected. Communication by telephone or in person will not be accepted. Attempts by or on behalf of a prospective or existing vendor to contact or to influence any member of the selection committee, any member of the City Council, or any employee of the City of

Hayward with regard to the acceptance of a proposal may lead to elimination of that vendor from further consideration.

2.3. Last Day for Questions

All questions must be submitted to the Question & Answer portal within the City's project posting by

4:00 pm Thursday, November 19, 2026. This will allow sufficient time for any addenda to be issued by the City to all bidders. Please submit each question SEPARATELY.

2.4. Award of Contract

The City reserves the right to reject any and all proposals, to contract work with whomever and in whatever manner the City decides, to abandon the work entirely and to waive any informality or non-substantive irregularity as the interest of the City may require and to be the sole judge of selection process. The City also reserves the right to negotiate separately in any manner to serve the best interest of the City. The City retains the right at its sole discretion to select a successful vendor.

2.5. City's Rights Reserved

• The City reserves the right to select the proposal which in its sole judgment best meets the needs of the City. The lowest proposed cost will not be the sole criterion for recommending the contract award. The recommended selection of the evaluation committee is final and subject only to review and final approval by the Steering Committee and the City Council.

• The City reserves the right to reject any or all proposals and to waive technicalities and informalities when such waiver is determined by the City to be in the City’s best interest.

• The City reserves the right to retain all accepted proposals, including proprietary documentation, regardless of which proposal is selected. No proposals will be returned to vendors.

https://procurement.opengov.com/signup https://procurement.opengov.com/portal/hayward-ca/projects/320815

• The City reserves the right to request any supplementary information it deems necessary to evaluate proposer’s experience or qualifications. This may include supplemental financial information, additional interview(s), and/or additional presentation by the proposer.

• The City reserves the right to reconsider any proposal submitted at any stage of the procurement. It also reserves the right to meet with select proposers at any time to gather additional information. Furthermore, the City reserves the right to delete or add functionality

(i.e., modules and components) until the final contract signing.

• The City reserves the right to cancel, in part or in its entirety, this RFP, including, but not limited to: selection schedule, submittal date, and submittal requirements. If the City cancels or revises this RFP, all proposers will be notified in writing by the City.

• The City reserves the right to revise the RFP prior to the date that proposals are due. The City will communicate changes through addendum to this RFP. All registered proposers will be notified of revisions to the RFP. The City reserves the right to extend the date by which the proposals are due.

• The City reserves the right to split the award from this RFP between multiple proposals when such split award is determined to be in the best interests of the City.

• The City reserves the right, in its sole discretion, to reject any and all proposals and to waive informalities and minor irregularities in any proposals received. Failure to furnish all information requested or to follow the format requested herein may disqualify the proposer, in the sole discretion of the City. False, incomplete, misleading or unresponsive statements in a proposal may also be sufficient cause for a proposal’s rejection.

• This RFP does not commit the City to award a contract. All proposals submitted in response to this RFP become the property of the City and public records, and as such, may be subject to public review.

• The City shall not be liable for any pre-contractual expenses incurred by prospective vendors or selected contractors, including but not limited to costs incurred in the preparation or submission of proposals. The City shall be held harmless and free from any and all liability, claims, or expenses whatsoever incurred by, or on behalf of, any person or organization responding to this

RFP.

• If the successful proposer defaults, the City may award this RFP to the next best proposal and may recover the loss occasioned by the successful proposer against a surety bond, if any, or by suit against the successful proposer.

• The City reserves the right to cancel, in part or in its entirety, this RFP including, but not limited to: selection procedures, submittal date, and submittal requirements. If the City cancels or revises the RFP, all interested firms will be notified.

• All proposals submitted in response to this RFP become the property of the City and public records and, as such, are subject to public review.

2.6. Protest

Should any proposer question or protest the award of the contract, such question or protest must be furnished in writing to the Purchasing Manager within three (3) calendar days after the City notifies all proposers of its Intent to Award. Such submittal must fully explain the basis of the objection supported by all relevant information facts and details. Letter must be signed by an authorized representative stating specific reason(s) for the protest including all relevant facts (law, rule, regulation, and criteria).

Questions or protests not furnished in writing as prescribed will not be accepted.

3. Scope of Work

3.1. Scope of Work

A. Project Overview: Notice is HEREBY given that the City of Hayward invites sealed proposals for

27-014 Request for Proposal (RFP) Third Party Administration (TPA) of Workers’ Compensation

Benefits. Each proposal shall be in accordance with the general provisions for purchase of work and services on file in the office of the Human Resources Department, 777 B Street, Hayward, CA 94541. All proposals must be submitted to the City’s eProcurement Portal, by 12:00pm on

December 11, 2026, and clearly identified with RFP title, number, company name and due date.

It is the sole responsibility of the proposing firm to ensure that proposals are received prior to the closing time, as late bids will not be accepted and deemed nonresponsive. The City of

Hayward is soliciting proposals from qualified Third-Party Administrators (TPA) for the administration of the City’s self-insured workers’ compensation program. The term is expected to be for three (3) years with two (2) one-year options to renew based on satisfactory performance. This RFP is open to all. All competing vendors will have the opportunity to share written questions before the submission due date. Answers to all questions will be shared with all vendors to ensure a fair and equitable submission process. Respondents will absorb all costs incurred in the preparation and presentation of their proposal.

1. Project Description:

a. The City desires The City of Hayward (hereinafter referred to as the “City”) is seeking professional services proposals from qualified and licensed Third Party Administrators

(hereinafter referred to as the “Administrator or TPA”) to provide workers’ compensation claims administration services for the City’s self-insured workers’ compensation Program. The City’s Human Resources Department is responsible for management of its workers’ compensation programs including administering the TPA contract. The TPA contract includes reporting injuries; employee contact; providing lost time and salary information; training for managers, supervisors, and employees;

assisting with early return to work program; claimant service evaluation and maintenance of the City’s workers’ compensation claim files. The Administrator shall provide effective and efficient claims administration services to the City in accordance with all California laws. The objective is to provide the City’s employees with appropriate benefits and medical treatment in a prompt and efficient manner.

2. Project Goals:

a. The goal of this RFP process is to secure a Third-Party Administrator (TPA) to provide appropriate workers' compensation claims administration and related services. In addition, the TPA is expected to analyze loss data, identify trends and develop methods to reduce costs for the City. Additionally, the TPA is expected to identify methods to improve program efficiency and effectiveness.

3. Project Deliverables:

a. The project includes the following deliverables:

i. Proposals shall clearly demonstrate that the Administrator has the training, required licensing, experience, relevant expertise and a thorough knowledge of professional services, functions, activities and related responsibilities to successfully perform workers’ compensation administration services. The successful Administrator shall have at a minimum the following qualifications: i. Must be licensed by the State of

California as a Third-Party Administrator (TPA). ii. Have a claim administration office within reasonable proximity to the San Francisco Bay Area. iii. Have a minimum of five (5) years’ experience administering claims as a claim administrator for a public entity. iv. Have sufficient means and/or resources to conduct field investigations, provide prompt reporting and adjudication of medical and indemnity payments. v.

Have an electronic database capable of producing specialized and ad hoc reports in addition to those required by the State of California. vi. Have not received sanctions for nonconforming performance by the California Department of Industrial Relations

(DIR) in the past three years. (Subject to verification with the State). vii. All claims administration services performed shall comply with those provisions set forth in the PRISM Standards for Workers’ Claims Administration Services. The

Administrator shall provide sufficient information in the proposal on how it will perform the required professional services in accordance with the specifications presented in this RFP. The respondent shall provide adequate information and supporting documentation for the evaluation of its ability to successfully provide the services as described in the Scope of Work. To be considered, the TPA shall demonstrate that the firm has the personnel and capital resources, knowledge, expertise, experience, creativity, innovation, insight and customer service skills to serve as a third-party administrator. The TPA must respond to all the required items in this RFP. The TPA shall demonstrate that all services will be performed in a manner commensurate with the highest standards of professionals in the industry.

The respondent’s management system shall have the capacity to transition all workers’ compensation claims and related payment and file data from the existing system into data in the respondent’s system within thirty (30) days of awarding the contract. The City’s claim payment data shall remain intact. The City reserves the right to select the Administrator that the City, in its sole discretion, determines will best serve its Workers’ Compensation Program. SPECIFICATIONS a) Records The

Administrator shall maintain complete and accurate records with respect to costs, expenses, receipts, and other such information required by the City that relates to the performance of services under this agreement. The Administrator shall maintain adequate records of services provided in sufficient detail to permit an evaluation of services. All such records shall be maintained in accordance with generally accepted accounting principles and shall be clearly identified and readily accessible. The

Administrator shall provide free access to the representatives of the City or its designee’s at all proper times to such books and records, and give the City the right to examine and audit same, and to make transcripts as necessary, and to allow inspection of all work, data, documents, proceedings and activities related to this agreement. Such records, together with supporting documents, shall be kept separate from other documents and records and shall be maintained for a period of no less than three (3) years after receipt of final payment. All original books, manuals, films or any other patentable or copyrightable material developed with contract funds, reproduced, prepared or caused to be prepared by the

Administrator pursuant to or in connection with this agreement shall be the exclusive property/rights of the City. The Administrator shall not copyright any report required by this agreement. Any report, information, and data acquired or required by this agreement shall become the property of the City and all publication rights are reserved to the City. All records, files, transcripts, computer tapes, and other material or workers’ compensation adjusting activity reports prepared by the

Administrator shall be the property of the City and must be relinquished by the

Administrator to the City at the conclusion of this contract. The City shall not be required to pay any additional costs for the retrieval of such information, documentation, and software. The Administrator shall take all steps necessary to safeguard any data, files, reports or other information from confidentiality breaches, loss, destruction or erasure. Liability for any costs or expense of replacing or damages resulting from the loss of such data shall be borne by the Administrator unless at the time of loss said data was in the exclusive custody of the City.

Administrator will cooperate with City and make available all claim files and records available for audits. The City will have reasonable access to the necessary portions of Administrator facilities, records, and files for review or audit purposes. The City, at its option, shall have the right to have a claims audit(s) performed. The audit(s) will be directed to, including but not limited to, the following areas: Staffing;

Examiner Caseloads; Reporting; Supervision; Case Reserves; File Documentation;

Medical Payments; Disability Benefit Delivery; Fines & Penalties; Diary System;

Claimant, Employer and Doctor Contact; Case Administration & Investigation; and

Contract for Claim Administration Services; application of current WCAB rules and regulations and case law. b) Dedicated Claims Unit and Assigned Personnel The objective of this RFP is the establishment of a dedicated claims unit to service and manage the City’s account exclusively. The respondent shall establish a dedicated claims office, or a segregated unit whose sole responsibility is the handling of the

City’s workers’ compensation claims. Please provide staffing plan as requested in this document. Administrator shall designate a full-time Claims Supervisor to be assigned to this account that will act as the primary contact for the City and will be selected with the concurrence of the City. The Claims Supervisor must possess a

State of California Self-Insurance Plan Certificate. Claims examiners assigned to the

City’s account should have significant (minimally 3-5 years) active claims adjusting experience. A claims assistant may not be substituted for an experienced examiner.

Examiners must hold a Self-Insured Competency Certificate. If for any reason the

City finds, in its sole discretion, that the service provided by any assigned personnel is unsatisfactory, the Administrator will agree to assign replacement personnel that must also be approved by the City. c) Caseloads Caseload for the purpose of this RFP and the resulting contract are defined as all open claims, indemnity and medical only, to calculate “Total Caseload.” Claims that are designated as companion files will be counted with the master claim file as one claim file. The maximum caseload for the assigned personnel shall be as follows: i. Claims Asst: 200 Med only claims

(max of 75 future medical) ii. Senior Claims Examiner: 125 open claims iii. Claims

Supervisor: 20 open claims For the City of Hayward, supervisory personnel should not handle a caseload, although they may handle specific issues. If at any time during the term of the agreement the number of all open claims exceeds 125 per

Senior Examiner or 20 for the Supervisor, the Administrator shall, with the City’s concurrence, assign additional staff to the City’s account. d) Program Administration

The City is seeking a TPA who shall meet the following minimum Program

Administration objectives: i. Develop policies and procedures relating to the workers’ compensation claims program, as well as provide information and guidance regarding the workers’ compensation program and specified claims. ii.

Inform the City of current changes or proposed changes in statutes, rules and regulations and case law affecting the workers’ compensation program. iii.

Represent City in all matters related to the set-up, investigation, adjustment, processing, negotiation and resolution of workers’ compensation claims against the

City. iv. Facilitate workers’ compensation and other related seminars for department heads and/or City’s staff at request of City. v. Represent administrator at quarterly meetings with departments on-site at City as requested, including the preparation of claim narratives for those attending the meetings. vi. Provide copies of file correspondence and documentation as requested. vii. Maintain and store all hardcopy and/or electronic files indefinitely once file is closed. viii. Destroy any claim records by shredding. There will be no additional cost to City for destruction of claim records. Provide Certificate of Destruction for all documents. ix. Administrator shall provide to City, at no additional cost, within five (5) business days of the date of termination of an Agreement, all claims, reports, files and electronic data of City’s self-insured workers’ compensation annual reports. x. City retains the right to approve all TPA staff members associated with its account. xi. Transfer electronic data to site chosen by City within five (5) days of termination of contract. e) Claims

Administration The City is seeking a TPA who shall meet the following minimum

Claims Administration objectives: i. Administer worker’s compensation benefits in accordance with California State Law. ii. Make initial contact with the injured employee and establish a claims file within one (1) business day of receipt of the notice of claim. iii. Complete a thorough analysis of relevant factors to determine compensability according to California law; recommend action by the City to accept or deny coverage; provide formal written analysis to City staff seeking authority for settlement or resolution of a claim. Final authority to accept or deny coverage or proceed with any settlement shall rest with the City. iv. Investigate any questionable claim; recommend special, outside independent investigation for a questionable claim with the consent, coordination and assistance of the City. City retains its right to select or approve any independent investigator vendor(s). v. Provide information and guidance to an injured employee about the workers' compensation benefits available according to California law and established City policies. vi. Make all claim files available for review by the City anytime during the administrator’s regular business hours. vii. Maintain Utilization Review process as governed by Labor Code section 4610 to review treatment recommended by physicians to determine if it is medically necessary, either in- house or with the respective City’s contracted vendor. City retains its right to select or approve the Utilization Review vendor(s).

viii. Monitor treatment programs for injured employees to ensure that they receive prompt proper care and eliminate any unnecessary treatment. This task includes referrals to the Drug Utilization review vendor for medications misuse, abuse or over-prescribing. ix. File and Serve all medical reports on interested parties to a claim within five (5) days of receipt of documents. x. Respond to City staff inquiries within twenty-four (24) hours; respond to City staff about any critical issues on the same day. xi. Provide Medicare Agent Services and the required reporting (including

Section 111 of the Medicare, Medicaid & SCHIP Extension Act (MMSEA) of 2007). xii.

Excess Insurance - report any claim to the City’s Excess Insurance Carrier as required by the policy; provide all necessary documentation to the excess insurance carrier;

seek reimbursement of funds from the excess insurance carrier. f) Medical Bill

Review A bill for any type of medical treatment (physician, pharmacy, hospital, therapist, etc.) received by the Administrator shall be reviewed for correctness and accuracy; approved for payment; and paid within 60 working days of receipt.

Administrator shall review each bill for medical services for reasonableness using the State Medical Fee Schedules and any appropriate Preferred Provider

Organization schedules. Administrator may elect to utilize a vendor to provide this service. The Administrator shall notify the medical provider in writing within 30 working days of receipt of an itemized bill about any contested, denied or incomplete amount on the itemized bill. The Administrator shall utilize an approved bill review process. The bill review process shall include participation in a Preferred

Provider Organization (PPO). The use of a Medical Panel Network (MPN) is desirable but not required. City retains its right to select, approve, or reject the Medical Bill

Review vendor(s) and any MPN. Any Administrator who elects to provide medical bill review services internally shall provide a guaranteed cost bill review program.

The Administrator must identify any costs associated with the medical bill review services separately from its administrative fees. Any Administrator who proposes using a vendor to provide medical bill review services shall identify the vendor and its fee schedule. City retains its right to select, approve, or reject the proposed Bill

Review vendor. g) Medical Service and Expenditures California law requires an employer to provide all medical care to relieve and or cure the effects of an industrial injury. The selected Administrator shall provide the services described below to any City employee who sustains an industrial injury or illness: i. Develop and recommend a panel of physicians for the initial treatment of an industrial injury or illness. ii. Monitor the medical treatment program for each claim including review of all medical reports, referring any requested services as necessary to a State approved and City approved utilization review management program for required determinations. iii. Recommend the use of nurse case management services for assistance in medical control. City retains its right to select the Nurse Case

Management vendor and approve or deny the use on any specific claim file. iv.

Maintain close liaison with all City assigned treating physicians. v. Provide guidance in the evaluation of the physical capacity of injured employees and in their ability to return to work. vi. Determine eligibility for and authorize payment of medical benefits. vii. Schedule and authorize medical examinations to determine the nature and extent of disability; advise all interested parties about all medical appointments, including Agreed or Independent Medical Evaluations and Independent Medical

Reviews using the panel list agreed upon between Administrator and City or as required by the State agency. viii. Review all billings for reasonableness using the

State Medical Fee Schedules and submit for medical auditing as necessary to a City-approved bill review service. Refer to the Medical Bill Review section (above). City retains its right to select the Bill Review vendor. ix. Assist City, if requested, with establishing a Medical Provider Network (MPN) to treat injured workers. City retains its right to opt out of a MPN and utilize a City approved PPO list of physicians. h)

Consultation With respect to consultation provided to City and/or employees who incur job-related injuries or illnesses, the Administrator shall: i. Provide information and guidance to injured employees regarding the benefits they will receive in accordance with City policies. ii. Attend appointments, including but not limited to meetings, conferences, court appearances, and scene investigations at the request of City human resources staff. iii. Provide information, guidance and assistance to injured employees regarding permanent disability ratings; Qualified Medical, Independent Medical Reviews and Agreed Medical Examiner process; delay process, denial process and settlement of claims. City retains its right to the final decision with regards to compensability on any claim. iv. Assist the City in solving employee non-legal problems arising out of industrial injury cases. v. Work with the injured employees, City personnel and other agencies to provide rehabilitation, retraining or reassignment of employees with physical or performance limitations arising out of an industrial injury. vi. Provide guidance to City staff to insure that the return to work by, or reassignment of, an injured employee is consistent with the medical findings. vii. Assist the City, as requested, with cost containment and incentive programs. i) Litigation Management Litigation management services by the

Administrator shall, at a minimum, include the following: i. Refer litigated cases to an attorney using a listing of approved attorneys provided by the City. ii. City retains its right to appoint legal counsel to our account. iii. Assist in the defense of litigated cases. iv. Assist in negotiation of claim resolution and settlements. v. Monitor each case for potential subrogation recovery, prepare correspondence to effect collection, and assist legal counsel where litigation is required to affect recovery. vi.

Ensure that, for employees who are represented by legal counsel, their attorneys receive copies of reports and correspondence as appropriate and required by law.

vii. Maintain a litigation management budget for each litigated file and provide litigation status reports on a regular basis for each litigation file. viii. Cooperate fully with all attorneys chosen by the City, including the City Attorney. j) Information

Management and Reports The City seeks a TPA who shall meet the following minimum Information Management and Reports objectives: i. Provide City’s management with computerized reports at specified intervals on new claims, closed claims, paid losses, incurred costs, the progress of individual claims and the effectiveness of safety and other cost control programs; commonly known as a Loss

Run. ii. Administer and provide a comprehensive annual statistical summary survey customized to meet the City’s needs, and if requested by the City, a narrative report to serve as the basis for evaluation of City programs. iii. Prepare the City’s annual

Cal-OSHA Log 300A Report as required by the Department of Labor. Reports are to be submitted to the City no later than 30 days prior to the due date. iv. Assemble and submit data as required for State reports, including annual report to Industrial

Relations, Self-Insurance Program Report, and annual actuarial studies performed on the workers’ compensation program. v. Provide City with written status reports on all open claims at the end of each fiscal quarter. Human Resources must receive the completed status reports on or before August 31st, November 30th, February

28th, and May 31st of each year. vi. Administrator shall provide the City’s staff the ability to access the Administrator’s computer system. vii. Administrator shall provide secure, electronic reports to allow performance of certain routine data analysis by the City. It is recommended that this data and similar reporting be accessible to the City via the TPA’s software system and that reports be run by the end user (City). Often referred to as ad hoc reports. viii. Provide narrative or analytical reports regarding major cases. ix. A contractual duty and accountability to report appropriate claims to The Centers of Medicare and Medicaid Services (CMS) in accordance with MMSEA Act of 2007. x. Submit to the City, a completed Cal-OSHA

Log 300 every 60 days. k) Financial Management The chosen Administrator shall establish a Workers’ Compensation imprest account for payment of Workers’

Compensation benefits. The purpose of this fund shall be to pay medical/legal and other expenses incurred as a result of accepted industrial injuries/illnesses, as well as payment of Workers’ Compensation benefits to which eligible employees are entitled. i. Report to the City at least monthly, or as needed, of charges against the fund, and obtain reimbursement to maintain the fund at an appropriate level determined by the City. ii. Manage the imprest account in a reasonable and prudent manner and in compliance with City directives and accepted accounting principles.

iii. Issue vouchers to the City from the imprest account in those instances where an employee is paid benefits directly by the City, i.e. Labor Code §4850; or salary continuation in lieu of temporary disability benefits. iv. Actively collect any overpayment of benefits. v. Reimburse the City for any penalty assessed against a claim file that results from the Administrator’s lack of proper claims handling or the holding of a check due to insufficient funds in the imprest account. vi. Establish procedures and necessary documentation enabling the TPA to draw checks for payment of benefits on an appropriate imprest account of the City. vii. Absorb any costs for the printing of any checks. The City's name will appear on the check, and be imprinted on all check copies. All checks shall be printed in numerical order, locked and controlled by the TPA’s accounting department. All checks must be accounted for as payments, voids, etc. viii. Use a separate check register for the City.

Daily entries will be made on all checks disbursed on the account. Credits, if any, shall be entered, as well as all deposits made on checks, received on reimbursement requests made from TPA’s office. TPA shall provide City with a check register, electronically mailed to City. ix. Provide City’s accounting office with one (1) copy of each check register, all voided checks, etc. x. Review the imprest account periodically to determine if the initial deposit remains adequate. The TPA’s accounting office shall submit a report recommending any change in the imprest account balance based on this review. Prompt payments on the TPA’s reimbursement requests are a major factor in the efficiency of an imprest account.

The City's reimbursement payments should reach the TPA’s office within ten (10) days from the date of TPA’s request in order to maintain a continuous flow of checks issued throughout the month.

3.2. Overview of Scope

A. Consultant Selection:

1. The purpose of this RFP is to solicit proposals to provide all of the above services.

B. Schedule:

1. The following provides milestones in the consultant selection process for City of Hayward

Third Party Administration of Workers' Compensation Benefits:

a. Electronically submit completed proposals to City of Hayward HR at 4:00 pm on Friday, December 11, 2026 to https://procurement.opengov.com/portal/hayward-ca/projects/320815.

b. Scope and fee negotiation: February / March 2027

c. Contract approval by City Council on or about February / March 2027

C. Proposal Requirements:

1. The proposal shall be organized in the following sections:

a. Cover letter. The cover letter should identify the primary contact person for your team.The cover letter must designate a primary point of contact who is authorized to answer questions about the proposal. Please provide this person’s name, title, address, phone number, email address, and qualifications for acting in this capacity. The letter should not exceed one page in length and should summarize key elements of the proposal.

b. References. Provide the names and contact information of three (3) relevant local government clients of similar size for which the firm has provided services within the last five years.

c. Team. Identify key members and their qualifications, the primary location where work will be done, and your proposed team organization.Provide a list of individual(s) who will be working on this transition and indicate the functions that each will perform and anticipated hours of service of each individual. Include a resume for each designated individual. TPA shall provide the resumes of all personnel working on the City account within 30 days of an awarded contract. Upon award and during the contract period, if the TPA chooses to assign different personnel to the project, the TPA must submit their names and qualifications including information listed above to the City for approval before they begin work. City retains its right to approve all personnel associated to its account. Please also identify any and all sub-contractors and their role in the project, including all the aforementioned information. Provide the firm's average turnover rate for claims examiners and claims supervisors during the past twenty-four (24) months.

Describe the firm's process for transitioning claim files and maintaining continuity of service when assigned personnel leave, are reassigned, or become unavailable.

d. Staffing Stability and Transition Management. Provide the firm's average annual turnover rate for claims examiners, claims supervisors, and account managers assigned to California public agency accounts during the past twenty-four (24) months. Describe any initiatives implemented to improve employee retention. - Describe the firm's process for maintaining service continuity when assigned personnel leave the organization, are reassigned, or are unavailable due to extended leave. Include:

-Procedures for transitioning claim files;

-Communication protocols with the City;

-Training and onboarding of replacement personnel;

-Estimated transition timelines; and

-Measures used to minimize disruption to claim administration services. Identify proposed backup personnel for key account positions, including the Claims Supervisor and Senior Claims Examiner(s), and describe their qualifications and availability to support the City's account.

e. Experience. Proposals shall clearly demonstrate that the Administrator has the training, required licensing, experience, relevant expertise and a thorough knowledge of professional services, functions, activities and related responsibilities to successfully perform workers’ compensation administration services. Please highlight specific experiences with municipal or public institutions and any familiarity with Hayward or the Bay Area. Provide a summary of similar completed projects which includes client name, description, project team, date completed and total cost.The City reserves the right to verify information provided through reference checks and publicly available records.

f. Approach. Identify key project issues and how they will be addressed.

g. Proposed Scope of Services. The proposed scope of services should describe tasks and identify deliverables as outlined in Section 3 - Project Deliverables. Additionally ensure how the Administrator will comply with PRISM Workers' Compensation Claims

Administration Standards - Attachment G.

h. Description of Process. Provide a detailed description of the approach and methodology to be used to accomplish the Scope of Work of this RFP. The Methodology

Section should include:

i. An implementation plan that describes in detail the methods, including controls by which your firm or entity manages clients of the type sought by this RFP;

ii. methodology for soliciting and documenting views of internal and external customers; and

iii. any other type of management or implementation strategies or techniques that the respondent intends to employ in carrying out the work.

iv. Detailed description of efforts your firm or entity will undertake to achieve client satisfaction and to satisfy the requirements of the "Scope of Work" section.

v. Detailed schedule for taking over claims administration, identifying all tasks and deliverables to be performed, durations for each task, completion dates for each task and overall time of completion.

vi. Detailed description of specific tasks you will require from City staff. Explain what the respective roles of City staff and your staff would be to complete the tasks specified in the Scope of Work.

vii. TPAs are also requested to identify any software systems that they will be using to manage the City’s workers’ compensation claims. Specifically, TPAs should detail the capabilities of the system, including the ability to generate custom reports and the capability of operating “paperless”. The selected TPA must maintain current and accurate data within the claims system and conform to all data security and handling requirements under State and Federal regulations. Confirm that your firm is able to meet the above requirements and detail data security protocols/methods for ensuring the confidentiality of records and information.

viii. Detailed description regarding your ability to meet and ensure compliance with

CSAC and/or LAWCX performance standards (see exhibit E).

i. Workplan. The workplan should show tasks that you consider important for this project and your estimate of the professional labor hours each month. The workplan shall be presented in tabular form, and is not subject to the 8½ x 11-inch page size limit (but is subject to the 30-page limit).

j. Proposed Schedule of Charges. Provide a schedule of charges for labor and expenses that you propose to charge the City on this project. Also, identify labor rates for the particular professional staff you propose will work on this project. The proposed schedule of charges is subject to negotiation prior to contract execution.

k. Proposed Budget. Provide the proposed budget based on the workplan and proposed schedule of charges. The proposed schedule of charges is subject to negotiation prior to contract execution. Pricing must be submitted on a “not to exceed” basis. Do not use

“TBD” or similar annotations for cost estimates.

l. Financial Capacity. Provide the TPA's latest audited financial statement or other pertinent information such as internal unaudited financial statements and financial references to allow the City to reasonably formulate a determination about the financial capacity of the TPA. Describe any administrative proceedings, claims, lawsuits, or other exposures pending against the TPA.

m. Fee Proposal. Provide an itemized cost analysis for the entirety of the project period, including billable rates for all personnel assigned to the project, materials, etc. Please break down costs on a “not-to-exceed” basis.

n. Resumes. Provide resumes for key personnel in Appendices.

o. Disclosure. List any vendors that your company has a relationship within Appendices.

D. The page limitation applies to sections “b” through “i” of the Proposal Requirements. The proposal cover, divider sheets, resumes and disclosure are not subject to the page limitation.

Resumes of key personnel shall be provided in an appendix bound with the proposal.

E. If any portion of the City’s standard Professional Services Agreement is unacceptable to your firm, please identify the particular clause(s) in a separate letter to the City submitted with your proposal.

3.3. Interview Format

The interview format and duration has not been determined. Firms being invited to interview will be informed of the interview format after Friday, December 11, 2026

4. Evaluation Criteria

The City will review all proposals received as part of a structured evaluation process. For each decision point in the process, the City will evaluate proposers according to specific criteria and will then elevate a certain number of proposers to compete in the next level.

The sole purpose of the proposal evaluation process is to determine which solution best meets the City’s needs. The evaluation process is not meant to imply that one proposer is superior to any other, but rather that the selected proposer can provide and has proposed the best solution and implementation approach for the City’s current and future workers' compensation administration needs.

A review committee will evaluate all responses to the RFP that meet the submittal requirements and deadline. Submittals that do not meet the requirement or deadline will not be considered. The review committee will rank the proposals and arrange interviews with the finalist prior to selection.

Responsiveness Screening

Proposals will first be screened to ensure responsiveness to the RFP. The City may reject as non-responsive any proposal that does not include the documents required to be submitted by this RFP. At any time during the evaluation process, the City reserves the right to request clarifications or additional information from any or all TPAs regarding their proposals.

Initial Proposal Review

The City will initially review and score all responsive written proposals based upon the Evaluation

Criteria set forth above. The City may also contact TPA's references. Proposals that receive the highest evaluation scores may be invited to the next stage of the evaluation process. The City may reject any proposal in which a TPA’s approach, qualifications, or price is not considered acceptable by the City. An unacceptable proposal is one that would have to be substantially rewritten to make it acceptable. The

City may conclude the evaluation process at this point and recommend award to the most responsive bidder. Alternatively, the City may elect to negotiate directly with one or more TPAs to obtain the best result for their respective City prior to making a recommendation or selection.

Interviews, Reference Checks, Revised Proposals, Discussions

Following the initial screening and review of proposals, the TPAs included in this stage of the evaluation process may be invited to participate in an oral interview. The individual(s) from the TPA's firm or entity that will be directly responsible for carrying out the contract if awarded should be present at the oral interview. Selected firms may be invited for additional interviews.

In addition to conducting an oral interview, the City may, during this stage of the evaluation process also contact and evaluate the TPA’s references, contact any TPA to clarify any response or request revised or additional information, contact any current users of a TPA’s services, solicit information from any available source concerning any aspect of a proposal, and seek and review any other information deemed pertinent to the evaluation process.

Following conclusion of this stage of the evaluation process, the City will again rank all TPAs according to the evaluation criteria set forth above. At this point, the City may conclude the evaluation process and determine which TPA will move forward with the agency, and make a recommendation for award, or it may request Best and Final Offers from TPAs. The City may accept the proposal or negotiate the terms and conditions of the agreement with the highest ranked firm, which shall be determined to be the most responsive bidder. The City may recommend award without Best and Final Offers, so TPAs should include their best proposal with their initial submission.

Recommendation for award is contingent upon the successful negotiation of final contract terms with the agency. Negotiations shall be confidential and not subject to disclosure to competing TPAs unless an agreement is reached. If contract negotiations cannot be concluded successfully within a time period determined by the City, the City may terminate negotiations and commence negotiations with the next highest scoring TPA or withdraw the RFP.

The table below describes the criteria that will be used to review proposals and interview performance.

The proposals will be reviewed by City staff. The composition of the interview panel has not been determined; it…