Third_Party_Administration_Self-Insured_Workers_Compensation_and_Heart_&_Lung_Claims_(Addendum_#1_Revision).pdf

REQUEST FOR QUALIFICATION

2022-RFQ-012

THIRD PARTY ADMINISTRATION SELF-INSURED

WORKERS COMPENSATION AND HEART & LUNG

CLAIMS

City of Scranton

340 N Washington Ave

Scranton, PA 18503

RELEASE DATE: June 27, 2022

DEADLINE FOR QUESTIONS: July 11, 2022

RESPONSE DEADLINE: July 14, 2022, 10:00 am

RESPONSES MUST BE SUBMITTED ELECTRONICALLY TO:

https://secure.procurenow.com/portal/scrantonpa https://secure.procurenow.com/portal/%7bproject.government.code%7d

City of Scranton

REQUEST FOR QUALIFICATION

Third Party Administration Self-Insured Workers Compensation and

Heart & Lung Claims

I. INTRODUCTION

II. GENERAL INFORMATION

III. GENERAL CONDITIONS

IV. PROBLEM STATEMENT

V. CRITERIA FOR SELECTION

VI. RESPONSE REQUIREMENTS

VII. SCOPE OF WORK

Attachments:

B - Actuary Report 8.31.21_Final

Request For Qualification #2022-RFQ-012 Title: Third Party Administration Self-Insured Workers Compensation and Heart & Lung Claims

1. INTRODUCTION

1.1. Summary

A. The City of Scranton Office of Business Administration is seeking separate sealed

Qualification Statements, hereinafter referred to as a "Response," from qualified individuals or firms, hereinafter referred to as a "Respondents," to provide Third Party

Administration Self-Insured Workers Compensation and Heart & Lung Claims.

Responses will be received online by the City of Scranton Controller via the City’s e-

Procurement Portal until 10:00 am on Thursday, July 14, 2022, at which time such

Responses will be opened in City Council Chambers, 2nd Floor and made available for public viewing at www.youtube.com/user/electriccitytv570.

CITY OF SCRANTON

Third Party Administration Self-Insured Workers Compensation and Heart & Lung Claims

Responses shall be made upon the specifications included in the official Request for

Qualifications (RFQ) which may be obtained by visiting the City of Scranton’s e-Procurement

Portal, https://secure.procurenow.com/portal/scrantonpa. If you intend to submit a Response, you shall register on the City’s e-Procurement Portal. Once registered, Companies may view and click "Follow" to be a prospective Respondent for this solicitation and will appear on the

Follower’s list. Companies that fail to Follow this project will not receive automatic addenda notifications, nor will they be able to draft a response in the City’s e-Procurement Portal, and therefore will be unable to participate or be considered for this RFQ.

All Response documents and supplementary documents must be uploaded and submitted using the City’s e-Procurement Portal prior to 10:00 am on Thursday, July 14, 2022, as instructed in this solicitation. Once file(s) have been uploaded and the Submission Status shows as

“Submitted” the submission is complete. At that point, the Respondent representative who is registered with the City will receive an email confirmation from the City’s e-Procurement Portal.

All Responses must be accompanied by a certificate of insurance, a signed affirmative action, non-segregated facilities, non-collusion affidavits, and disclosure by current contractor.

All communications regarding technical, scope, and/or project related questions and requests for clarifications, changes, exceptions, and deviations to the terms and conditions set forth in this

RFQ shall be submitted via “Q&A” through the City’s e-Procurement Portal, before the deadline of 4:00 pm on Monday, July 11, 2022 and according to these specifications herein.

If a Respondent encounters any technical difficulties utilizing the City's e-Procurement Portal, a representative may contact, OpenGov, the Software Administrator, using the real-time chat function on the website (located in lower right-hand corner of the screen), or via email at support@procurenow.com. It is still the Respondent's responsibility to ensure that their response is submitted before the deadline.

http://www.youtube.com/user/electriccitytv570

1.2. Background

In order to provide the City of Scranton with the most effective Self-Insured Workers'

Compensation Program, the City of Scranton will be soliciting bids for a Third-Party

Administrative Services to handle the daily management of the City's Self-Insured Workers'

Compensation and Heart & Lung (Public Law 477) Claims.

1.3. Contact Information

Matthew Domines

Finance Director

340 North Washington Avenue

Scranton, PA 18503

Email: mdomines@scrantonpa.gov

Phone: (570) 348-4118

Department:

Business Administration

Department Head:

Larry West

Business Administrator

1.4. Timeline

RFQ Release Date June 27, 2022

Question Submission Deadline July 11, 2022, 4:00pm

Response Submission Deadline July 14, 2022, 10:00am

City Council Chambers

2nd Floor in City Hall

340 North Washington Ave. Scranton, Pa.

18503 mailto:mdomines@scrantonpa.gov tel:(570)348-4118

2. GENERAL INFORMATION

A. PURPOSE

1. This Request for Qualifications (RFQ) provides interested parties with sufficient information to prepare and submit Responses for consideration by the City of

Scranton for Third Party Administration Self-Insured Workers Compensation and

Heart & Lung Claims.

B. ISSUING OFFICE

1. This RFQ is issued for the City of Scranton. The submittal of Responses must be submitted no later than 10:00 am on Thursday, July 14, 2022 to the City of Scranton

Controller via the City’s e-Procurement Portal. Hard copy (mailed or hand delivered), Fax, or e-mail submittals will not be accepted or considered.

2. Responses will be handled confidentially by the City during the pre-award process.

3. The Response shall be binding for a period of ninety (90) days from the due date for submission.

4. The City will not be responsible for any expenses incurred by an entity submitting a

Response in connection with this procurement.

C. GENERAL CONSIDERATIONS

1. QUESTIONS

a. Questions about this project shall be submitted in writing via “Q&A” through the

City’s e-Procurement Portal, before 4:00 pm on Monday, July 11, 2022.

b. All questions must be received before the deadline set forth above. Inquiries received afterwards will not receive responses.

c. No telephone calls with questions will be taken.

2. ADDENDA

a. To ensure consistent interpretation of certain items, answers to questions the City deems to be in the interest of all will be made available to all Respondents.

b. Responses to questions will be issued in the form of an Addendum to the RFQ.

c. Unless otherwise specified, any addenda issued while this RFQ is open and still accepting Responses must be acknowledged electronically via the City’s e-

Procurement Portal, which will be made part of the Response. Addenda notifications will be provided to those listed on the Follower’s List via email.

https://secure.procurenow.com/portal/scrantonpa

3. GENERAL CONDITIONS

A. No verbal information to Respondents will be binding on the City. The written requirements will be considered clear and complete, unless written attention is called to any apparent discrepancies or incompleteness before the opening of the Responses. All alterations to the RFQ will be made in the form of a written communication emailed to all prospective Respondents. The communications shall then be considered to be part of the

RFQ.

B. Submission of a Response will be considered as conclusive evidence of the Respondent’s complete examination and understanding of the request.

C. In the event a Respondent is unable to submit a timely response in accordance with the instructions herein due to personal or company internet or hardware limitations, settings or restrictions, internet speed, power outage, network connection, use of a malfunctioning electronic device, or the like, neither the City, nor the Software Administrator, will be held responsible. Companies shall be solely responsible for ensuring the capability of their computer system while responding to this solicitation, and for the stability of their internet service. Uploading large documents may take significant time depending on the size of the file(s) and the Internet connection speed that the Respondent representative is using to submit a response. Failure of the Respondent to successfully submit an electronic

Response before the deadline indicated herein shall be at the Respondent’s sole risk, and no relief will be given for late and/or improperly submitted Responses.

D. The City of Scranton reserves the right to reject any and all Responses submitted and to request additional information from any Respondent. The City of Scranton reserves the right to waive minor irregularities in the procedures or Responses if it is deemed in the best interests of the City of Scranton. The City may elect, at its sole and absolute discretion, to award a Contract based on the initial Responses, or, to open negotiations, either written or oral, with one or more Respondents to address performance, technical, pricing, delivery, or other provisions. If negotiations are opened, the City may elect, at its sole and absolute discretion, to conclude negotiations at any time if it is determined to be in its best interest, or they will be closed upon settlement of all questions and clarifications. Responses may be rejected and negotiations terminated by the City. The award will be based on the offers submitted, as well as any and all negotiations conducted. The City further reserves the right to reject all Responses and seek new

Responses when such procedure is considered to be in the best interest of the City.

E. The award will be made to that responsive and responsible Respondent whose Response, conforming to requirements of the request, will be most advantageous to the City, price and other factors considered. The award may or may not be made to the firm with the lowest cost.

F. The City shall have the right, without invalidating the contract, to make additions to or deductions from the items or work covered by the RFQ. In case such deductions or additions are made, an equitable price adjustment shall be made between the City and the

Respondent. Any such adjustments in price shall be made in writing.

G. After notice from the City, the selected Respondent will be required to enter into a contract upon receipt of a Notice of Award. If a contract is not executed by the selected

Respondent, then the City reserves the right to retract the Notice of Award and enter into a contract with another Respondent.

H. Response forms must be in typewritten form and submitted electronically. Unsigned or incomplete Responses will not be accepted. Respondents are expected to examine the content of the request and respond accordingly. Failure to do so will be at the

Respondent’s risk.

I. No Response will be accepted from or contract awarded to any person, firm or corporation that is in arrears or is in default to the City upon any contract, or that is a defaulter, as surety or otherwise, upon any obligation to the City or who had failed to faithfully perform any previous contract with the City.

J. Unless otherwise specified, all formal Responses submitted shall be binding for ninety

(90) calendar days following the bid opening date and may be extended at the agreement of both parties.

K. AUTHORITY

o The Department of Business Administration has the sole responsibility to respond to inquiries regarding the RFQ.

L. COMPLIANCE WITH LAWS

o The individual or firm selected shall at all times observe and comply with all laws, ordinances, regulations and codes of the federal, state, City and other local government agencies, which may in any manner affect the performance of the contract.

M. CONTRACTOR COMPLIANCE

o If applicable, each Respondent is required to be in compliance with the City of

Scranton local tax requirements. Failure to be in compliance with City of Scranton local tax requirements may result in bid disqualification and/or voiding of any contract that may result therefrom.

N. CONTRACT TERMINATION

o A contract may be canceled by the City by giving the Respondent written notice of intent to cancel.

O. CONTROLLING LAW

o This RFQ is governed by, and will be construed and enforced in accordance with the laws of the Commonwealth of Pennsylvania without regard to any conflict of law provisions.

P. INSURANCE REQUIREMENTS

1. The Successful Respondent, at the time of execution of the contract, shall also furnish the City with insurance certificates of adequate limits, as later indicated, to protect the

City of Scranton, its agents, and employees from any litigation involving Worker’s

Compensation, Public Liability and Property Damage, involved in the work. All subcontractors must also furnish copies of their liability insurance and Worker’s

Compensation Insurance certificates to the City. No subcontractor will be allowed to perform any work under this contract by the City unless such certificates are submitted to and approved by the City beforehand.\

2. The status of the Respondent in the work to be performed is that of any independent

Respondent and as such, he shall properly safeguard against any and all injury or damage to the public, to public and private property, materials and things, and as such he alone shall be responsible for any and all damage, loss or injury to persons or property that may arise, or be incurred, in or during the conduct or progress of said work without regard to whether or not the Respondent, subcontractors, agents, or employees have been negligent, and the

3. Respondent shall keep the City free and discharged of and from any and all responsibility and liability therefore of any sort or kind. The Respondent shall assume all responsibility for risks or casualties of every description, for any or all damage, loss or injury to persons or property arising out of the nature of the work from the action of the elements, or from any unforeseen or unusual difficulty, including all legal defense costs incurred by the City. The Respondent shall assume and be liable for all blame and loss of whatsoever nature by reason of neglect or violation of any

Federal, State, County or Local laws, regulations, or ordinances; the Respondent shall indemnify and save harmless the City from all suits or actions at law of any kind whatsoever in connection with this work and shall if required by the City, produce evidence of settlement of any such action before final payment shall be made the

City. Respondent’s Liability Insurance Certificate shall include the save harmless clause and shall be filed with the City.

4. The Respondent shall maintain such insurance as will protect the Respondent from claims under worker’s compensation acts and from claims for damages because of bodily injury, including death, and property damage, which may arise from and during operations under this Contract, whether such operations be by himself, by any subcontractor or anyone directly, or indirectly employed by either of them.

Respondent’s liability insurance shall be in the names of the Respondent and the City as their respective interests may appear. Each policy and Certificate of Insurance shall contain an endorsement naming the City of Scranton as additionally insured.

Certificates of such insurance shall be filed with the City.

5. The minimum amount of liability insurance to be maintained by the Respondent during the life of the contract shall be as follows:

6. Professional Liability – in minimum amounts of $1,000,000 per occurrence and

$2,000,000 aggregate.

7. Prior to commencement of performance of this Agreement, Respondent shall furnish to the City a certificate of insurance evidencing all required coverage in at least the limits required herein, naming the City of Scranton, its elected officials, agents, and employees as additional insureds under the Comprehensive General Liability coverage, and providing that no policies may be modified or cancelled without thirty

(30) days advance written notice to the City. Such certificate shall be issued to City of

Scranton, Law Department, 340 North Washington Avenue, Scranton, PA 18503. All policies shall be in effect with companies holding an A.M. Best rating of “A-” or better and shall be licensed to do business in the Commonwealth of Pennsylvania.

Such companies shall also be acceptable to the City.

8. Please forward a certificate of insurance verifying these insurance requirements.

9. All subcontractors performing work under this contract must furnish to the City a copy of their Certificate of Insurance for Worker’s Compensation and liability for bodily injury and property damage.

Q. RESPONDENT’S ETHICS AND COLLUSION

1. Collusive Bidding: Any firm that submits more than one Response in such a manner as to make it appear that one of the Responses submitted is competitive with that of a different Respondent, or any two or more firms that agree to fix their respective

Responses in such a manner as to be awarded the contract shall be disqualified from further consideration of award of this contract and shall be subject to any applicable penalties under the law.

2. Bribery: Any firm that attempts to influence a City official to award this contract to such Respondent’s firm by promising to provide or by providing to such City official any gratuity, entertainment, commission or any other gift, in exchange for a promise to award the contract to such firm shall be disqualified from further consideration of award of this contract and shall be subject to any applicable penalties under the law.

3. Conflict of Interest: Any firm that knows of any City official having a material direct or indirect financial interest in such Respondent’s firm shall be required to submit a written statement, along with the Form of Proposal, detailing such interest.

Failure to disclose a known such financial interest shall result in the firm’s disqualification from further consideration of award of this contract.

R. INDEMNIFICATION

o This agreement shall be binding on the parties hereto, their heirs, successors and assigns.

S. OPEN RECORDS LAW/PUBLIC INFORMATION

1. Under the Pennsylvania Right-to-Know Law (the “Law”), 65 P. S. Section 67.101 et.

seq., a record in the possession of the City is presumed to be a public record subject to disclosure to any legal resident of the United States, upon request, unless protected by a statutory exception.

2. Any contract dealing with the receipt or disbursement of funds by the City or the

City’s acquisition, use or disposal of services, supplies, materials, equipment or property is subject to disclosure under the Law. The following are not subject to disclosure under an exception in the Law:

a. A Response pertaining to the City’s procurement or disposal of supplies, services or construction prior to the award of a contract or prior to the opening and rejection of all Responses; and

b. Financial information of a Respondent requested in an invitation to bid or RFQ to demonstrate the Respondent’s economic capability.

T. TRANSFERS AND ASSIGNMENTS

1. Respondent shall not, without written consent of the City, assign, hypothecate or mortgage this agreement. Any attempted assignment, hypothecation or mortgage without the consent of the City shall render this agreement null and void.

2. Neither this agreement nor any interest therein shall be transferable in proceedings in attachment or execution against Respondent or in voluntary or involuntary proceedings in bankruptcy or insolvency or receivership taken by or against the respondent, or by any process of law including proceedings under Chapter X and XI of the Bankruptcy Act.

4. PROBLEM STATEMENT

The RFQ format for professional services enables the City to thoroughly evaluate the conditions for selection such as prior class action legal experience with sufficient flexibility in awarding the contract.

A. REJECTION OF RESPONSES

o The City of Scranton reserves the right to reject any and all Responses received resulting from this request and to negotiate with those Respondents deemed finalists.

B. INCURRING COSTS

o The City of Scranton will not be liable for costs incurred by the selected Respondent prior to the issuance of a contract.

C. PRE-RFQ CONFERENCE

o A pre-proposal conference will not be held.

D. REFERENCES

o As a requirement for consideration, Responses must include at least two (2) references, including contact information, who can attest to the attributes of the

Respondent.

5. CRITERIA FOR SELECTION

A. EVALUATION PROTOCOL

1. All Responses received by the City of Scranton will be reviewed by the Department of Business Administration. A City selection review group will review the merits of content and select the Response which most closely meets the requirements of the

RFQ. The final selection may not be the lowest cost Response but that which most closely meets the requirements of the City.

2. Upon receipt by the due date of responses to this RFQ by qualified Respondents, the

City will evaluate the Responses for completeness and adherence to the provisions of the RFQ. A City selection review group will evaluate all Responses submitted based on the following areas and weighting, and the City shall give consideration to the review group’s evaluation in selecting a Respondent. The City reserves the right to request additional information or clarifications.

3. The City will then schedule interviews with the selected firms if necessary. The selected firms will be given the opportunity to discuss in more detail their qualifications, past experience, proposed work plan and fee Response.

4. The City reserves the right to waive the interview process and evaluate the offerors based on their Responses and fee schedules alone and open fee schedules before or prior to interviews.

5. The City will determine whether the final scope of the project to be negotiated will be entirely as described in this RFQ, a portion of the scope, or a revised scope.

B. SELECTION BASED ON QUALIFICATIONS

1. The Response selected by the City Department of Business Administration will be deemed to respond most favorably to the requirements of the Request.

No. Evaluation Criteria Scoring Method Weight (Points)

1. Completeness and quality of the Response 0-5 Points 10 (10% of Total)

2. Responsiveness to the requirements set forth in the solicitation 0-5 Points 25

(25% of Total)

3. Professional qualifications and experience 0-5 Points 25 (25% of Total)

4. Proposed work plan 0-5 Points 25 (25% of Total)

5. Project fee and per hour rate for staff 0-5 Points 15 (15% of Total)

6. RESPONSE REQUIREMENTS

Responses must meet the identified criteria and format. Consideration will be based on compliance with those requirements. All other information considered relevant by the

Respondent will be included as addenda information (attached separately) to the Response.

6.1. RFQ CONTENT*

A. STATEMENT OF SERVICES RENDERED

o The Respondent will identify the scope of services provided to the City of Scranton for its Project.

o The Respondent will identify how they will be responsive to each of the requirements outlined above.

o Include information which will assist the City to determine the Respondent’s capability of performing the work.

B. MANAGEMENT SUMMARY

o Provide a narrative description of the proposed effort, a list of services delivered by the Respondent and a brief history of your company.

C. EXPERIENCE

o Include examples of experience. The documentation of experience should include primary and secondary services, if applicable, and any pertinent experience of the support staff.

o References related to prior activities should be listed as addenda information, including contact information. These should be clients of similar size, claim frequency and exposures as the City of Scranton.

o The City requests each claim adjuster have a minimum of three (3) to five (5) years of experience in the field Worker’s Compensation and Heart and Lung investigations.

Please attach resumes for all claim adjusters that would be assigned to the City of

Scranton.

o Provide in detail, your experience dealing with governmental entities and Self-

Insurance programs.

o Provide in detail, your experience handling claims by injured employees covered under the Heart and Lung Act.

o Please describe your Firm’s:

▪ Process for assigning claims to adjusters and supervisors;

▪ Claimant notification and contract standards;

▪ Reserving practices and philosophy;

▪ Efforts to enforce the Ninety (90) Day Panel Requirement;

▪ Medical Bill Review Procedures;

▪ Preferred Provider Networks (please include Lackawanna Specific Medical

Providers in your network);

▪ Case management philosophy;

▪ Assignment of nurse case managers;

▪ Procedures to conduct independent medical exams;

▪ Procedures regarding modified or light duty/return to work programs.

o Disclose the maximum pending caseload for each adjuster proposed to work on this account, including information on what will occur if the maximum caseload per adjuster is reached or exceeded.

o Provide a detailed implementation plan that outlines how you will phase in the delivery of services:

▪ Timeline of how your firm will take over all existing claim files

▪ Training of City of Scranton Staff on reporting claims

▪ Meeting with personnel directly responsible for City of Scranton program o Selected vendor will agree to allow the City input on the selection of Third-Party

Vendors.

o Provide a detailed description of your claim management system.

o Confirm the ability and willingness to act as the City’s agent in ensuring compliance with Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007

(MMSEA) including the completion of and reporting of all necessary claims, files and reports.

o Demonstrate Statement on Auditing Standards (SAS) 70.

o Ability to provide customizable claims data and statistics on a departmental and injury-specific basis sufficient to effectively guide safety training, equipment, and personnel decisions.

D. PERSONNEL

o Include the names of executive and professional personnel who will be assigned including support staff. Resumes for those assigned directly to the activities of this project may be uploaded as addenda information. Do not list firm personnel who will not be assigned to represent the City.

E. REGISTRATION

o Respondents must be duly registered with the applicable federal, state, or local oversight body(s) required to fulfill the scope of services outlined herein. That registration must remain valid and current throughout any period of representation of the City. Copies demonstrating proof of all required registrations, certifications, and/or licenses from applicable federal, state, or local oversight body(s) may be uploaded in this section.

*Response required

6.2. COST AND PRICE*

The City of Scranton is requesting a three (3) year arrangement with one flat annual fee to handle all Workers’ Compensation and Heart and Lung Claims. This includes record only, medical and indemnity claims. Please include all charges to the City of Scranton including:

• Flat Annual Fee

• Cost Containment Fee

• Section 111 Reporting Fee

• Medical Bill Re-Pricing

• System Usage and Access

• Any other Fees

Pricing should outline costs in detail for each contract year 2022, 2023 and 2024. Respondents shall submit a document that includes all associated costs and hourly rates applicable to fulfill the scope of services outlined herein. The selected Respondent(s) shall submit monthly invoices to the City for fees in performing the contracted services during each such period. The City anticipates an annual fee divided into 12 equal monthly installments.

*Response required

6.3. RELATIONSHIPS*

The Response must identify any relationships of the firms and its principals and assigned employees with any official of the City of Scranton. Respondents shall identify any relationships here, or type "N/A" if respondent has no such relationships meeting this criteria.

*Response required

6.4. AFFIDAVITS

The following affidavits are required by the City of Scranton:

• Affirmative Action Certificate

• Certificate of Non-Segregated Facilities

• Non-Collusion Affidavit

• Disclosures by Current Contractor

6.4.1. Affirmative Action Certification*

During the term of this contract, Respondent agrees as follows:

(1) Respondent shall not discriminate against any employee, applicant for employment, independent contractor or any other person because of race, color, religious creed, ancestry, national origin, age, sex or handicap. Respondent shall take affirmative action to insure that applicants are employed, and that employees or agents are treated during employment, without regard to their race, color, religious creed, ancestry, national origin, age, sex or handicap. Such affirmative action shall include, but is not limited to the following: employment, upgrading, demotion or transfer; recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training. Respondent shall post in conspicuous places, available to employees, agents, applicants for employment, and other persons, a notice to be provided by the contracting agency setting forth the provision of this affirmative action certification.

(2) Respondent shall, in advertisements or requests for employment placed by it or on its behalf, state all qualified applicants will received consideration for employment without regard to race, color, religious creed, ancestry, national origin, age, sex or handicap.

(3) Respondent shall send each labor union or workers’ representative with which it has a collective bargaining agreement to other contract or understanding, a notice advising said labor union or worker’s representative of its commitment to this affirmative action certification.

Similar notice shall be sent to every other source of recruitment regularly utilized by

Respondent.

(4) It shall be no defense to a finding of noncompliance with this affirmative action certification that Respondent has delegated some of its employment practices to any union, training program, or other source of recruitment which prevents it from meeting its obligations. However, if the evidence indicates that the Respondent was not on notice of the third-party discrimination or made a good faith effort to correct it, such a factor shall be considered in mitigation in determining appropriate sanctions.

(5) Where the practices of a union or of any training program or other source of recruitment will result in the exclusion of minority group persons, so Respondent will be unable to meet its obligations under this affirmative action certification, Respondent shall then employ and fill vacancies through other affirmative action employment procedures.

(6) Respondent shall comply with all state and federal laws prohibiting discrimination in hiring or employment opportunities. In the event of Respondent’s noncompliance with affirmative action certification of this contract or with any such laws, this contract may be terminated or suspended, in whole or in part, and Respondent may be declared temporarily ineligible for further City of Scranton contracts, and other sanctions may be imposed and remedies invoked.

(7) Respondent shall furnish all necessary employment documents and records to, and permit access to its books, records, and accounts by, the City of Scranton Department of Business

Administration, for purposes of investigation to ascertain Compliance with the provision of this certification. If Respondent does not possess documents or records reflecting the necessary information requested, it shall furnish such information on reporting forms supplied by the City of Scranton Department of Business Administration.

(8) Respondent shall actively recruit minority subcontractors or subcontractors with substantial minority representation among their employees.

(9) Respondent shall include the provisions of this affirmative action certification in every subcontract, so that such provisions will be binding upon each subcontractor.

(10) Respondent’s obligations under this clause are limited to the Respondent’s facilities within

Pennsylvania, or where the contract id for purchase of goods manufactured outside of

Pennsylvania, the facilities at which such goods are actually produces.

☐ Please confirm

*Response required

6.4.2. Certificate of Non-Segregated Facilities*

The Respondent certifies that he does not maintain or provide for his employees and segregated facilities at any of his establishments, and that he does not permit his employees to perform their services at any location under his control where segregated facilities are maintained. The

Respondent certifies further that he will not maintain or provide for his employees any segregated facilities at any of his establishments, and that he does not permit his employees to perform their services at any location under his control where segregated facilities are maintained. The Respondent agrees that a breach of this certification will be a violation of the

Equal opportunity clause in any contract resulting from acceptance of his bid. As used in this certification, the term “segregated Facilities,” means any waiting rooms, work areas, restrooms and washrooms, restaurants and other eating areas, time clocks, locker rooms and other storage or dressing areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, and housing directive or are in fact segregated on the basis of race, color, religion, or national origin, because of habit, local custom, or otherwise. The Respondent agrees that

(except where he has obtained identical certifications from subcontractors for specific time periods) he will obtain identical certifications from proposed subcontractors prior to the award of sub-contracts exceeding $10,000 which are not exempt from the provisions of the Equal

Opportunity clause, and that he will retain such certification in his files.

NOTE: The penalty for making false statements in offers is prescribed in 18 U.S.C. §1001.

☐ Please confirm

*Response required

6.4.3. Non-Collusion Affidavit*

Please download, complete, and upload the below document.

• Non-Collusion_Affidavit.pdf

*Response required

6.4.4. Disclosures by Respondent*

Please download, complete, and upload the below document.

• Disclosures_by_Respondent.pdf

*Response required

6.5. INSURANCE COVERAGE

All Responses submitted to the City of Scranton shall include the following:

6.5.1. A statement of the prospective Respondent’s insurance coverage.*

The City requires the successful Respondent to carry the types and amounts of insurance listed hereinabove. All insurance coverages should name the City of Scranton as an additional insured.

All insurance coverages must be kept effective during the contract period. The loss of insurance coverages could result in contract termination.

*Response required

6.5.2. A statement of assurance attesting that the prospective Respondent is not currently in violation of any regulatory rules and regulations that may impact its operations.*

*Response required

6.5.3. A statement that the prospective Respondent is not involved in any current litigation against the City of Scranton.*

*Response required https://government-project.s3.us-west-2.amazonaws.com/19696/47e77c65-7fcc-42a6-8237-e81cedad4ad0_Non-Collusion_Affidavit.pdf?AWSAccessKeyId=AKIAJX4CP36AEOP5JL2A&Expires=1656522429&Signature=oeQlrLi3y2eNV9XVe%2B52sGe7yYo%3D&response-content-disposition=attachment%3B%20filename%3D%22Non-Collusion_Affidavit.pdf%22 https://government-project.s3.us-west-2.amazonaws.com/19696/402ae5bc-c68a-4f9d-a9ef-c76a1ae42e5e_Disclosures_by_Respondent.pdf?AWSAccessKeyId=AKIAJX4CP36AEOP5JL2A&Expires=1656522429&Signature=WGg4jKqM4zZe9Qgtgg3mRHbKrBs%3D&response-content-disposition=attachment%3B%20filename%3D%22Disclosures_by_Respondent.pdf%22

7. SCOPE OF WORK

7.1. Third-Party Administrator of Self-insured Workers' Compensation and Heart and Lung

Claims

Scope of Services

A. The following is a general scope of what is required to manage a cost effective Workers’

Compensation Program. There may be services your vendor may provide not listed, please outline those in detail as well.

1. Act as administrator of the City of Scranton’s Workers’ Compensation Program, pay claims and expenses on the City of Scranton’s behalf and provide monthly financial reports.

2. Establish records of all claims, including those resulting in no payment (“Record

Only”), medical only and compensable, including allocated loss adjustment expenses

(ALAE).

3. Complete any regulatory reporting forms, or other documents required by governing authorities.

4. Establish claimant contact in a timely fashion, and make necessary medical and loss time payments to claimants and medical providers.

5. Employ third party vendors and special investigators when necessary. The City of

Scranton reserves the right to select those vendors.

6. Attempt to achieve the return to work of injured employees, and render advice to the

City regarding the return to work and light duty options that could be utilized.

7. Establish appropriate reserves and maintain records of all payments for medical indemnity, and expenses for each Worker’s Compensation claims.

8. Meet with City of Scranton personnel at least once per quarter to review the status of the claims administration process and other matters pertinent to the services being performed.

9. Conduct an annual stewardship meeting reviewing the services performed the previous year, the status of open claims, loss payment history and trends, and incurred loss experience and trends, with recommendations for the upcoming year.

10. Report claims to the excess insurer in accordance with the requirements of the policy.

11. Provide claim status reports as requested by the City.

12. Attached as Exhibit “A” please find a copy of the evaluation performed by Gary R.

Abramson, ACAS, MAAA, which provides a reserve analysis and loss forecast of the

City’s Self Insured program, along with claims data.