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Home My WebLink About5.423 Original Contract 5. <t:e Frank Gates The Frank Gates Service Company Off Ice Northgate Executive Center II 9725 Third A venue N E, Suite 207 Seattle, W A 98115 800-933-7058 206-517 -4800 Fax 206-517 -4888 c WORKERS' COMPENSATION SELF-INSURANCE SERVICE AGREEMENT This SELF-INSURANCE SERVICE AGREEMENT (the "Agreement") is entered into this ;.'{d- day of \.r~7. , 1999 by and between THE FRANK GATES SERVICE COMPANY, an Ohio corporation, with its principal place fbusiness located at 5000 Bradenton Avenue, Dublin, Ohio 43017 ("Frank Gates"), and CITY OF PORT ANGELES, its principal place of business located at POBox 1150, Port Angeles, W A 98362 ("Employer"). RECITALS WHEREAS, Employer maintains a self-insurance program, including workers' compensation and other benefits, for the benefit of its employees in the State of Washington, and WHEREAS, Frank Gates provides consultation and administration services with respect to workers' compensation self-insurance matters; and WHEREAS, Employer is desirous of contracting with Frank Gates for the performance of consultation and administration services with respect to its self-insurance program, and WHEREAS, Frank Gates is desirous of performing such services for Employer PROVISIONS NOW, THEREFORE, in consideration of the foregoing and the mutual promises contained herein, the parties hereby agree as follows' 1 Term of Agreement The term of this Agreement shall be for a one (1) year period beginning January 1, 2000, and ending December 31, 2000, (the "Initial Term") on the terms and conditions set forth in this Agreement Upon expiration of the Initial Term, the Agreement shall automatically renew itself for successive one (1) year periods unless written notice to the contrary is provided by either party at east one hundred and twenty (120) days prior to the expiration of the then current term of this Agreement. 2. Services to be Provided. Frank Gates shall provide the following administrative services to Employer (the "Services"); (a) Frank Gates shall recommend to Employer procedures as required for prompt reporting and recording of all occupational injuries and diseases. It shall provide claim forms for the reporting of such injuries or diseases to the proper state claIm administrative agency. (b) Frank Gates shall evaluate any open claims and make recommendations to Employer as to their proper disposition. (c) Frank Gates, if applicable, shall review all claims for determination of possible relief from charges under the provisions pertaining to second injury funds, etc. (d) Frank Gates shall maintain complete records (hard copy ancl!or computerized) on all reported claims on behalf of and as custodian for Employer. At Employer's request and for an implementation fee to be determined, Frank Gates will examine all claims relating to injuries or occupational diseases arising prior to the effective date of this contract, enter such claims into Employer's claim data and assist in the management and control of said claims. (e) Frank Gates shall submit a monthly report to Employer of workers' compensation expenditures. Such reports shall contain and summarize all expenditures made and estimates of all known future liabilities based upon facts available. (f) Frank Gates shall prepare and deliver all appropriate benefit payments (indemnity and medical) utilizing a payment method (check or voucher) agreed upon. Employer will be responsible for all expenses relating to checking account maintenance including check or voucher stock. (g) Frank Gates shall recommend a panel of qualified physicians, surgeons and other specialists in the states which require or permit such panels, for the treatment of employees sustaining an occupational injury or disease. It shall review physicians findings, consult with doctors to resolve medical questions and, if requested by Employer, arrange for and monitor rehabilitation services. It shall review, or cause to be reviewed by a sub contractor as an allocated expense, medical bills for compliance with fee schedules where appropriate ancl!or are reasonable, customary and payable under the state workers' compensation act. , ' (h) Upon request by Employer, Frank Gates will recommend attorneys to assist Employer in any case where representation is desired and will consult with and furnish available claim information to any attorney chosen to represent Employer. (i) Frank Gates shall furnish Employer, upon request, all information available to it for assistance in making third party claims, and reporting appropriate losses and details therein to Employer's excess insurance carner. (j) Frank Gates shall meet periodically with Employer at mutually agreeable times to review all open indemnity claims to discuss estimated liabilities and claim management strategies. (k) Frank Gates shall consult with Employer on matters pertaining to self- insurance at times deemed necessary by Employer or consultants. (1) Frank Gates will assist Employer in the preparation and submission of all state required forms related to Employer's workers' compensation claims. (m) Frank Gates shall assist in the preparation and filing of such annual reports for self-insured risks as required by the appropriate State Agency of Washington. In the event this Agreement is terminated, Frank Gates will continue to administer any qualified claims or losses remaining open, where appropriate provided that Employer shall continue to make adequate funds available for the payment of such qualified claims or losses and any allocated loss expenses. The additional fee for this service shall be negotiated and agreed upon prior to the effective date of termination. In addition to the Services and post-termination Services as outlined above, Frank Gates will provide additional ministerial services to Employer, upon request and for an additional fee as may be mutually agreed upon by the parties, to further assist Employer in admmistering Employer's self-insurance program. The additional ministerial functions may include claims services provided for claims incurred by the employer prior to the inception date of this Contract. 3. Fees. In consideration of the Services, Employer shall pay Frank Gates a fee for said Services payable in accordance with the schedule attached hereto as Exhibit A ("Service Fees"). The Service Fees shall be paid in advance by Employer on a quarterly basis and are payable within thirty (30) days of receiving billing therefor. Late payments are subject to a service charge of 1 1/2% per month (18% ANNUAL RATE). 4. Amended Fees. In the event that the business operations of Employer expand or contract to such an extent that the need for the services are significantly affected, the Service Fee may be renegotiated at any time during the term of this Agreement based upon good faith shown by either party that the Service Fee is inequitable. In addition, Frank Gates may increase the Service Fee applicable to any term of this Agreement (other than the Initial Term) by providing written notice to Employer of such increase at least ninety (90) days prior to expiration of the then current term of this Agreement. 5. Mutual Indemnification. Employer agrees to indemnifY and hold harmless Frank Gates and its directors, officers and employees against any and all loss, liability, claim, damage and expense, including, but not necessarily limited to, court costs and attorneys' fees, resulting from or arising out of, directly or indirectly, claims, demands, or lawsuits brought by employees of Employer, or by one acting on their behalf, against Frank Gates relating in any manner to workers' compensation or claiming that the Employer has not acted in conformity with its legal obligations as a self-insured employer under the laws of the State of Washington. Frank Gates agrees to indemnifY and hold harmless Employer and its directors, officers and employees against any and all loss, liability, claims, damage and expense, including, but not necessarily limited to, court costs and attorneys' fees, resulting from or arising out of, directly or indirectly, claims, demands, or lawsuits brought by employees of Frank Gates or by one acting on their behalf, against Employer relating in any manner to workers' compensation or claiming that Frank Gates has not acted in conformity with its legal obligations as an employer under the laws of the State of Washington. 6. Return ofInformation upon Termination. Upon the termination of this Agreement, Employer shall be entitled to the return of all hard copy claim files and any computerized claim identification and payment data, but not including any computer hardware, software, firmware or other proprietary information of Frank Gates. Frank Gates, its employees, agents or attorneys shall be entitled to inspect such files prior to their return to Employer and make copies or extract information therefrom. If Employer does not request such files within sixty (60) days after termination of this Agreement, they may be destroyed at Frank Gates' option, subject to the approval of the appropriate state agency, and Employer shall have no recourse against Frank Gates. 7. Compliance with Laws. The Services provided pursuant to this Agreement shall be in compliance with the rules and regulations of the State of Washington and shall specifically exclude any services which now or in the future may be deemed to be the practice oflaw. . . ~ 8. Miscellaneous. (a) This Agreement supersedes all previous contracts between Prank Gates and Employer, written or oral, and constitutes the entire understanding and agreement of the parties hereto and shall not be modified, amended or revoked except by the express written consent of the parties hereto. (b) This Agreement shall be governed and construed in accordance with the laws of the State of Washington. (c) This Agreement shall be binding upon and shall inure to the benefit of the parties hereto and their respective successors and assigns. (d) Prank Gates may seek the services of third party experts in performing its duties and obligations under this Agreement. Prank Gates will provide diagnostic and medical authorization services on an on going and per claim basis. Por all other third party services, Prank Gates shall consult with Employer, its legal counsel, and/or legal counsel designated by Prank Gates prior to engagement. (e) Any notice to Prank Gates under this Agreement shall be sufficient if sent via Certified mail and addressed to: The Prank Gates Service Company 9725 Third Ave., NE, Suite 207 Seatcle, WA 98115 Any notice to Employer under this Agreement shall be sufficient if sent via Certified mail and addressed to: City of Port Angeles PO Box 1150 Port Angeles, W A 98362 Notice shall be validly given by either party to the other if directed to any other person or address either party may from time to time specify. (f) The offer represented by this Agreement shall automatically expire if said offer is not accepted by Employer, by execution of this Agreement, within sixty (60) days after receipt hereof. (g) This Agreement may be executed in counterparts, each of which shall be deemed an original, but all of which shall constitute one and the same instrument. . . · r .. IN WITNESS WHEREOF, the parties hereto have executed this Agreement on the day and year first above written. THE FRANK GATES SERVICE CO. By: ~l~~ J1--~ ~~.~ ~ ~s -C;9 ~ Title: Date: CITY OF PORT ANGELES By: Title: Date: ~fl.: ......~ .. CtJ ~,,~ ~y~r EXHIBIT A SERVICE FEES Company Name City of Port Angeles (Employer) State. Washington Initial Term of Service Agreement: January 1, 2000 through December 31, and 2000. Service Fee' Employer agrees to pay Frank Gates for services rendered at a per claim rate according to the following schedule. All billings shall be payable within thirty (30) days of date of invoice SCHEDULE Flat $105.00 for each new medical only claim Flat $500 00 for each new indemnity or litigated claim Flat 10% Administration Fee (adjusted at year-end to 10% of total actual claim cost) Includes, but not limited to: Local Account coordination Account Executive Bank Account Management Standard Reports including monthly check registers Assistance in data collection for jurisdictional renewals/reporting Quarterly claims meetings Allocated expenses shall be billed on a cost only basis and include, but are not limited to the following' > Medical Management > Loss Control > Vocational Rehabilitation > Attorneys > Investigations > Fee Bill Review (outside) All outside vendors will be approved by Employer FrankGates 5, </d.5 Telephone 206-682-4808 Telefax 206-682-9539 The Frank Gates ServIce Company Benefit and RIsk Management Services Monday,December23,1996 Robert Coons Human Resources Mgr. City of Port Angeles 321 Fifth PO Box 1150 Port Angeles, WA 98362 Dear Bob: Regional OffIce One Umon Square 600 Um verslty, SUIte 315 Seattle, WA 98101 r.. ,/ r,) f;:1 rn 'I' l). - If I'C! It.! r; " .1) -. /1:' II flf II IF, - , , ! ~'u, DEe 2 ,_, L_ 4/996 "'" ... ~ '\...! ! I... '! r r, r-"'f"'- l . \ "l.:~ ni', -, ,~ -- - .... -"',-' ('~~""J ' -. ,--' t:J . Enclosed you will find two original revised copies of our Self Insurance Administration Agreement for your signature. Please keep one copy and return the other to me in the enclosed envelope. If you should have any questions, please give me a call. I hope you have a very Happy Christmas, and we look forward to working with you come Jan. 1, 1997. HAPPY HOLIDAYS I!!!!!!!!!!!!!!! Very truly yours, The Frank Gates Service Company tk t{~ Victor A. Merolla Regional Sales Manager . y CjW /:J\. / ~ \~ 5.-<I~3 ... FrankGates The Frank Gates Servtce Company Benefit and Risk Management ServICes RegiOnal Office One Union Square 600 University, SUite 315 Seattle, WA 98101 Telephone 206-682-4808 Telefax 206-682-9539 WORKERS. COMPENSATION SELF-INSURANCE SERVICE AGREEMENT This SELF-INSURANCE SERVICE AGREEMENT (the "Agreement") is entered into this ~ I day of ~ e c.e"",61'/L , 1996 by and between THE FRANK GATES SERVICE COMPANY, an Ohio corporation, with its principal place of business located at 5000 Bradenton Avenue, Dublin, Ohio 43017 ("Frank Gates"), and CTIY OF PORT ANGELES, with its principal place of business located at 321 East Fifth, PO Box 1150, Port Angeles, WA 98362 ("Employer"). RECITALS WHEREAS, Employer maintains a self-insurance program, including workers' compensation and other benefits, for the benefit of its employees in the State of Washington; and WHEREAS, Frank Gates provides consultation and administration services with respect to workers' compensation self-insurance matters; and WHEREAS, Employer is desirous of contracting with Frank Gates for the performance of consultation and administration services with respect to its self-insurance program; and WHEREAS, Frank Gates is desirous of performing such services for Employer. PROVISIONS NOW, THEREFORE, in consideration of the foregoing and the mutual promIses contained herein, the parties hereby agree as follows: 1. Term of Agreement. The term of this Agreement shall be for a one (1) year period beginning January 1, 1997, and ending December 31,1997, (the "Initial Term") on the terms and conditions set forth in this Agreement. Upon expiration of the Initial Term, this Agreement shall automatically renew itself for successive one (1) year periods unless written notice to the contrary is provided by either party at least one hundred and twenty (120) days prior to the expiration of the then current term of this Agreement. , 2. Services to be Provided. Frank Gates shall provide the followmg administrative services to Employer (the "ServlCes"); (a) Frank Gates shall recommend to Employer procedures as required for prompt reporting and recording of all occupational injuries and diseases. It shall provide claim forms for the reporting of such injuries or diseases to the proper state claim admmistrative agency. (b) Frank Gates shall evaluate any open claims and make recommendations to Employer as to their proper disposItion. (c) Frank Gates, if appltcable, shall review all claIms for determination of possible relief from charges under the provisions pertaining to second injury funds, ete. (d) Frank Gates shall mamtam complete records (hard copy and/or computerized) on all reported claims on behalf of and as custodian for Employer. At Employer's request and for an implementatIon fee to be determined, Frank Gates will examine all claims relating to mjuries or occupational diseases ansmg prior to the effective date of thIs contract, enter such claims into Employer's claim data and assist in the management and control of said claims. (e) Frank Gates shall submit a monthly report to Employer of workers' compensation expenditures. Such reports shall contain and summarize all expenditures made and estImates of all known future liabilities based upon facts available. (f) Frank Gates shall prepare and deliver all appropriate benefit payments (mdemnity and medical) utilizing a payment method (check or voucher) agreed upon. Employer will be responsible for all expenses relating to checkmg account maintenance includmg check or voucher stock. (g) Frank Gates shall recommend a panel of qualified physIcians, surgeons and other specialtsts in the states which require or permit such panels, for the treatment of employees sustaimng an occupational injury or disease. It shall review physicians findings, consult with doctors to resolve medical questions and, If requested by Employer, arrange for and monitor rehabilitation services. It shall review, or cause to be reviewed by a sub contractor as an allocated expense, medical bills for compliance with fee schedules where appropriate and/or are reasonable, customary and payable under the state workers' compensation act. , (h) Upon request by Employer, Frank Gates will recommend attorneys to assist Employer in any case where representation is desired and will consult with and furnish available claim information to any attorney chosen to represent Employer. (i) Frank Gates shall furnish Employer, upon request, all information available to it for assistance in making third party claims, and reporting appropriate losses and details therem to Employer's excess insurance carrier. (j) Frank Gates shall meet periodiCally with Employer at mutually agreeable times to review all open indemnity claims to discuss estimated liabilities and claim management strategies. (k) Frank Gates shall consult with Employer on matters pertammg to self.. insurance at times deemed necessary by Employer or consultants. (1) Frank Gates will assist Employer in the preparation and submission of all state required forms related to Employer's workers' compensation claims. (m) Frank Gates shall assist in the preparation and filing of such annual reports for self-insured risks as required by the appropriate State Agency of Washmgton. In the event this Agreement is terminated, Frank Gates will continue to administer any qualified claims or losses remaining open, where appropriate provided that Employer shall continue to make adequate funds available for the payment of such qualified claims or losses and any allocated loss expenses. The additional fee for this service shall be negotiated and agreed upon prior to the effective date of termination. In addition to the Services and post-terminatlOn Services as outlined above, Frank Gates will provide additional ministerial services to Employer, upon request and for an additional fee as may be mutually agreed upon by the parties, to further assist Employer in administering Employer's self-insurance program. The additional ministerial functions may include claims services provided for claims mcurred by the Employer prior to the inception date of this Contract. 3. Fees. In consideration of the Services, Employer shall pay Frank Gates a fee for said ServiCes payable m accordance with the schedule included herein as SectlOn 9 ("Service Fees"). The Service Fees shall be paid in advance by Employer on a quarterly basis and are payable within thirty (30) days of receivmg billing therefor. Late payments are subject to a service charge ofll/2% per month (18% ANNUAL RATE). . , 4. Amended Fees. In the event that the business operations of Employer expand or contract to such an extent that the need for the services are significantly aHected, the ServIce Fee may be renegotiated at any time during the term of this Agreement based upon good faIth shown by either party that the Service Fee is inequitable. In addition, Frank Gates may increase the ServIce Fee applicable to any term of this Agreement (other than the Initial Term) by providing written notice to Employer of such increase at least ninety (90) days prior to expiration of the then current term of this Agreement. 5. Mutual Indemnification. Employer agrees to indemnity and hold harmless Frank Gates and its dIrectors, offIcers and employees agamst any and all loss, lIability, claim, damage and expense, including, but not necessarily limited to, court costs and attorneys' fees, resulting from or arising out of, directly or indirectly, claims, demands, or lawsuits brought by employees of Employer, or by one acting on their beha1f~ against Frank Gates relating in any manner to workers' compensation or claiming that the Employer has not acted in conformity with its legal obligations as a self-insured employer under the laws of the State Washington. Frank Gates agrees to indemnity and hold harmless Employer and Its directors, officers and employees against any and all loss, liability, claim, damage and expense, including, but not necessanly limited to, court costs and attorneys' fees, resulting from or arising out of, directly or indirectly, claims, demands, or lawsuits brought by employees of Frank Gates, or by one acting on their beha1f~ against Employer relating in any manner to workers' compensation or claiming that Frank Gates has not acted in conformity with its legal oblIgations as an employer under the laws of the State of Washington. 6. Return oflnformation upon Termination. Upon the termination of this Agreement, Employer shall be entitled to the return of all hard copy claIm files and any computerized claim identificatIOn and payment data, but not including any computer hardware, software, firmware or other proprietary information of Frank Gates. Frank Gates, its employees, agents or attorneys shall be entitled to inspect such files prior to their return to Employer and make copies or extract information therefrom. If Employer does not request such files within sixty (60) days after termination of this Agreement, they may be destroyed at Frank Gates' option, subject to the approval of the appropnate state agency, and Employer shall have no recourse against Frank Gates. 7. Compliance WIth Laws. The Services provided pursuant to this Agreement shall be in compliance with the rules and regulations of the State ofWashmgton and shall specifically exclude any services which now or in the future may be deemed to be the practice oflaw. 8. Miscellaneous. (a) This Agreement supersedes all previous contracts between Frank Gates and Employer, written or oral, and constitutes the entIre understandIng and agreement of the parties hereto and shall not be modified, amended or revoked except by the express written consent of the parties hereto. (b) This Agreement shall be governed and construed in accordance with the laws of the State of Washington. (c) This Agreement shall be binding upon and shall inure to the benefit of the parties hereto and their respectIve successors and assIgns. (d) Frank Gates may seek the servIces of third party experts In performing its duties and obligations under this Agreement. Frank Gates wIll provide diagnostIc and medical authonzation services on an on going and per claim basis. For all other third party services, Frank Gates shall consult with Employer, its legal counsel, andlor legal counsel designated by Frank Gates prior to engagement. (e) Any notice to Frank Gates under this Agreement shall be sufficient if addressed to: The Frank Gates Service Company One Union Square 600 University Suite 315 Seattle, W A 98101 Any notice to Employer under this Agreement shall be sufficient If addressed to: City of Port Angeles 321 East Fifth PO Box 1150 Port Angeles, W A 98362 Notice shall be validly given by eIther party to the other if directed to any other person or address either party may from time to time specifY. (f) The offer represented by this Agreement shall automatically expire if said ofter is not accepted by Employer, by executIOn of this Agreement, withIn sixty (60) days after receipt hereof (g) This Agreement may be executed in counterparts, each of which shall be deemed an original, but all of whICh shall constitute one and the same instrument. 9. Service Fees. Company Name: City of Port Angeles ("Employer") State: Washington Initial Term of Service Agreement: January 1, 1997, through December 31, 1997. Service Fee: Minimum Annual Fee of $5,000.00, payable at the end of each quarter upon receipt of invoice, at the rate of$I,250.00. Employer agrees to pay Frank Gates a set up fee of $1,500.00 in advance for general admmistration, data processing, record transfer of claims data, modem link up, plus quarterly services fee for processing, ete. Each new medical only claim and mdemnity claim will be processed @ $125.00 per claim. Each indemnity claim that exceeds $1,000.00 in indemnity payment will be processed for an additional $350.00 per claim. These would be tracked on a quarterly basis. Each existing tail claim will be processed @ $200.00 per claim. Allocated expenses shall be billed on a cost only basis and include, but are not limited to the following: 0 Medical Management 0 Loss Control 0 Vocational Rehabilitation 0 Attorneys 0 InveStigatiOns 0 Fee Bill Review (outside) All outside vendors will be approved by Employer. IN WITNESS WHEREOF, the parties hereto have executed this Agreement on the day and year first above wntten. THE Flfl\NK GATES SERVICE CO. By: {)~A.1t.~ Title: f?~.t S~ m'!J1. . Date: /;;. - :2 3 - 9 b CITY OF PORT ANGELES By: ~ U~ . Title: IItI~~,v ,e'f.fe:JVYI-€ ~1tI1j?'ve... Date: II).. -.1.1 - 96