FY1992 11/20/1991
1Dannp 1.. Itolbage
BRANCH OFFICE
3117 OVERSEAS HIGHWAY
MARATl-ION, FLORIDA 33050
TEL. (305) 743.9036
CLERK OF THE CIRCUIT COURT
MONROE COUNTY
500 WHITEHEAD STREET
KEY WEST, FLORIDA 33040
TEL. (305) 294-4641
BRANCH OFFICE
P.O. BOX 379
PLANTATION KEY, FLORIDA 33070
TEL. (305) 852-9253
M E M 0 RAN DUM
To:
Division of Management Services
From:
Rosalie L. Connolly, Deputy Clerk
Date:
November 27, 1991
On November 20, 1991, the Board of County Commissioners
approved and authorized execution of a renewal service
contract with Gallagher Bassett Services, Inc. in the
amount of $34,952.00 to administer the Workers Compensa-
tion Program.
Attached is one duplicate original and one Xerox copy of
the subject contract, now executed and sealed by all
parties. The duplicate original (raised seal) should be
returned to Gallagher Bassett and the Xerox copy kept in
your proper departmental files.
Attachments
cc: County Attorney
County Administrator w/o document
Finance Director
File
GALLAGHER BASSETT SERVICES, INC.
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CONTRACT FOR SERVICES
.91
NO\i 27 /J 0 ::
PARTIES
;.., U N H t
Monroe County Board of County Commissioners (hereinafter "CLIENT") hereby retains Gallagher Bassett
Services, Inc. (hereinafter "GB") to perform the services listed on Schedule V.
TERM
This contract shall be in effect from 10/1/91 through 9/30/92 and shall remain in full force and effect unless
amended or terminated.
ATTACHMENTS
Attached hereto and made a part hereof are the following schedules:
I. OBLIGATIONS OF THE PARTIES
II. BANKING
III.
TERMS AND CONDITIONS
By
~.A ~~' AS TO r, n~tV
D L G S C/:7JCY.
I
.
6" JA~.OffiC9
V)J "it
IV.
DEFINITIONS
V.
SERVICES AND FEES
Dats
MONROE COUNTY BOARD OF
COUNTY COMMISSIONERS
GALLAGHER BASSETT SERVICES, INC.
By: ~~..J '"no:: ~~ ~ By:
Title: ell A lit 1ft A A,)
Date: 11- ~() ... 9/
ADDRESS: 51 00 ~&r College Rd., Room 215
Key West, FL 33040
NNY L. KOLHAGE, CLERK
Date:
Two Pierce Place
Itasca, IL 60143-3141
By
Cont-LE (2/91)
-2-
SCHEDULE I
OBLIGATIONS OF THE PARTIES
A. Obliaations of GB
G8 agrees to perform the following services:
1. With regard to Claims Administration, G8 shall:
a. Review each claim and loss report submitted by the CLIENT during the term of this
contract.
b. Conduct an investigation of each qualified claim or loss to the extent deemed necessary by
GB.
c. Maintain a file for each qualified claim or loss which shall be available for review by the
CLIENT.
d. Adjust, settle or resist all qualified claims or losses:
1) within the stated discretionary settlement authority limit;
2) with specific approval of the CLIENT, if outside the stated authority limit.
e. Perform necessary and customary administrative and clerical work in connection with each
qualified claim or loss, including the preparation of checks or vouchers, releases,
agreements and other documents needed to finalize a claim.
f. Establish and update claim reserves as needed.
g. Assist the CLIENT in establishing a banking arrangement for loss and expense payments as
set forth in Schedule II.
h. Notify CLIENT, CLIENT's agent or carriers, as designated by the CLIENT, of all qualified
claims or losses which may exceed the CLIENT's retention and, if requested, provide
information on the status of those claims or losses.
i. Coordinate investigations on litigated claims with attorneys representing the CLIENT and
with representatives of the excess carrier, as required. It is expressly understood that all
legal costs and loss payments will be charged to the CLIENT.
j. Have G8's internal Product Support staff review large and unusual claims at no additional
cost to the CLIENT.
1) Investigate and pursue subrogation possibilities in behalf of the CLIENT in all states
permitting subrogation. Funds received from all subrogation collections shall be
considered revenue of the CLIENT.
k. Maintain an automated loss and information system, and provide the CLIENT with reports
from RISX-FACS@ as set forth in Schedule V.
I. Provide forms, as determined by GB, needed to administer the CLIENT's program.
Cont-LE (10,90)
-3-
m. Provide additional ad hoc information, analysis, reports and services on a time and expense
basis.
n. Assist the CLIENT in selecting appropriate experts or specialists as the claims may require.
o. Provide personnel needed to perform the services agreed to herein.
2. With respect to Self-Insurance Qualification, GB shall assist the CLIENT in the filing of periodic
reports and renewal applications required by state administrative agencies. All fees and
assessments in connection with such are the obligation of the CLIENT.
3. With regard to Risk Management Consulting and Appraisals, GB shall provide the services set
forth in Schedule V.
4. Provide other services as set forth in Schedule V.
B. Obliaations of CLIENT
1. CLIENT shall pay GB for services the annual sum set forth on Schedule V. At the end of the first
year of this contract, the annual compensation shall be subject to aqjustment.
2. CLIENT shall provide funds for the payment of qualified claims or losses and allocated loss
expenses. GB shall not be required to advance funds to pay losses, allocated loss expenses or
bank charges.
3. Fees are payable upon receipt of invoice. GB reserves the right to charge 1 % per month on
balances unpaid after 30 days.
SCHEDULE II
BANKING - VOUCHER
1. GB agrees to assist the CLIENT in setting up a voucher system for loss and expense payments.
2. CLIENT shall at all times be responsible for the payment of qualified claims or losses and of allocated
loss expenses. For this purpose, allocated loss expenses shall mean all costs, charges or expenses of
third parties incurred by GB, its agents or its employees, which are properly chargeable to a qualified
claim or loss including without limitation court costs, fees and expenses of attorneys, independent
investigators, experts and witnesses, fees for obtaining diagrams, reports, documents, photographs,
surveillance and appraisals.
3. CLIENT will establish procedures to make timely payments of loss and expense vouchers submitted by
GB during the course of its claims management program.
4. It is expressly understood that GB shall not be required to advance its own funds to pay losses, and GB
shall have authority to commit the CLIENT's funds up to the discretionary payment limit set forth in
Schedule III.
Cont-LE (10/90)
-4-
SCHEDULE III
TERMS AND CONDITIONS
A. Settlement Authoritv - The limit on any settlement payment by GB shall be ZERO Dollars ($0). This
amount may be changed by the CLIENT upon written notice to GB. It is agreed that GB shall have full
authority in all matters pertaining to the payment, processing, investigation and administration of qualified
claims or losses within this limit. Failure of GB to settle a qualified claim or loss within such limit shall not
subject GB to liability to any party in the event of an adverse judgment entered by any court or the
settlement of such claim or loss for an amount in excess of such limit.
B. Terms of Cancellation or Nonrenewal - Either party shall have the right to cancel or renegotiate the
contract after the initial one-year period by giving the other party written notice of intent to cancel or
renegotiate at least sixty (60) days in advance. If timely notice of cancellation is given, this contract shall
terminate upon the expiration of the current term.
In the event of cancellation or nonrenewal of this contract, GB will continue to manage all pending
claims, and claims occurring but not reported prior to the date of termination, at a fee to be determined.
A reduced RISX-FACS@ reporting package will be provided as long as GB handles the claims.
If the CLIENT fails to pay GB's service fee, GB shall have the right to terminate the contract by giving
the CLIENT ten (10) days' notice in writing. GB will then return all files to the CLIENT in an orderly
manner. Costs for file transfer shall be the obligation of the CLIENT.
C. Practice of Law - GB will not perform any services which may constitute the unauthorized practice of law.
D. Mutual Indemnification - GB agrees to defend, indemnify, protect, save and keep harmless CLIENT from
any and all loss, cost, damage or exposure arising from the negligent acts or omissions of GB.
CLIENT agrees to defend, indemnify, protect, save and keep harmless GB from any and all loss, cost,
damage or exposure arising from the negligent acts or omissions of CLIENT.
E. Notices - Any notice required to be given under this contract shall be sent by certified mail to the
following in the case of GB:
Jack H. Lazzaro
Vice President Finance
Gallagher Bassett Services, Inc.
The Gallagher Centre
Two Pierce Place
Itasca, IL 60143-3141
and in the case of the CLIENT:
Ms. Stella Otto
Employee Benefits Coordinator
Monroe County Board of County Commissioners
5100 Junior College Rd., Room 215
Key West, FL 33040
Cont-lE (10/90)
-5-
F. Successors - This contract shall be binding upon and shall inure to the benefit of all assigns, transferees
and successors in interest of the parties.
G. Modification - This contract represents the entire agreement between the parties and may be modified
only in writing. GB reserves the right to charge additional fees if service terms are modified.
H. Confidentiality of Data - All data furnished by the CLIENT, or generated as a result of services performed
under this agreement, and other information designated by the CLIENT in writing, shall be treated as
confidential. GB reserves the right to use statistical information or other data, so long as the CLIENT's
name and/or confidential data are adequately protected.
I. Status - It is understood that GB is engaged to perform services under this contract as an independent
contractor and not as an agent of the CLIENT. This contract shall be governed by the laws of the State
of Florida.
J. Cost Containment - If GB provides cost containment services for the CLIENT's program, GB shall
receive a fee for these additional services.
K. Reportina - GB will not assume that other coverage (unknown to GB) exists for a qualified claim or loss.
GB shall not be responsible for reporting to carriers on a type of claim or loss not managed by GB.
L. Property Catastrophe Charaes - Any property loss involving multiple locations as a result of natural
disasters from a covered peril will be billed at time and expense at GB's prevailing hourly rate.
M. Fines and Penalties - GB shall not be responsible for any fines or penalties assessed by any
governmental agency because of the acts or omissions of the CLIENT, or by previous or successor claim
administrators.
SCHEDULE IV
DEFINITIONS
Discretionary Settlement Authority - GB is authorized to make payment, for loss or expense, up to this
amount, as GB deems necessary.
Qualified Loss or Claims - GB will investigate and adjust any loss or claim occurring within the service term,
provided the loss or claim type is identified in Schedule V.
Allocated Expenses - Shall be the responsibility of the CLIENT and shall include, but not be limited to:
.
.
.
.
.
.
.
.
legal fees
professional photographs
medical records
experts' rehabilitation costs
accident reconstruction
architects, contractors
engineers
police, fire, coroner, weather, or other such
reports
property damage appraisals
extraordinary costs for witness statements
official documents and transcripts
.
.
.
Cont-LE (10/90)
.
.
.
.
.
.
.
.
sub rosa investigations
medical examinations
extraordinary travel made at CLIENT's request
court reporters
fees for service of process
pre- and post-judgment interest paid
chemists
any other similar cost, fee or expense reasonably
chargeable to the investigation, negotiation,
settlement or defense of a claim or loss which
must have the explicit prior approval of the
CLIENT
-6-
SCHEDULE V
SERVICES AND FEES
Client:
Monroe County Board of County Commissioners
Service Period: From 10/1/91 through 9/30/92 GB Client #: 010371
SERVICES PROVIDED: Incl. SERVICES PROVIDED: Incl.
A. Claims Administration PS Mail
Auto Liability-Bodily Injury (AB) Other:
Auto Liability-Property Damage (AD) C. Loss Funding
Auto Physical Damage (APD) SIMMS
General Liability-Bodily Injury (GB) Voucher ~
General Liability-Property Damage (GO) D. Supplemental
Products Liability Loss Notice Program
Professional Liability Reporting Level $
Property (PR) Topical Captioned Reports ~
Workers Comp (We) Reporting Level $50,000
WIC Med Only ~ Meetings ~
Indemnity ~ Settlement Authority $0 ~
Other: Index Bureau ~
Run-Off Coordination ~
Assumption Set Up/Program
Other: Incident Processing
B. Information Services Record Only Processing
RISX-FACS@ Update Appraisals
Standard Package ~ Risk Inspections
NonStandard Reports ~ Copying Med. Bills ~
MICRO-FACS@ E. Risk Management Consulting
Terminals & Printers Loss Control - 4 Days x
Data Transfer-Fronter Risx-Control Consulting
Data Transfer-Client Other:
TOTAL
$34,952
ADDITIONAL SERVICE TERMS AND CONDITIONS:
Client will be billed $146 per claim for each Workers' Compensation claim reported in excess of 156.
BilliNG AND PAYMENT TERMS:
Fee of $34,952 is payable in 1 installment of $34,952 beginning 10/1/91.
Cont-LE (10/90)
-:.
rt
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l'
,
NOV 07 ?91 13:38
P.3/11
, .
SWORN STATEMENT PURSUANT TO SECTION 281.133(3)(a),
rJ.QItIDA STATUTES. ON PUBLIC ENTllY ClUMES
, ,
TmS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NO'I ~y PUBUC OR
OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS.
L This SVW>fJ1 statement is submitted to MONRQt: w~Q1lliI1
. . I " [print DIme ot the pobJlc entity)
by
tor
DALE R. BICKNELL ' m~ rr
(print individual's name and t~lle] .
ARTHVR y~Jt G:ALLAGHER & CO. / GALLAGIIER BASS~T~ SERVICES, INC.
[ptint aamo of entity Iubmittbtg sworn state!Qent)
whosebuainesaaddresais 8355 N.W. 53rd Street-, ~te.212' Miami, FL 33166
and (it'applicable) its Federal Employer IdentUlcatJon Number (FEIN) is. 59-1743669
(If the entity 1185 no FEIN. include the Social Security Number of the individual dgning t.h1s swom
I I' . .
statem~nt:
.)
2.
1 understand that a "public entity crill'l~1I as defined in Paraf:aph 2Jj7.133(1)(g~., Florida Statute"
means a violation of .any state or federal law by a person WIth respect to and directly related to
the transaction ot business with any public entity or with an aJeney or political subdivision of any
other state or of the United States, inclUding. but not limited tot any bid or co'\tract for goods or
services to be provided to any public entity or an agency or political subdi'risior of any Other State
or of the United States and involving antitrwit. fraud, tbeft. briberyj coll\: '~ion~ racketeerin,.
conspiracy, or material misrepresentati9D.
I undelStand that "convicted- or Reonviction- as defined in Paragraph 287.133(1)(1 )) Florida St1lttJte~.
means a finding ot guilt or a conviction ot a public entity crlme, with or withoUl an adjudication ot
,guilt. in any federal or state trial court ot record relating to charges brough' by indictment or
informu tJon after July 1, 1989, as a result of a jury verdict, nonjury trial, Or ent:r: of a plea of guilty
or nolo contendere.
3.
4.
I understand that an .affiliatelt as defined in Paragraph 2S7.133(1)~a). Flo~lda ~~8tute5, means:
1. A predecessor or successor of a pe~on conVicted. of a. public entity crime; ( r
2. An entity under the control of any natural pe1'Son who is active in the ma1Ulg.~ment ot the entity
and who has been convicted of a public entity crime. The tcnn .a.ffiliatcW incl' ',des those officcn,
dircx:tors, executives. pattIlem, shareholders, emplOyees. members, and agents wI 0 are active in the
management or an affiliate. The ownership by one person of shares constit.ttfng a contrOlling
. . inter~t in another pasoD, or a pooling of equipment Or income among person~ whell not for {air
matket value under an annJs length agreement. sha11 be a prima facie case that ( ne person controls
another person. A person who knOwingly enters into a JOint venture with a pf.,'Son who has been
convicted of a public entity crime in Florida during the preceding 36 months . hall be considered.
an affiliate.
5. I understand that a -person- as defined in Pazagraph 281.133(1)(e), l!lc,nidll. f~ means any
. ~. natural person or entity organized under the laws of any state or of the: United ~ tate$ with the legal ·
power to enter into a binding contract and which bids or applies to bid ,on contra, ts (or the ptOYisiOD
of goods or services let by a puliliC entity. or which Otherwise transacts Or applies ~o lransaCt business
with a pubJi(; entity. The term 'personA inclUdes those officers) directorst, (,ccuti"cst partners,
shareholders, employees, members, and agents who are active in management ' if an entity.
ROV ~;. 4 1991
!"
. .. . ... . ". ...'.. .. ',, . J ; . ~~: - t.
... ..
NOV 07 '91 13:39
P.4/11
~\
.'
6. Based on information and ~ the statement which I ba~ marked below is :roe in relation to
the entity submitting this swarn statement. [indlate whim stateznent appUes.]
....
.xx Neither the entity submitting this sworn statement,'llor any of its officers, d rectors. executives,
paiiiiers, Shareholders, employees, m.embers. or agents who are activo in the 1 ~anagement of the
entitYt nor any a.f.filia.tc of the entity has been tharged with and. convicted of a )ublic entity crime
subsequent to July 1. 1989, . '
_ The entity Submitting this Sworn statementt or one or IllOre of its officers, d . rectors. execulives,
partners, shareholded. employccs, members, or agents who are active In the I :.anagement Qf the
entity, or an af1iIiate of the entity has been charged with and con'Victed of a 'ubUc entity aime
sUbsequent to July 1, 1989. .
--. 'The entity submitting this sworn statement, Or one or more of its officers, d . rectors; ~ecutives,
partners, shareholders, employees, membersJ or agents who are active in the Itanagcment of the
entitYlt or an atftUate of the entil.}' has been Charged with and convicted of ~ \ublic entity crimo
subsequent to July It 1989.. However. there has been a sUbsequent proceedin; before a Hearing
. Officer 01 the State of Floridat Division of Administrative Hearings and the Fin~ l Order cntered by
the Hearing OUicer dttennined that it was not in the public interest to place t.h } entity submitting
this SWorn 31atcment on the convicted vendor list., [attach n copy or the final ' rder]
I UNDERSTAND THAT nm SUBMISSION OF 'lIDS FORM TO THE CONTRACTIr. G OFFICER FOR
TI:lE PUBUC ENTIn IDENTIJfIED IN PARAGRAPH 1 (ONE) ABOVE IS FOR THAl PUBUC ENTI1Y
ONLY AND. TlWt TIns FORM IS VALID THROUGH DECEMBER 31 OF nm CAl~DAR YEAR IN
WHICH IT IS FILED. I ALSO UNDERSTAND THAT I AM REQUIRED TO INFO lM THE PUBLIC
ENnlY PlUOR TO ENTElUNG INTO A CONTRACT IN EXCESS OF THE TaR.E" 'HOLD AMOUNT
I~ROV1DED IN SECTION 281.011~ FLORIDA STATurES FOB. CATEGORY lWO 011' \.NY CHANGE IN
nJE INFORMATION CONTAINED IN TSIS FORM.
(."'.... !.) l' (" . . "".
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[signt~urel
STATE OF
,COUN1'Y OF
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My commission expires:
who, after fitst being sworn by m~ a!fixc j hjs/her signature
/;r day. of" J/If2/ I, 19 9( .
~ >h.~
NOTARY l:tUBLIC
in Liie space provided above on this
Porm PUR 7068 (Rev. 04/10/91)
NOV 1 4 1991
:,:. ',:. ,. ~..~: :', .".'.!
, NaV 07 '91 13: 40
P.S/11
SWORN STATEM8NT UNDER ORDINANCE NO~ 10-19~O
MONROE COON'EY, FI..ORIDA
ETHICS CLAUSE
SERVICES, INC.
ARTHUR J...:._SALLA~H~_~_~_C_~.~._.~.~~,~~?HE..~_~~~~~,!._,_"._.,. ,warrants that he/it has not employed.
retained or otherwise had act on hia/ita behalf any fOlmer County officer
or employee in voliation of Section 2 of Ordinance'No. 10-1990 or any
County officer or employee ill violatioll of Sec tion 3 01 Ordinance No.
10-1990. For breach or violation of this provision thE County may, in
its discretion, terminate this contract without liability and may also,
in its discretion, deduct from the contract or purchaa~ price, or
otherwise recoverl the full amount of any fee, commissi~n, percentaqe~
giftl or cOfisidecation paid to tile forlner county office r or employ.e.
(', .. . ... (.I ("1' .. ..... '
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( signatllre )
D a.t e : ".'.' J. ] l.L2~':""Lt , .,.. _..__.._____~---...
STATE OF
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-~_............_._.___.__._. on.
COUNTY OF
::.~.:w~-;z:z;;;;~~.... ~he und:::~9:::e:\l:::: t ::ing sworn by me I
atfixe~er sjgnature (name of individual siqning)~n the space .
provided above on thi s .~...
._,_21rf7d.. ._., ',.. .. I 19..CZ/ __.. .
/ ?_.._... _day of
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NO"I'ARY PUBLIC
My commission expires:
NOV 1 4 1991
MCPit:4 REV. 6/91