Gardena City Council
September 13, 2022

6. Timing of Performance. Time is of the essence with respect to Consultant’s performance of the Services required by this Agreement. Consultant shall diligently and timely pursue and complete the performance of the Services required of it by this Agreement City, in its sole discretion, may extend the time for performance of any Service.

7. Compensation. Compensation for the Services shall be billed as set forth in Attachment A, attached hereto. The Compensation is inclusive of a ll costs that may be incurred by Consultant in performance of the Services, including but not limited to such items as travel, copies, delivery charges, phone charges, and facsimile charges.

8. Term of Agreement/Termination.

A. This Agreement shall be effective as of the date of execution by the City and shall remain in effect until all Services are completed or until terminated as provided for herein.

B. City may terminate this Agreement without cause by providing written notice to Consultant not less than three days prior to an effective termination date. City’s only obligation in the event of termination will be payment of fees and allowed expenses incur red up to and including the effective date of termination.

C. Unless for cause, Consultant may not terminate this Agreement.

D. Upon receipt of a termination notice, Consultant shall: (1) promptly discontinue all Services, unless the notice directs otherwise; and (2) within ten (10) days, deliver to City all files, data, reports, estimates, summaries, and such other information and materials as may have been accumulated or prepared to date by Consultant in performing the Services under this Agreement, whether completed or in progress. Consultant shall provide these documents by both hard copy and in electronic format if available. I n the event of termination for other than cause attributable to Consultant, Consultant shall be entitled to reasonable compensation for the services it performs up to the date of termination and shall be deemed released from liability for any work assigned but not completed as of the effective date of termination.

9. Invoices and Payments.

A. Payment shall be made upon receipt and approval of invoices for Services rendered. In order for payment to be made, Consultant’s invoice must include an itemization as to the services rendered, date(s) of service, direct and/or subcontract costs, and be submitted on an official letterhead or invoice with Consultant’s name, address, and telephone number referenced.

B. The Agreement Administrator shall review the invoices to determine whether services performed and documents submitted are consistent with this Agreement. Payment shall be made within forty-five (45) days following receipt of the invoice or the Agreement Administrator shall provide Consultant with a written statement objecting to the charges and stating the reasons therefore.

C. Payment by City under this Agreement shall not be deemed a waiver of defects, even if such defects were known to City at the time of payment.

10. Records/Audit.

A. Consultant shall be responsible for ensuring accuracy and propriety of all billings and shall maintain all supporting documentation for a minimum of three (3) years from the completion date of the Services under this agreement the following records:

1. All accounts and records, including personnel, property and financial, adequate to identify and account for all costs pertaining to this Agreement and assure proper accounting for all

funds.

2. Records which establish that Consultant and any subconsultant who renders Services under this Agreement are in full compliance with the requirements of this Agreement and all federal, state and local laws and regulations.

3. Any additional records deemed necessary by City to assume verification of full compliance with this Agreement.

B. City shall have the right to audit Consultant’s invoices and all supporting documentation for purposes of compliance with this Agreement for a period of three years following the completion of Services under this Agreement.

C. Upon reasonable notice from City or any other governmental agency, Consultant shall cooperate fully with any audit of its billings conducted by, or of, City and shall permit access to its books, records and accounts as may be necessary to conduct such audits.

11. Successors and Assignment. This Agreement covers professional services of a specific and unique nature. Except as otherwise provided herein, Consultant shall not assign or transfer its interest in this Agreement or subcontract any services to be performed without amending this Agreement. This Agreement shall be binding upon the heirs, executors, administrators, successors and assigns of the parties hereto.

12. Change in Name, Ownership or Control. Consultant shall notify the Agreement Administrator, in writing, of any change in name, ownership or control of Consultant’s firm or subconsultant. Change of ownership or control of Consultant’s firm may require an amendment to the Agreement.

13. Key Personnel . City has relied upon the professional training and ability of Consultant to perform the services hereunder as a material inducement to enter into this Agreement. Consultant shall provide properly skilled professional and technical per sonnel to perform all services under this Agreement. In the event that City, in its sole discretion, at any time during the Agreement, desires the removal of any person or persons assigned by Consultant to perform Services pursuant to this Agreement, Consultant shall remove any such person immediately upon receiving notice from City.

14. Use of Materials.

A. City shall make available to Consultant such materials from its files as may be required by Consultant to perform Services under this Agreement. Such materials shall remain the property of City while in Consultant’s possession. Upon termination of this Agreement and payment of outstanding invoices of Consultant, or completion of work under this Agreement, Consultant shall return to City any property of City in its possession and any calculations, notes, reports, electronic files, or other materials prepared by Consultant in the course of performance of this Agreement.

B. City may utilize any material prepared or work performed by Consultant pursuant to this Agreement, including computer software, in any manner, which City deems proper without additional compensation to Consultant. Consultant shall have no responsibility or liability for any revisions, changes, or corrections made by City, or any use or reuse pursuant to this paragraph unless Consultant accepts such responsibility in writing.

15. Confidentiality. Consultant acknowledges that some of the material and information that may come into its possession or knowledge in connection with this Agreement or its performance may consist of information that is exempt from disclosure to the public or other unauthori zed persons under either state or federal statutes ("Confidential Information"). Confidential Information includes, but is not limited to, names, addresses, Social Security numbers, e -mail addresses, telephone numbers, financial

profiles, credit card infor mation, driver's license numbers, medical data, law enforcement records, agency source code or object code, agency security data, or information identifiable to an individual that relates to any of these types of information. Consultant agrees to hold Conf idential Information in strictest confidence and not to make use of Confidential Information for any purpose other than the performance of this Agreement, to release it only to authorized employees or Sub-consultants requiring such information for the purp oses of carrying out this Agreement, and not to release, divulge, publish, transfer, sell, disclose, or otherwise make the information known to any other party without City's express written consent or as provided by law. Consultant agrees to release such information or material only to employees or Sub-consultants who have signed a nondisclosure agreement, the terms of which have been previously approved by City. Consultant agrees to implement physical, electronic, and managerial safeguards to prevent unauthorized access to Confidential Information.

"Personal information" including, but not limited to, "Protected Health Information" (PHI) under Health Insurance Portability And Accountability Act (HIPAA), individuals' names, addresses, phone numbers, birth dates, and social security numbers collected, used, or acquired in connection with this Agreement shall be protected against unauthorized use, disclosure, modification or loss.

HIPAA establishes national minimum standards for the use and disclosure of certain health information.

The Consultant must comply with all HIPAA requirements and rules when determined applicable by the City. If City determines that (1) City is a "covered entity" under HIPAA, and that (2) Consultant will perform "business associate" services and activities covered under HIPAA, then at City's request, Consultant agrees to execute City's Agreement in compliance with HIPAA.

Consultant shall ensure its directors, officers, employees, Sub-consultants or agents use personal information solely for the purposes of accomplishing the services set forth herein. Consultant and its Sub-consultants agree not to release, divulge, publish, transfer, sell or otherwise make known to unauthorized persons personal information without the express written consent of the City or as otherwise required by law.

Any breach of this provision may result in termination of the Agreement and demand for return of all personal information. Moreover, Consultant will indemnify and hold the City harmless from and against all losses and damages resulting from any unauthorized or improper disclosure, dissemination or use of the information as a result, in whole or in part, of Consultant’s action or inaction.

16. Nonuse of Intellectual Property of Third Parties. Consultant shall not use, disclose or copy any intellectual property of any third parties in connection with work carried out under this Agreement, except for intellectual property for which Consultant has a license. Consultant shall indemnify and hold City harmless against all claims raised against City based upon allegations that Consultant has wrongfully used intellectual property of others in performing work for City, or that City has wrongfully used intellectual property developed by Consultant pursuant to this Agreement.

17. Ownership of Work Product. All documents or other information created, developed, or received by Consultant shall, for purposes of copyright law, be deemed worked made for hire for City by Consultant and shall be the sole property of City. Consultant shall provide City with copies of these items upon demand, and in any event, upon termination of this Agreement.

18. Legal Requirements.

A. Consultant shall secure and maintain all licenses or permits required by law, including a City business license, and shall comply with all ordinances, laws, orders, rules, and regulations

pertaining to the work.

B. Consultant warrants that it shall perform the services required by this Agreement in compliance with all applicable Federal and California employment laws, including, but not limited to, those laws related to minimum hours and wages; occupational health and safety; fair employment and employment practices; workers’ compensation; and all other Federal, State and local laws and ordinances applicable to the services required under this Agreements.

C. Consultant covenants that thee shall be no discrimination based upon race, color, creed, religion, sex, marital status, age, handicap, national origin or ancestry, or any other category forbidden by law in performance of this Agreement.

19. Conflict of Interest and Reporting.

A. Consultant shall at all times avoid conflicts of interest or the appearance of a conflict of interest in the performance of this Agreement. If required, Consultant shall comply with the City’s Conflict of Interest reporting requirements. Consultant understands that pursuant to Gardena Municipal Code sections 2.24.020H and 2.24.025G, it is forbidden to make any contribution to a candidate or committee of a candidate for a municipal office of the City, or to an officeholder, until the completion of services to be performed under this Agreement.

B. Consultant and its representatives shall refrain from lobbying City of Gardena officials, employees and representatives for the duration of this Agreement.

20. Guarantee and Warranty. Consultant warrants to City that the material, analysis, data, programs and SERVICES to be delivered or rendered hereunder will be of the kind and quality designated and will be performed by qualified personnel. Without waiver of City’s other rights or remedies, City may require Consultant to re - perform any of said services, which were not performed in accordance with these standards. Consultant shall perform the remedial services at its sole expense.

21. Insurance.

A. Commencement of Work. Consultant shall not commence work under this Agreement until it has obtained City approved insurance. Before beginning work hereunder, during the entire period of this Agreement, for any extensions hereto, and for periods after the end of this Agreement as may be indicated below, Consultant must have and maintain in place all of the insurance coverage required in this Section. Consultant’s insurance shall comply with all items specified by this Agreement.

Any subcontractors shall be subject to a ll of the requirements of this Section and Consultant shall be responsible to obtain evidence of insurance from each subcontractor and provide it to City before the subcontractor commences work. Alternatively, Consultant’s insurance may cover all subcontractors.

B. Insurance Company Requirements. All insurance policies used to satisfy the requirements imposed hereunder shall be issued by insurers admitted to do business in the State of California. Insurers shall have a current Best’s rating of not less than A-: VII, unless otherwise approved by City.

C. Coverage, Limits and Policy Requirements. Consultant shall maintain the types of coverage and limits indicated below:

1. Commercial General Liability Insurance - a policy for occurrence coverage for bodily injury, personal injury and property damage, including all coverage provided by and to the extent afforded by Insurance Services Office Form CG 2010 ed. 10/93 or 11/85, with no special limitations affecting City. The limit for all coverage under this policy shall be no less than one million dollars ($1,000,000.00) per occurrence.

2. General Auto Liability Insurance - a policy including all coverage provided by and to the extent afforded by Insurance Services Office form CA 0001, ed. 12/93, including hired and non-owned autos wi th no special limitations affecting City. The limit for bodily injury and property damage liability shall be no less than one million dollars ($1,000,000.00) per accident.

3. Worker’s Compensation and Employer’s Liability Insurance - a policy which meets all statutory benefit requirements of the Labor Code, or other applicable law, of the State of California. The minimum coverage limits for said insurance shall be no less than one million dollars per claim. The policy shall be issued by an insurance company which is admitted to do business in the State of California and shall contain a clause that the policy may not be canceled without thirty (30) days prior written notice, return receipt requested, is mailed to City.

4. Professional Errors & Omissions - a policy with minimum limits of one million dollars ($1,000,000.00) per claim and aggregate. This policy shall be issued by an insurance company which is admitted to do business in the State of California and shall contain a clause that the policy may not be canceled until thirty (30) days written notice, unless cancelled for non-payment, then ten (10) calendar days notice shall be given, is mailed to City.

5. Policy Requirements. The policies set forth above shall comply with the following, as evidenced by the policies or endorsements to the policies:
a. The City, its appointed and elected officers, employees, agents and volunteers shall be added as additional insured to the policy. b. The insurer shall agree to provide City with thirty (30) days prior written notice, of any cancellation, non-renewal or material change in coverage, unless cancelled for non-payment, then ten (10) calendar days notice shall be given. c. For any claims with respect to the Services covered by this Agreement, Consultant’s insurance coverage shall be primary insurance as respects the City, its elected and appointed officers, employees, agents and volunteers. Any insurance or self-insurance maintained by the City, its elected and appointed officers, employees, agents and volunteers shall be excess of Consultant’s insurance and shall not contribute with it.

D. Additional Requirements. The procuring of such required policies of insurance shall not be construed to limit Consultant’s liability hereunder or to fulfill the indemnification provisions and requirements of this Agreement. There shall be no recourse against City for payment of premiums or other amounts with respect thereto. City shall notify Consultant in writing of changes in the insurance requirements. If Consultant does not deposit copies of acceptable insurance policies or endorsements with City incorporating such changes within sixty (60) days of receipt of such notice, Consultant shall be deemed in default hereunder.

E. Deductibles. Any deductible or self -insured retention over $25,000 per occurrence must be declared to and approved by City. Any deductible exceeding an amount acceptable to City shall be subject to the following changes: either the insurer shall eliminate or reduce such deductibles or self-insured retentions with respect to City, its officers, employees, agents and volunteers (with additional premium, if any, to be paid by Consultant); or Consultant shall provide satisfactory financial guarantee for payment of losses and related investigations, claim administration and defense expenses.

F. Verification of Compliance. Consultant shall furnish City with original policies or certificates and endorsements effecting coverage required by this Agreement. The endorsements are to be signed by a person authorized by the insurer to bind coverage on its behalf. All endorsements are to be received and approved by City before work commences. Not less than fifteen (15) days prior to the

expiration date of any policy of insurance required by this Agreement, Consultant shall deliver to City a binder or certificate of insurance with respect to each renewal policy, bearing a notation evidencing payment of the premium therefore, or accompanied by other proof of payment satisfactory to City.

Consultant shall provide full copies of any requested policies to City within three (3) days of any such request by City.

G. Termination for Lack of Required Coverage. If Consultant, for any reason, fails to have in place, at all times during the term of this Agreement, including any extension hereto, all required insurance and coverage, City may immediately obtain such coverag e at Consultant’s expense and/or terminate this Agreement.

22. Indemnity.

A. Consultant assumes all risk of injury to its employees, agents, and contractors, including loss or damage to property.

B. Consultant shall defend, indemnify, and hold harmless the City, including its officials, officers, employees, and agents from and against all claims, suits, or causes of action for injury to any person or damage to any property arising out of any intentional or negligent acts or errors or omissions to act by Consultant or its agents, officers, employees, subcontractors, or independent contractor, in the performance of its obligations pursuant to this Agreement. This indemnity shall apply to all claims and liability regardless of whether any insurance policies are applicable. The policy limits do not act as a limitation upon the amount of indemnification to be provided by Consultant. This indemnity shall not apply if the claim arises out of the sole negligence or willful misconduct of City, its officers, agents, employees or volunteers.

C. No official, employee, agent or volunteer of City shall be personally liable for any default or liability under this Agreement.

23. Independent Contractor. Consultant agrees to furnish consulting services in the capacity of an independent contractor and neither Consultant nor any of its employees shall be considered to be an employee or agent of City.

24. PERS Eligibility Indemnification. In the event that Consultant or any employee, agent, or subcontractor of Consultant providing services under this Agreement claims or is determined by a court of competent jurisdiction or the California Public Employees Retirement System (PERS) to be eligible for enrollment in PERS as an employee of the City, Consultant shall indemnify, defend, and hold harmless City for the payment of any employee and/or employer contributions for PERS benefits on behalf of Consultant or its employees, agents, or subcontractors, as well as for the payment of any penalties and interest on such contributions, which would otherwise be the responsibility of City.

Notwithstanding any other agency, state or federal policy, rule, regulation, la w or ordinance to the contrary, Consultant and any of its employees, agents, and subcontractors providing service under this Agreement shall not qualify for or become entitled to, and hereby agree to waive any claims to, any compensation, benefit, or any i ncident of employment by City, including but not limited to eligibility to enroll in PERS as an employee of City and entitlement to any contribution to be paid by City for employer contribution and/or employee contributions for PERS benefits.

25. Notices. Any notice or communication given under this Agreement shall be effective when deposited, postage prepaid, with the United States Postal Service and addressed to the contracting parties. Name, address, telephone and facsimile numbers of the parties are as follows:

City of Gardena – GTrans
Attn: Rachel Yoo
13999 S. Western Avenue
Gardena, California, 90249
Email: [email protected]
Delta Motor Co., Inc.

Attn: Doug Yeomans
2492 Brayton Avenue
Signal Hill, California 90755
Email: [email protected]
Either party may change the information to which notice or communication is to be sent by providing advance written notice to the other party.

26. Severability. If any provision of this Agreement shall be held illegal, invalid, or unenforceable, in whole or in part, such provision shall be modified to the minimum extent necessary to make it legal, valid, and enforceable, and the legality, validity, and enforceability of the remaining provisions shall not be affected thereby.

27. Jurisdiction and Venue. This Agreement shall be deemed a contract under the laws of the State of California and for all purposes shall be interpreted in accordance with such laws. Both parties hereby agree and consent to the exclusive jurisdiction of the courts of the State of California and that the venue of any action brought hereunder shall be Los Angeles County, California.

28. Waiver. No delay or failure by either Party to exercise or enforce at any time any right or provision of this Agreement shall be considered a waiver thereof or of such Party’s right thereafter to exercise or enforce each and every right and provision of this Agreement. To be valid a waiver shall be in writing but need not be supported by consideration. No single waiver shall constitute a continuing or subsequent waiver.

29. Entire Agreement.

A. This writing contains the entire agreement of the Parties relating to the subject matter hereof; and the Parties have made no agreements, representations, or warranties either written or oral relating to the subject matter hereof which are not set forth herein. Except as provided herein, this Agreement may not be modified or altered without formal amendment thereto.

B. Notwithstanding the foregoing, and to realize the purpose of this Agreement, the Agreement Administrator may issue a written modification to the Scope of Work, if this modification will not require a change to any other term of this Agreement.

30. Joint Drafting. Each party acknowledges that it has had an adequate opportunity to revie w each and every provision in this Agreement and to submit the same to counsel and other consultants for review and comment and that the parties jointly drafted this Agreement. No provision of this Agreement or any Assignment shall be construed more strictly against one p arty than the other party by reason that one or the other party proposed, drafted or modified such provision or any other existing or proposed provision.

31. Public Records Act Disclosure. Consultant has been advised and is aware that this Agreement and all reports, documents, information and data, including, but not limited to, computer tapes, discs or files furnished or prepared by Consultant, or any of its subcontractors, pursuant to this Agreement and provided to City may be subject to public disclosure as required by the California Public Records Act (California Government Code section 6250 et seq.). Exceptions to public disclosure may be those documents or information that qualify as trade secrets, as that term is defined in the California Government Code section 6254.7, and of which Consultant informs City of such trade secret. The City will endeavor to maintain as confidential all information obtained by it that is designated as a trade secret. The City shall not, in any way, be liable or responsible for the disclosure of any trade secret including, without limitation, those records so marked if disclosure is deemed to be required by law or by order of the Court.

32. Counterparts. This Agreement may be executed in one or more counterparts, each of which s hall be

RFQ 2022-01 Page 1 of 38
Reconditioning of Siemens Electric Hybrid Components

Request for Quotation
For
Reconditioning of Siemens Electric Hybrid Components
RFQ No. 2022-01

August 2022

City of Gardena GTrans
13999 S. Western Avenue
Gardena, CA 90249

RFQ 2022-01 Page 2 of 38
Reconditioning of Siemens Electric Hybrid Components

TABLE OF CONTENTS

INVITATION FOR REQUEST FOR QUOTATIONS ………………………..………..…… 3 PROCUREMENT SCHEDULE ……………..…………………………..…………………..…… 4
SECTION I – GENERAL INFORMATION ………………………..……………….…….….… 5 SECTION II – SCOPE OF WORK ……………………………..…………………………….…… 9 SECTION III – REQUIRED FORMS ……………………..……………………………………… 16 ATTACHMENT A – FEDERAL CLAUSES & CERTIFICATIONS
ATTACHMENT B – SAMPLE AGREEMENT

RFQ 2022-01 Page 3 of 38
Reconditioning of Siemens Electric Hybrid Components

INVITATION FOR REQUEST FOR QUOTATION
NO. 2022-01

RECONDITIONING OF SIEMENS ELECTRIC HYBRID COMPONENTS

PUBLIC NOTICE IS HEREBY GIVEN that GTrans of Gardena – its Transportation Department (GTrans) invites and shall receive quotations up to the hour of 3:00 PM (PST) on August 24, 202 2 for reconditioning/overhaul services for electric drive components used in New Flyer Gasoline Hybrid Electric propulsion drive systems.

This procurement is a Federal Transit Administration (FTA) funded project and therefore Bidders are hereby bound by all applicable federal, state and local laws and regulation s, and certifications. In accordance with the Civil Rights Act of 1964, Proposers are hereby notified that Disadvantaged Business Enterprises (DBEs) and Small Business Enterprises (SBE) are encouraged to submit Proposals and will be afforded full opportunity to submit and participate in this request. Prime contractors should exert best efforts to subcontract work to DBEs and SBEs as part of their Proposal. Proposals received after the date and time specified above shall be rejected by GTrans as non-responsive.

GTrans’ annual overall goal for DBE participation for Fiscal Year 20 22-24 is 4.0%. A specific DBE participation goal has not been established for this contract. However, DBE and SBE prime contractors and DBE and SBE subcontractors are STRONGLY ENCOURAGED to compete for this contract, which will be awarded fairly, without discrimination on the basis of race, color, sex, or national origin.

Copies of the proposals and any addendums may be obtained by visiting GTrans’ online procurement platform, “PlanetBids”, which can be accessed via GTrans webpage at:
http://ridegtrans.com/contact/how-to-do-business-with-gtrans/

Proposals shall only be accepted via PlanetBids and are due by no later than August 24, 2022 at 3:00 PM PST.

RFQ 2022-01 Page 4 of 25
Reconditioning of Siemens Electric Hybrid Components

PROCUREMENT SCHEDULE

The schedule of activities and corresponding due dates related to this RFQ, are as follows.

GTrans reserves the right to modify this schedule as needed.

ACTIVITY DATE
Release of Request for Quotation August 12, 2022
Deadline for Questions August 17, 2022 at 3:00 PM PST
Deadline for Submission of Proposal August 24, 2022 at 3:00 PM PST

RFQ 2022-01 Page 5 of 25
Reconditioning of Siemens Electric Hybrid Components

SECTION I

GENERAL INFORMATION

RFQ 2022-01 Page 6 of 25
Reconditioning of Siemens Electric Hybrid Components

1. INTRODUCTION
The City of Gardena – GTrans is requesting quotation for reconditioning/overhaul services for various electric hybrid components used in New Flyer Gasoline Hybrid Electric propulsion drive systems, model years 2005 through 2010.

2. SUBMITTAL INSTRUCTIONS
The City of Gardena – GTrans uses PlanetBids, a web-based bid management service to manage request for quotes. PlanetBids can be accessed at https://pbsystem.planetbids.com/portal/39470/portal-home. All quotes shall be submitted via PlanetBids. GTrans will not accept submittals through any other platform. All quotes shall be submitted no later than 3:00 PM PST on Wednesday, August 24, 2022. Questions shall be submitted no later than 3:00 PM PST on Wednesday, August 17, 2022.

3. GENERAL REQUIREMENTS
All quotations hereunder and the Contract awarded hereunder shall be filled, made and executed in accordance with all laws of the State of California, and of the United States, and of the City of Gardena which related to quotations of this nature, whether same are expressly referred to herein or not. The successful Bidder shall warrant that in performance of the contract, it shall comply with all applicable federal, state and local laws, statues and ordinances and all lawful orders, rules and regulations promulgated thereunder. The successful Bidder will be required to comply with all applicable Equal Employment Opportunity laws and regulations. All of the work performed under the contract shall be done in accordance with the provisions of the Labor Code of the State of California in all respects and reference is hereby made to said Labor Code for further particulars in that regard.

3.1. FEDERAL TRANSIT ADMINISTRATION
This contract will be funded by the Federal Transit Administration (FTA). Therefore, the awarded contractor will be subject to all applicable FTA rules and regulations. Please refer to the FTA Clauses and Certifications document, Att.

3.2. DISADVANTAGED BUSINESS ENTERPRISE
GTrans’ annual overall goal for DBE participation for fiscal year 20 22-24 is 4%. A specific DBE participation goal has not been established for this contract. However, DBE prime contractors and DBE subcontractors are strongly encouraged to compete for this contract which will be awarded fairly, without discrimination on the basis of race, color, sex, or national origin.

4. QUOTATION
Quotation shall include all labor, taxes, shipping, overhead, and any other additional costs proposed. Prices quoted shall remain firm for the duration of the contract. In the event that the scope of work is substantially modified, the extra cost or credit shall be negotiated based on the submitted rates.

5. PROTEST PROCEDURES
City of Gardena Ordinance No. 1493 specifies the policies and procedures to be used to insure that all purchases, contracts and services are obtained through fair and open competition. The Purchasing Officer has the authority and the responsibility to insure that all procurement is in compliance with this policy.

Should any individual, organization or group believe that these policies have been violated they may make an appeal in writing to the Purchasing Officer who is obligated to investigate the protest and provide an official response to the protest.

RFQ 2022-01 Page 7 of 25
Reconditioning of Siemens Electric Hybrid Components
Protests shall be submitted within ten (10) working days of notification that a bid has been awarded. All protests shall state specifically:
• The Bid title, opening or award date, purchase order or other identifying data; • The specific policy that is alleged to have been violated; • The adverse effect alleged to have resulted from the policy violations; • The corrective action being sought as a remedy.

The Purchasing Officer will respond in writing to the protester no later than ten (10) working days from receipt of the protest. The response shall include:
• Review of the policy as applied in the transaction being questioned; • Response to each material issue raised in the protest; • Statement of whether a violation has indeed occurred; • Corrective action to be taken if any is warranted.

According to City policies, the decision of the Purchasing Officer is appealable to the City Manager by a firm receiving the decision by the Purchasing Officer. If no appeal has been received in the office of the City Manager on the fifth working day following the date of the decision, the decision of the Purchasing Officer shall be considered final.

Should an appeal be received by the City Manager, a response will be provided to the protester within five (5) working days and shall be considered final.

Whenever possible, the award of procurement will not be made final until all Bid protests have been satisfactorily resolved. Final award will not be made until five (5) days after notification of protest decision has been provided to the protesting party(ies). The City does reserve the right to proceed with the award pending the resolution of the bid protest when it is determined that:

When federal or state funding is involved, these procedures will be followed and will be supplemented by the regulations of the funding source. Should there be a conflict in the funding regulations and those set forth herein by the City, the more restrictive procedure shall take precedence. Bidders can protest directly to FTA in the event that it can be claimed that the City did not follow the selection process described herein, but only within five (5) business days after receipt of the response from the City. The protester shall deliver its appeal to the FTA Regional Administrator for the region administering its project or the FTA Associate Administrator for the program office administering its project within five (5) working days of the date when the protester has identified other grounds for appeal to FTA. For example, other grounds for appeal include the recipient’s failure to have or failure to comply with its protest procedures or failure to review the protest.

Bid protests are to be directed in writing to:

City of Gardena – Purchasing Officer
Bid Protest for – RECONDITIONING OF SIEMENS ELECTRIC HYBRID COMPONENTS, RFQ 2022-01 13999 S. Western Ave.

Gardena, CA 90249
Formal Protests shall clearly state the following on the outside of the envelope:

BID PROTEST FOR – “RECONDITIONING OF SIEMENS ELECTRIC HYBRID COMPONENTS, RFQ 2022-01”

RFQ 2022-01 Page 8 of 25
Reconditioning of Siemens Electric Hybrid Components

6. REQUIRED DOCUMENTS/CHECKLIST
Offeror shall include the following completed documents with their quotation package:

1. Form A – Proposal Checklist

2. Form B – Business Questionnaire

3. Form C – Designation of Subcontractors

4. Form D – Equal Employment Opportunity Certification

5. Form E – Drug-Free Workplace Certification

6. Form F- Proof of Non-Debarment or Suspension (SAM.gov)

7. Form G – Quotation

8. Attachment A – FTA Certifications and Clauses

RFQ 2022-01 Page 9 of 25
Reconditioning of Siemens Electric Hybrid Components

SECTION II

SCOPE OF WORK

RFQ 2022-01 Page 10 of 25
Reconditioning of Siemens Electric Hybrid Components

SCOPE OF WORK

1. Approximate Quantities:

The following approximations are being provided as good faith estimates of annual usage, consequently is not guaranteed usage
• 2 - Siemens 96/150 KW Generator, Model No.: 1FV5139-6WS20-Z W12 • 2 - Siemens 200KW Generator, Model No.: 1FV5168-8WS24-Z W12 • 14 - Siemens 85/150 KW Drive Motor, Model No.: 1PV5138-4WS24-Z W12

2. Warranty:

The term of the warranty (parts, labor and tech support) shall be 2 years. The term of warranty shall commence upon GTrans’ installation of the components into the vehicle. Warranty shall cover damage to components that results from poor workmanship for components that fail within two years of the installation

3. Other References:
• American National Standards Institute (ANSI/EASA) AR100, 2015, Recommended Practice for the Repair of Rotating Electrical Apparatus
• International Electro technical Commission (IEC) 60072-1, Feb 1991, Dimensions and Output Series for Rotating Electrical Machines - Part 1: Frame Numbers 56 to 400 and Flange Numbers 55 to 1080.
• MIL-D-16791, Jan 1993, Detergents, General Purpose (Liquid Nonionic) • MIL-I-24092/2, Sep 1993, Insulating Varnish, Solvent Containing, Baking, Flexible, for Dip Processing, Grade CB, Class 130 to 180 Thermal Class
• MIL-I-24092/5, Sep 1993, Insulating Resin, Solventless, Baking, Flexible, for Dip Processing, Grade SF, Class 130 to 180 Thermal Class
• MIL-I-24718/3, Apr 1990, Insulating Resins, Solventless, Vacuum-Pressure-Impregnating Polyester Diallyl Phthalate, Slightly Thixotropic
• National Electrical Manufacturers Association (NEMA) MG1, 2006, Motors and Generators • Underwriters Laboratories Inc. (UL) 1446, Feb 2007, Standard for Safety Systems of Insulating Materials – General
• U.S. Department of Energy (DOE/GO) 10099-935, Nov 1999, Model Repair Specifications for Low Voltage Induction Motors

4. Contractor Requirements:

4.1 General.

4.1.1 Inspection, test notification, and documentation . Abide by the following requirements for all inspections and tests specified herein.

4.1.2 Original equipment manufacturer’s guidance. Adhere to the requirements, cautions, and warnings stated in the motor manufacturer’s instruction book during the performance of this work.

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Reconditioning of Siemens Electric Hybrid Components

4.1.3 Materials. New material used or installed during work on the components shall be equal or superior to the material used by the original manufacturer. If materials deviate from original equipment manufacturer (OEM) specification than the contractor shall supply GTrans with supporting documentation for approved equal replacement.

4.1.4 Overhaul technician. Inspection and shop work shall be performed by a firm that is a member of the Electrical Apparatus Service Association (EASA) and that shop shall adhere to the association’s standards, including ANSI/EASA AR100.

4.2 Initial inspection. Prior to performing the shop work specified by the work item, the repair facility shall accomplish the following

4.2.1 Disassembly and inspections. Unpack the assembly, disassemble and remove the Rotor.

4.2.2 Visual inspections . Perf orm a visual inspection of the components for the presence of contamination by dust, dirt, moisture, oil, and other foreign matter. Attempt to determine the origin, such as leaking seals, or any unusual conditions prior to the start of cleaning. Note all abnormal conditions on the stator, rotor, and windings. Carefully examine the interior of th e component for loose objects such as, nuts and bolts; remove all such items. Inspect all electrical connections for tightness. Check all wedges, bands, and soldered connections and correct any minor deficiencies. Check for evidence of overheating, both general and localized.

Identify any mechanical deficiencies, including non-conformance with Section 2 of ANSI/EASA AR100. Inspect insulation condition in accordance with Section 4 of ANSI/EASA AR100. Record all findings, including the types of contaminants (oil, water, carbon, dirt, etc.) found.

4.2.3 Accessories. Replace Temperature Sensor and inspect accessories, such as Encoders and the associated internal wiring. Test accessory operation and submit a CFR with recommendations for repair or renewal.

4.2.4 Digital Documentation. During inspection process any unusual wear or damage shall be digitally documented and provided to GTrans as an attachment to Quote f or refurbishment this shall include but not limited to any CFR submitted in excess of $100

4.3 Initial insulation resistance tests. Assess insulation system conditions in accordance with Section 4.2 of ANSI/EASA AR100. At a minimum, the following shall be performed:

4.3.1 Insulation resistance test. Measure and record the insulation resistance of stator and rotor windings per Section 4.2.1 of ANSI/EASA AR100.

4.3.2 Insulation resistance polarization index (PI) test. Measure and record stator and rotor winding PI test data per Section 4.2.2 of ANSI/EASA AR100.

4.3.3 Initial winding tests. Assess winding conditions in accordance with Section 4.3 of ANSI/EASA AR100.

4.4 Shop work. Perform the following work at repair facility:

4.4.1 Cleaning and reconditioning. When stated in the work item, or if a Change Request has been released and authorized by GTrans, clean and recondition the designated per guideline of ANSI/EASA AR100

4.4.2 Rewinding. The winding should maintain the same electrical characteristics as the original.

Winding data should be reviewed for accuracy in accordance to Section 3 ANSI/EASA AR100

4.4.3 Bearings. Replace all bearings with new OEM equivalent or superior quality.

4.4.4 Powered by an Inverter. GTrans Gasoline Hybrid Electric Vehicles components are powered by an Inverter and therefor the motor is powered by a pulse -width-modulated inverter. The windings shall be sufficiently insulated and supported to withstand this type of power supply.

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Magnet wire must be of a design intended for inverter duty. The wire manufacturer and specification shall be approved by GTrans prior to using.

4.4.5 Miscellaneous repairs. When stated in the work item, or if a Change Request has been released and authorized by GTrans, repair the designated motor per the applicable paragraph of Appendix C shown in Table 1 below.

4.5 Subcontracted Work. If any work is to be subcontracted (e.g., rotor balancing) or any subassemblies (e.g., formed coils) are to be provided by outside sources, the purchaser shall be advised of the providers of these parts/services as soon as it is known they are required.

4.6 Load Run. The component shall be run and load tested to within 2/3 capacity of name plate voltage and checked for balanced currents and vibration. When applicable Encoder will be calibrated during bench testing to ensure timing accuracy. Test specifications shall be noted on the Repairer’s Q/C Form.

4.7 Re-used Components. All parts of the component must be cleaned, primed and painted.

4.8 Component Identification. All GTrans refurbished equipment will have an identification plate attached to the motor in an easily accessible location.

4.8.1 Identification Plate. Will include the name of the company which performed the refurbishment. Related job number and date refurbishment was performed.

TABLE 1 – MISCELLANEOUS REPAIRS MATRIX

REPAIR APPENDIX C
Shafting C2.1
Frame and bearing housings C2.2
Temperature sensors C2.3

4.9 Balancing. Dynamically balance the rotor assembly per the manufacturer’s specifications and the following:

4.9.1 In the absence of manufacturer’s balancing specifications, balance per ANSI S2.19 to quality grade G as follows:

4.9.2 Reassembly. Reassemble the motor and reinstall all motor access covers and fasteners, except those at the terminal box.

4.9.3 Replace all disturbed seals, gaskets and O-rings with new OEM equivalent or superior quality.

4.10 Shop Acceptance Testing. Perform the following shop acceptance tests:

4.10.1 Final shop insulation resistance tests. Assess insulation system conditions in accordance with Section 4.2 of ANSI/EASA AR100. At a minimum, the following shall be performed:

4.10.2 Insulation resistance test. Measure and record the insulation resistance of stator and rotor windings per Section 4.2 of ANSI/EASA AR100.

4.10.3 Insulation resistance polarization index (PI) test. Measure and record stator and rotor winding PI test data per Section 4.2 of ANSI/EASA AR100.

4.10.4 Bearing insulation resistance test . Measure and record bearing insulation resistance per Section 4.2 of ANSI/EASA AR100.

4.10.5 Winding tests. Assess winding conditions in accordance with Section 4 of ANSI/EASA AR100.

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Reconditioning of Siemens Electric Hybrid Components

4.10.6 High potential tests. Perform high potential tests in accordance with Section 4 of ANSI/EASA AR100.

4.10.7 Accessory tests. Test accessories in accordance with Section 4.4.2 of ANSI/EASA AR100.

4.10.8 Packaging. Package the component assembly for transport back to GTrans. If the component will not be promptly reinstalled, store the packing crate in a climate-controlled environment or pack the container with desiccant and shrink-wrap it with heavy plastic film.

APPENDIX A - Recondition AC Component

A1. Scope:

A1.1 Intent. This appendix describes the requirements for reconditioning alternating current (AC) component windings.

A2. Requirements:

A2.1 Insulation treatment. Upon satisfactory completion of cleaning, drying, and any other authorized repairs, accomplish insulation treatment of the rotor and stator windings per Section 3 and Section 4 of ANSI/EASA AR100.

APPENDIX B - Rewind AC Component

B1. Scope:

B1.1 Intent. This appendix describes the requirements for rewinding an alternating current (AC) component at a suitable repair facility
B2. Requirements:

B2.1 Core loss test. Perform an insulation resistance test in accordance with Section 4.2 of ANSI/EASA AR100.

B2.2 Rewinding. Strip, clean, test, and rewind the component per Section 3 of ANSI/EASA AR100, observing the following:

B2.2.1 Burn out. Strip the old windings in accordance with Section 3.3 of ANSI/EASA AR100.

B2.2.2 Cleaning. Clean and dry each core in accordance with Section 1.5 of ANSI/EASA AR10 B2.2.3 Core inspection. Re-perform the test of paragraph C2.1 above on the bare core. If results are unsatisfactory or there is visual evidence of damage, submit a CFR with the recommended repair course of action.

B2.2.4 Core preparation . Prepare the bare core for winding, touching up the interlaminar insulation, varnishing the iron, and installing ground wall insulation, as necessary, to restore component to a like new condition.

B2.2.5 Windings. Wind coils in accordance with Sections 3 of ANSI/EASA AR100.

B2.2.6 Banding. Apply banding in accordance with Section 3.13 of ANSI/EASA AR100. Use the same type of wire or glass banding that was installed by the original manufacturer. Do not substitute one for the other, nor replace magnetic banding wire with non-magnetic or vice versa.

B2.2.7 Quality assurance . Visually inspect and test the windings per Section 2.7.8 of DOE/GO 10099-935 prior to impregnation to ensure that there are no improper connectio ns or shorted turns.

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Reconditioning of Siemens Electric Hybrid Components
B2.3 Vacuum-pressure impregnation . Upon satisfactory completion of rewinding and any other authorized repairs, accomplish insulation treatment of the rotor and stator windings per Section

3.4, Section 3.7 and Section 4.4 of ANSI/EASA AR100 using the vacuum pressure impregnation (VPI) method.

APPENDIX C - Miscellaneous AC Component Repairs

C1. Scope:

C1.1 Intent. This appendix describes the requirements for miscellaneous repairs to an alternating current (AC) component.

C2. Requirements:

C2.1 Shafting. Correct shafting deficiencies in accordance with Section 2.1 of ANSI/EASA AR100. Renew cracked or bent shafts; do not attempt weld repair or straightening unless specifically authorized by the work item or Change Request.

C2.2 Frame and bearing housings . Repair the frame and bearing housings in accordance with Section

2.4 of ANSI/EASA AR100.

C2.3 Temperature sensors. Replace with new “Only”
C3. Common repairs. The above are the most common miscellaneous repairs. Requirements for correcting other deficiencies shall be submitted as extra work.

APPENDIX D

D1. Quality Control:

D1.1 Measuring Instrument.

D1.1.1 Calibration:

All measuring instruments shall be calib rated regularly. The calibration records shall be available for purchaser inspection. Minimum frequency of calibration shall be annually, except:
• Insulation Testers. Insulation resistance testers —every six months to a known resistance.
• Dimension Meters. Micrometers, Vernier calipers and other dimension measuring devices every six months against a minimum grade AA gauge block set. • Bore Gauges. Bore gauges shall be calibrated to a certified standard before and after each use.

D1.1.2 Storage:

All measuring equipment shall be stored in a clean dry environment.

D1.2 Bench Testing
D1.2.1 Data / Forms:
• Contractor Database: every component must be characterized & documented.

Contractor will retain records, to include component specifications, (serial number, Model Number, Q/C measurement points, tolerances, manufactured date, Q/C Technician, job number, ( BOM) list specific to each component etc.) Copy of this information will be provided to GTrans upon receipt of equipment.

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Reconditioning of Siemens Electric Hybrid Components
• Contractor shall create form outlining final test out procedures and specifications standards noting that performance standards will be equivalent to (OEM) “New” or superior.
• Each area of assessment will be documented and signed off by the technician who performed final Q/C.

D1.2.2 Documentation:
• Copy of final Q/C will be attached to equipment and delivered to GTrans.

APPENDIX E

E1. Deliverables:

E1.1 Cores:
• Contractor will be notified by GTrans for core retrieval. Contractor shall provide freight and handling. Retrieval of cores once notified by GTrans shall not exceed two (2) business days.

E1.2 Quotes:
• Components replaced outside of a general refurbishment will be outlined separately from the normal work performed. If prescribed work costs exceed $100 dollars, then a digital photo of the component or item will be included within the quotation for repair. Components referenced will include a P/N when applicable. Quote submittals shall not exceed five (5) business days from the date of retrieval of core.

The following conditions shall be assumed for the term of the contract:

1. Freight / Handling: All costs associated with shipping to include pick -up, packaging, and delivery shall be included within the total cost of the unit.

2. Turn Around: Refurbished equipment shall be returned to GTrans within ten (10) business days of shipping or pick-up date.

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Reconditioning of Siemens Electric Hybrid Components

SECTION III

REQUIRED DOCUMENTS

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Reconditioning of Siemens Electric Hybrid Components
FORM A

SUBMITTAL CHECK LIST

This checklist shall be completed and returned with your quotation. Failure to return this checklist and the required documents may be cause for considering the proposal non-responsive.

DESCRIPTION

REQUIRED
FORMS

REFERENCE
LETTER
PROPOSER’S

INITIALS

1. SUBMITTAL CHECKLIST (THIS FORM) A

2. BUSINESS QUESTIONNAIRE B

3. DESIGNATION OF SUBCONTRACTORS C

4. EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION D

5. DRUG-FREE WORKPLACE CERTIFICATION E

6. PROOF NON-DEBARRMENT OR SUSPENSION F

7. QUOTATION G

Company Name:

Name of Bidder initialing
document (print):

Email address of Company
Contact:

Signature:

Title:

Date:

Delta Motor Co. Inc.

Doug Yeomans
[email protected] or [email protected]
Doug Yeomans, President / CEO or Tim Sanchez / Service Manager 08/16/2022
RFQ 2022-01 Page 18 of 25
Reconditioning of Siemens Electric Hybrid Components
FORM B

BUSINESS QUESTIONNAIRE

1. Name of Proposed Contractor ("Business”, herein): __________________________________________________

___________________________________________________________________________________________

Doing Business As: ___________________________________________________________________________ Other business name, if applicable)
EIN#______________________________

2. Business Mailing Address: _____________________________________________________________________ Street Address
_____________________________________________________________________ City State Zip Code

3. Business Telephone Number: ( ) _____________________ Fax Number: ( ) ________________________

E-mail address:
_______________________________________________________

4. Business Type: Individual Corporation Partnership Joint Venture

5. Number of Years in Business: __________________________________________________________________

6. Annual Gross Revenue: (M represents Millions)

$1M or less $1M-$5M $5M-$10M $10M-$16M $16M or Over

7. Number of Employees:

Less than 50 50-100* 101-750 751-1,000 1,001 or over

8. Is Business Owned by Minority Ethnicity? Yes No

9. Ethnic Group: African American Hispanic American Native American Asian Pacific American Subcontinent Asian
American Caucasian
Other (Please Specify)
_____________________________________

10. Female Owned Business? Male Owned Business?

11. Type of Work Performed: Construction Wholesale/Distributor Manufacturing Professional Service General/Technical Service Retail

12. Please provide a brief description of your materials and/or services:

13. Is the Business a subsidiary of another entity? Yes No

14. Has the Business, or any officer or partner thereof, failed to complete a contract? Yes No

15. Is any litigation pending against the Business? Yes No

16. Has the Business ever been declared a "not responsible" vendor by a public agency? Yes No

17. Has the Business been debarred, suspended, proposed for debarment, declared ineligible, voluntarily excluded or otherwise disqualified from bidding, proposing or contracting? Yes No Delta Motor Co., Inc.

N/A
95-2038022
2492 Brayton Avenue
Signal Hill, CA 90755
562
424-2824
562
426-3504
[email protected]
77 Years
Delta Motor Company is a sales and service center for electric motors, generator and other related apparatus.

RFQ 2022-01 Page 19 of 25
Reconditioning of Siemens Electric Hybrid Components
FORM B - Continued

BUSINESS QUESTIONNAIRE

18. Has the Business been a defaulter, as principal, surety or otherwise? Yes No19. Has the government or other public entity requested or required enforcement of any of its rights under a surety agreement on the basis of a default or in lieu of declaring the Business in default? Yes No

20. Is the Business in arrears upon a contract or debt? Yes No

21. Are there any proceedings pending relating to the Business' responsibility, debarment, suspension, voluntary exclusion or qualification to receive a public contract? Yes No

22. Have liquidated damages or penalty provisions been assessed against the Business for failure to complete the work on time or for any other reason? Yes No

23. If a "yes" response is given under questions 15 through 22, please provide a detailed explanation including dates, references to contract information, contacts, etc. (attach additional pages as necessary). GTrans reserves the right to inquire further with respect thereto.

24. Name of principal financial institution for financial responsibility reference.

Name of Bank:

Address:

City and State:

Officer familiar with bidders account:

Federal Taxpayer I.D. number:

27. Please check all classifications that apply to your business:

DBE WBE MBE SBE SBRA LSAF

I, individually and on behalf of the business named above, do by my signature below certify that the information provided in this questionnaire is true and correct. I understand that if the information provided herein contains any false statements or any misrepresentations: 1) GTrans will have the grounds to terminate any or all contracts which GTrans has or may have with the business; 2) GTrans may disqualify the business named above from consideration for contracts and may r emove the business from GTrans’ bidders list; or/and 3) GTrans may have grounds for initiating legal action under federal, state or local law.

Note: This questionnaire is also a certification form; the information requested will be used to determine small business status as per 13 CFR Part 121. Additionally, this information will allow GTrans to report the amount of subcontracting activity with all businesses that offer the commodities and services used by GTrans.

Printed Name: Title

Signature of Owner: Date:
(Owner, CEO, President, Majority Stockholder or Designated Representative)

Bank of America
2800 N Main, Ste. 2068
Santa Ana, CA 92705
Doug Yeomans
Owner/ President / CEO
08/16/2022
RFQ 2022-01 Page 20 of 25
Reconditioning of Siemens Electric Hybrid Components
FORM C

DESIGNATION OF SUBCONTRACTORS

Contractor shall provide the names and business addresses of each subcontractor who will perform work under the contract.

Attach additional copies of this form if more space is needed.

Company Name and Address /
Contact Name and Phone No.

DBE
(Included in
CUCP List)
(Yes / No)
Description of
Work/Services
Estimated
Dollar Amount

We are a full service repair facility we do not use subcontractors.

RFQ 2022-01 Page 21 of 25
Reconditioning of Siemens Electric Hybrid Components

EXHIBIT D

EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION
The successful bidder hereby certifies compliance with all applicable equal employment opportunity laws and regulations, as applicable:

1. In implementing the project, the successful bidder may not discriminate against any employee or applicant for employment because of race, color, creed, sex, disability, age or national origin. The recipient agrees to take affirmative action to ensure that applicants are employed, and that employees are treated during emp loyment without regard to their race, color, creed, sex, disability, age, or national origin. Such action shall include, but not be limited to, the following:
employment, upgrading, demotion or transfer, recruitment or recruitment advertising, layoff or termination, rates of pay or other forms of compensation, and selection for training, including apprenticeship.

2. The successful bidder shall be responsible for requiring that all subcontractors of the project comply with this provision, except subcontracts f or standard commercial supplies of new materials.

____________________________
Date

______________________________________________
Company

By: ______________________________________________
Signature of Authorized Official

______________________________________________
Print Name of Authorized Official

______________________________________________
Title of Authorized Official

08/16/2022
Delta Motor Co. Inc.

Doug Yeomans
Owner/ President / CEO
RFQ 2022-01 Page 22 of 25
Reconditioning of Siemens Electric Hybrid Components

EXHIBIT E

DRUG-FREE WORKPLACE CERTIFICATION

I, _____________________________________________________, hereby certify on behalf of (name of authorized official)
_________________________________________ that:
(name of company)
The Contractor named above, and all Sub -Contractors working on this Contract, will comply with Government Code Section 8355 in matters relating to providing a drug-free workplace. The Contractor and all Sub-Contractors will, therefore:

1. Publish a statement notifying employees that unlawful manufacture, distribution, dispensation, possession, or use of a controlled substance are prohibited, and that specified actions will be taken against employees for violation of these prohibitions, as required by Government Code Section 8355(a).

2. Establish a Drug-Free Awareness Program, as required by Government Code Section 8355(b), to inform employees about all of the following:
a. The dangers of drug abuse in the workplace.
b. The firm’s policy of maintaining a drug-free workplace. c. Any available counseling, rehabilitation and employee assistance programs, and; d. Penalties that may be imposed upon employees for drug abuse violations, including that no employee who tests positive for use of a controlled substance shall be permitted to work on this Contract.

3. Provide, as required by Government Code Section 8355(c), that every employee who works on the proposed Contract:
a. Will receive a copy of the firm’s drug-free policy statement, and; b. Will agree to abide by the terms of the firm’s statement as a condition of employment on the Contract.

CERTIFICATION:

I, _______________________________________, hereby certify that the above named company, which I am duly authorized to represent, will comply with the Drug -Free Workplace requirements of this Contract. I understand that this certification is made under penalty of perjury, under the laws of the State of California.

Executed this ________ day of _____________________, 20___ By ____________________________________________
(Signature of Authorized Official)
______________________________________________
(Title of Authorized Official)

Doug Yeomans
Delta Motor Co. Inc.

Doug Yeomans
August
22 16th
Owner/ President / CEO
RFQ 2022-01 Page 23 of 25
Reconditioning of Siemens Electric Hybrid Components
FORM F

PROOF OF NON-DEBARMENT OR SUSPENSION
(*THIS IS A SAMPLE ONLY)

WWW. SAM.GOV

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Reconditioning of Siemens Electric Hybrid Components
FORM G

QUOTATION

In accordance with the Request for Quotation issued by the City of Gardena Transportation Department (hereinafter referred to as “Buyer”), the undersigned Company hereby agrees to furnish all necessary labor, materials, shipping/delivery and incidentals required for the above stated project as set forth in the Scope of Work and any addenda thereto, and to perform all work in the manner and time prescribed therein.

Below quotation shall include any labor, taxes and shipping. GTrans shall place orders via email on an as-needed basis.

Model Number: 1FV5139-6WS20-Z W12 1FV5168-8WS24-Z W12 1PV5138-4WS24-Z W12 Name: Siemens 96/150 KW
Generator
Siemens 200 KW
Generator
Siemens 85/150 KW
Drive Motors
Quantity: Up to 2 Up to 2 Up to 14
Turn Around Time:

Warranty Term:

Material Cost Per Unit:

Labor Cost Per Unit:

Labor Hourly Rate for
Additional Work*:

Subtotal
Grand Total

*Additional Work must be pre-approved by GTrans prior to execution.

$
$
$
$
$
$
$
$
2,175.00
$
3,750.00
2,175.00

75.00 $
$

75.00 75.00
3,332.62
5,293.50
3,225.00 + 107.62 Tax
5,150.00 + 143.50 Tax
3,225.00 + 107.62 Tax
$
3,332.62
$
1,050.00 (Taxable @ 10.25%)
$
1,400.00 (Taxable @ 10.25%)
$
1,050.00 (Taxable @ 10.25%)
2 Years
2 Years
2 Years
15 Working Days
20 Working Days
15 Working Days
RFQ 2022-01 Page 25 of 25
Reconditioning of Siemens Electric Hybrid Components
FORM G - Continued

QUOTATION

The undersigned agrees that within ten (10) working days after notification of award by the Buyer, execute a Contract in accordance with the terms of this proposal.

(Seal if proposed by a Corporation)

Bidder’s Company
Name

Address
City, State, Zip
Phone Number
Fax Number
Email Address
Federal Employer ID/
TIN No.

Title of Person
Authorized to Sign

Print Name
Authorized to Sign

Authorized Signature
Date Signed
Bid shall be signed by an authorized representative with authority to bind the firm.

2492 Brayton Avenue
Signal Hill, CA 90755
[email protected]
95-2038022
Owner/ President / CEO
Doug Yeomans
08/16/2022
Delta Motor Co., Inc.
562-424-2824
562-426-3504
RFQ 2022-01
Reconditioning of Siemens Electric Hybrid
Components
Attachment A
Federal Clauses & Certifications

Federal Clauses
ACCESS TO RECORDS AND REPORTS
a. Record Retention. The Contractor will retain, and will require its subcontractors of all tiers to retain, complete and readily accessible records related in whole or in part to the contract, including, but not limited to, data, documents, reports, statistics, sub­Contracts, leases, subcontracts, arrangements, other third party Contracts of any type, and supporting materials related to those records. b. Retention Period. The Contractor agrees to comply with the record retention requirements in accordance with 2 C.F.R. § 200.333. The Contractor shall maintain all books, records, accounts and reports required under this Contract for a period of at not less than three (3) years after the date of termination or expiration of this Contract, except in the event of litigation or settlement of claims arising from the performance of this Contract, in which case records shall be maintained until the disposition of all such litigation, appeals, claims or exceptions related thereto. c. Access to Records. The Contractor agrees to provide sufficient access to FTA and its contractors to inspect and audit records and information related to performance of this contract as reasonably may be required. d. Access to the Sites of Performance. The Contractor agrees to permit FTA and its contractors access to the sites of performance under this contract as reasonably may be required.

AMERICANS WITH DISABILITIES ACT(ADA)
The contractor agrees to comply with the requirements of 49 U.S.C. § 5301 (d), which states the Federal policy that the elderly and persons with disabilities have the same right as other persons to use mass transportation service and facilities, and that special efforts shall be made in planning and designing those services and facilities to implement that policy. The contractor also agrees to comply with all applicable requirements of section 504 of the Rehabilitation Act of 1973, as amended, 29 U.S.C. § 794, which prohibits discrimination on the basis of handicaps, with the Americans with Disabilities Act of 1990 (ADA), as amended, 42 U.S.C. §§ 12101 et seq., which requires that accessible facilities and services be made available to persons with disabilities, including any subsequent amendments to that Act, and with the Architectural Barriers act of 1968, as amended, 42 U.S.C. §§ 4151 et seq., which requires that buildings and public accommodations be accessible to persons with disabilities, including any subsequent amendments to that Act. In addition, the contractor agrees to comply with any and all applicable requirements issued by the FTA, DOT, DOJ, U.S. GSA, U.S. EEOC, U.S. FCC, any subsequent amendments thereto and any other nondiscrimination statute(s) that may apply to the Project.

BYRD ANTI­LOBBYING AMENDMENT
Contractors who apply or bid for an award of $100,000 or more shall file the required certification. Each tier certifies to the tier above that it will not and has not used Federal appropriated funds to pay any person or organization for influencing or attempting to influence an officer or employee of any agency, a member of Congress, officer or employee of Congress, or an employee of a member of Congress in connection with obtaining any Federal contract, grant, or any other award covered by 31 U.S.C. § 1352. Each tier shall also disclose any lobbying with non­Federal funds that takes place in connection with obtaining any Federal award. Such disclosures are forwarded from tier to tier up to the Agency.” CARGO PREFERENCE REQUIREMENTS
The contractor agrees:
a. to use privately owned United States­Flag commercial vessels to ship at least 50 percent of the gross tonnage (computed separately for dry bulk carriers, dry cargo liners, and tankers) involved, whenever shipping any equipment, material, or commodities pursuant to the underlying contract to the extent such vessels are available at fair and reasonable rates for United States­Flag commercial vessels; b. to furnish within 20 working days following the date of loading for shipments originating within the United States or within 30 working days following the date of loading for shipments originating outside the United States, a legible copy of a rated, "on­board" commercial ocean bill­of­lading in English for each shipment of cargo described in the preceding paragraph to the Division of National Cargo, Office of Market Development, Maritime Administration, Washington, DC 20590 and to the FTA Recipient (through the contractor in the case of a subcontractor's bill­of­lading.); and c. to include these requirements in all subcontracts issued pursuant to this contract when the subcontract may involve the transport of equipment, material, or commodities by ocean vessel.

CIVIL RIGHTS LAWS AND REGULATIONS
The following Federal Civil Rights laws and regulations apply to all contracts. 1 Federal Equal Employment Opportunity (EEO) Requirements.These include, but are not limited to:
a) Nondiscrimination in Federal Public Transportation Programs. 49 U.S.C. § 5332, covering projects, programs, and activities financed under 49 U.S.C.

Chapter 53, prohibits discrimination on the basis of race, color, religion, national origin, sex (including sexual orientation and gender identity), disability, or age, and prohibits discrimination in employment or business opportunity. b) Prohibition against Employment Discrimination. Title VII of the Civil Rights Act of 1964, as amended, 42 U.S.C. § 2000e, and Executive Order No. 11246, “Equal Employment Opportunity,” September 24, 1965, as amended, prohibit discrimination in employment on the basis of race, color, religion, sex, or national origin.
2 Nondiscrimination on the Basis of Sex. Title IX of the Education Amendments of 1972, as amended, 20 U.S.C. § 1681 et seq. and implementing Federal regulations, “Nondiscrimination on the Basis of Sex in Education Programs or Activities Receiving Federal Financial Assistance,” 49 C.F.R. part 25 prohibit discrimination on the basis of sex.
3 Nondiscrimination on the Basis of Age. The “Age Discrimination Act of 1975,” as amended, 42 U.S.C. § 6101 et seq., and Department of Health and Human Services implementing regulations, “Nondiscrimination on the Basis of Age in Programs or Activities Receiving Federal Financial Assistance,” 45 C.F.R. part 90, prohibit discrimination by participants in federally assisted programs against individuals on the basis of age. The Age Discrimination in Employment Act (ADEA), 29 U.S.C. § 621 et seq., and Equal Employment Opportunity Commission (EEOC) implementing regulations, “Age Discrimination in Employment Act,” 29 C.F.R. part 1625, also prohibit employment discrimination against individuals age 40 and over on the basis of age. 4 Federal Protections for Individuals with Disabilities. The Americans with Disabilities Act of 1990, as amended (ADA), 42 U.S.C. § 12101 et seq., prohibits discrimination against qualified individuals with disabilities in programs, activities, and services, and imposes specific requirements on public and private entities. Third party contractors must comply with their responsibilities under Titles I, II, III, IV, and V of the ADA in employment, public services, public accommodations, telecommunications, and other provisions, many of which are subject to regulations issued by other Federal agencies.

Civil Rights and Equal Opportunity
The Agency is an Equal Opportunity Employer. As such, the Agency agrees to comply with all applicable Federal civil rights laws and implementing regulations. Apart from inconsistent requirements imposed by Federal laws or regulations, the Agency agrees to comply with the requirements of 49 U.S.C. § 5323(h) (3) by not using any Federal assistance awarded by FTA to support procurements using exclusionary or discriminatory specifications. Under this Contract, the Contractor shall at all times comply with the following requirements and shall include these requirements in each subcontract entered into as part thereof.

1. Nondiscrimination.In accordance with Federal transit law at 49 U.S.C. § 5332, the Contractor agrees that it will not discriminate against any employee or applicant for employment because of race, color, religion, national origin, sex, disability, or age. In addition, the Contractor agrees to comply with applicable Federal implementing regulations and other implementing requirements FTA may issue.

2. Race, Color, Religion, National Origin, Sex. In accordance with Title VII of the Civil Rights Act, as amended, 42 U.S.C. § 2000e et seq., and Federal transit laws at 49 U.S.C. § 5332, the Contractor agrees to comply with all applicable equal employment opportunity requirements of U.S. Department of Labor (U.S. DOL) regulations, "Office of Federal Contract Compliance Programs, Equal Employment Opportunity, Department of Labor," 41 C.F.R. chapter 60, and Executive Order No. 11246, "Equal Employment Opportunity in Federal Employment," September 24, 1965, 42 U.S.C. § 2000e note, as amended by any later Executive Order that amends or supersedes it, referenced in 42 U.S.C. § 2000e note. The Contractor agrees to take affirmative action to ensure that applicants are employed, and that employees are treated during employment, without regard to their race, color, religion, national origin, or sex (including sexual orientation and gender identity). Such action shall include, but not be limited to, the following: employment, promotion, demotion or transfer, recruitment or recruitment advertising, layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship.

In addition, the Contractor agrees to comply with any implementing requirements FTA may issue.

3. Age. In accordance with the Age Discrimination in Employment Act, 29 U.S.C. §§ 621­634, U.S. Equal Employment Opportunity Commission (U.S.

EEOC) regulations, “Age Discrimination in Employment Act,” 29 C.F.R. part 1625, the Age Discrimination Act of 1975, as amended, 42 U.S.C. § 6101 et seq., U.S. Health and Human Services regulations, “Nondiscrimination on the Basis of Age in Programs or Activities Receiving Federal Financial Assistance,” 45 C.F.R. part 90, and Federal transit law at 49 U.S.C. § 5332, the Contractor agrees to refrain from discrimination against present and prospective employees for reason of age. In addition, the Contractor agrees to comply with any Implementing requirements FTA may issue.

4.Disabilities. In accordance with section 504 of the Rehabilitation Act of 1973, as amended, 29 U.S.C. § 794, the Americans with Disabilities Act of 1990, as amended, 42 U.S.C. § 12101 et seq., the Architectural Barriers Act of 1968, as amended, 42 U.S.C. § 4151 et seq., and Federal transit law at 49 U.S.C. § 5332, the Contractor agrees that it will not discriminate against individuals on the basis of disability. In addition, the Contractor agrees to comply with any implementing requirements FTA may issue.

5.Promoting Free Speech and Religious Liberty. The Contractor shall ensure that Federal funding is expended in full accordance with the U.S.

Constitution, Federal Law, and statutory and public policy requirements: including, but not limited to, those protecting free speech, religious liberty, public welfare, the environment, and prohibiting discrimination.

CONFORMANCE WITH ITS NATIONAL ARCHITECTURE
Intelligent Transportation Systems (ITS) projects shall conform to the National ITS Architecture and standards. Conformance with the National ITS Architecture is interpreted to mean the use of the National ITS Architecture to develop a regional ITS architecture in support of integration and the subsequent adherence of all ITS projects to that regional ITS architecture. Development of the regional ITS architecture should be consistent with the transportation planning process for Statewide and Metropolitan Transportation Planning (49 CFR Part 613 and 621).

DEBARMENT AND SUSPENSION
a. Applicability: This requirement applies to all FTA grant and cooperative agreement programs for a contract in the amount of at least $25,000 (1) This contract is a covered transaction for purposes of 2 C.F.R. pt. 180 and 2 C.F.R. pt. 3000. As such the contractor is required to verify that none of the contractor, its principals (defined at 2 C.F.R. § 180.995), or its affiliates (defined at 2 C.F.R. § 180.905) are excluded (defined at 2 C.F.R. § 180.940) or disqualified (defined at 2 C.F.R. § 180.935).
(2) C.F.R. pt. 3000, subpart C and must include a requirement to comply with these regulations in any lower tier covered transaction it enters into. (3) The accompanying certification is a material representation of fact relied upon by the subrecipient. If it is later determined that the contractor did not comply with 2 C.F.R. pt. 180, subpart C and 2 C.F.R. pt. 3000, subpart C, in addition to remedies available to the Agency and subrecipient, the Federal Government may pursue available remedies, including but not limited to suspension and/or debarment.

The bidder or proposer agrees to comply with the requirements of 2 C.F.R. pt. 180, subpart C and 2 C.F.R. pt. 3000, subpart C while this offer is valid and throughout the period of any contract that may arise from this offer. The bidder or proposer further agrees to include a provision requiring such compliance in its lower tier covered transactions.”
DISADVANTAGED BUSINESS ENTERPRISE (DBE)
The contractor or subcontractor shall not discriminate on the basis of race, color, national origin, or sex in the performance of this contract. The contractor shall carry out applicable requirements of 49 C.F.R. part 26 in the award and administration of DOT­assisted contracts. Failure by the contractor to carry out these requirements is a material breach of this contract, which may result in the termination of this contract or such other remedy as the Agency deems appropriate, which may include, but is not limited to:
(1) Withholding monthly progress payments; (2) Assessing sanctions; (3) Liquidated damages; and/or (4) Disqualifying the contractor from future bidding as non­responsible. 49 C.F.R. § 26.13(b).

Prime contractors are required to pay subcontractors for satisfactory performance of their contracts no later than 30 days from receipt of each payment the Agency makes to the prime contractor. 49 C.F.R. § 26.29(a).

Finally, for contracts with defined DBE contract goals, each FTA Recipient must include in each prime contract a provision stating that the contractor shall utilize the specific DBEs listed unless the contractor obtains the Agency’s written consent; and that, unless the Agency’s consent is provided, the contractor shall not be entitled to any payment for work or material unless it is performed or supplied by the listed DBE. 49 C.F.R. § 26.53(f) (1).

It is the policy of the Agency and the United States Department of Transportation (“DOT”) that Disadvantaged Business Enterprises (“DBE’s”), as defined herein and in the Federal regulations published at 49 C.F.R. part 26, shall have an equal opportunity to participate in DOT­assisted contracts.

DHS SEAL, LOGO, AND FLAGS
The contractor shall not use the DHS seal(s), logos, crests, or reproductions of flags or likenesses of DHS agency officials without specific FTA pre­ approval.

ENERGY CONSERVATION
The contractor agrees to comply with mandatory standards and policies relating to energy efficiency, which are contained in the state energy conservation plan issued in compliance with the Energy Policy and Conservation Act.

EQUAL EMPLOYMENT OPPORTUNITY
During the performance of this contract, the contractor agrees as follows:
(1) The contractor will not discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, or national origin. The contractor will take affirmative action to ensure that applicants are employed, and that employees are treated during employment, without regard to their race, color, religion, sex, sexual orientation, gender identity, or national origin. Such action shall include, but not be limited to the following: Employment, upgrading, demotion, or transfer, recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. The contractor agrees to post in conspicuous places, available to employees and applicants for employment, notices to be provided by the contracting officer setting forth the provisions of this nondiscrimination clause. (2) The contractor will, in all solicitations or advertisements for employees placed by or on behalf of the contractor, state that all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin. (3) The contractor will not discharge or in any other manner discriminate against any employee or applicant for employment because such employee or applicant has inquired about, discussed, or disclosed the compensation of the employee or applicant or another employee or applicant. This provision shall not apply to instances in which an employee who has access to the compensation information of other employees or applicants as a part of such employee's essential job functions discloses the compensation of such other employees or applicants to individuals who do not otherwise have access to such information, unless such disclosure is in response to a formal complaint or charge, in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or is consistent with the contractor's legal duty to furnish information. (4) The contractor will send to each labor union or representative of workers with which it has a collective bargaining agreement or other contract or understanding, a notice to be provided by the agency contracting officer, advising the labor union or workers' representative of the contractor's commitments under section 202 of Executive Order 11246 of September 24, 1965, and shall post copies of the notice in conspicuous places available to employees and applicants for employment.
(5) The contractor will comply with all provisions of Executive Order 11246 of September 24, 1965, and of the rules, regulations, and relevant orders of the Secretary of Labor.
(6) The contractor will furnish all information and reports required by Executive Order 11246 of September 24, 1965, and by the rules, regulations, and orders of the Secretary of Labor, or pursuant thereto, and will permit access to his books, records, and accounts by the contracting agency and the Secretary of Labor for purposes of investigation to ascertain compliance with such rules, regulations, and orders. (7) In the event of the contractor's non­compliance with the nondiscrimination clauses of this contract or with any of such rules, regulations, or orders, this contract may be canceled, terminated or suspended in whole or in part and the contractor may be declared ineligible for further Government contracts in accordance with procedures authorized in Executive Order 11246 of September 24, 1965, and such other sanctions may be imposed and remedies invoked as provided in Executive Order 11246 of September 24, 1965, or by rule, regulation, or order of the Secretary of Labor, or as otherwise provided by law. (8) The contractor will include the provisions of paragraphs (1) through (8) in every subcontract or purchase order unless exempted by rules, regulations, or orders of the Secretary of Labor issued pursuant to section 204 of Executive Order 11246 of September 24, 1965, so that such provisions will be binding upon each subcontractor or vendor. The contractor will take such action with respect to any subcontract or purchase order as may be directed by the Secretary of Labor as a means of enforcing such provisions including sanctions for noncompliance: Provided, however, that in the event the contractor becomes involved in, or is threatened with, litigation with a subcontractor or vendor as a result of such direction, the contractor may request the United States to enter into such litigation to protect the interests of the United States.

FEDERAL CHANGES
49 CFR Part 18 Federal Changes ­ Contractor shall at all times comply with all applicable FTA regulations, policies, procedures and directives, including without limitation those listed directly or by reference in the Master Agreement between Purchaser and FTA, as they may be amended or promulgated from time to time during the term of this contract. Contractor's failure to so comply shall constitute a material breach of this contract.

FLY AMERICA
a) Definitions. As used in this clause—
1) “International air transportation” means transportation by air between a place in the United States and a place outside the United States or between two places both of which are outside the United States. 2) “United States” means the 50 States, the District of Columbia, and outlying areas. 3) “U.S.­flag air carrier” means an air carrier holding a certificate under 49 U.S.C. Chapter 411. b) When Federal funds are used to fund travel, Section 5 of the International Air Transportation Fair Competitive Practices Act of 1974 (49 U.S.C. 40118) (Fly America Act) requires contractors, Agencys, and others use U.S.­flag air carriers for U.S. Government­financed international air transportation of personnel (and their personal effects) or property, to the extent that service by those carriers is available. It requires the Comptroller General of the United States, in the absence of satisfactory proof of the necessity for foreign­flag air transportation, to disallow expenditures from funds, appropriated or otherwise established for the account of the United States, for international air transportation secured aboard a foreign­flag air carrier if a U.S.­flag air carrier is available to provide such services.
c) If available, the Contractor, in performing work under this contract, shall use U.S.­flag carriers for international air transportation of personnel (and their personal effects) or property.
d) In the event that the Contractor selects a carrier other than a U.S.­flag air carrier for international air transportation, the Contractor shall include a statement on vouchers involving such transportation essentially as follows:

Statement of Unavailability of U.S.­Flag Air Carriers
International air transportation of persons (and their personal effects) or property by U.S.­flag air carrier was not available or it was necessary to use foreign­ flag air carrier service for the following reasons. See FAR § 47.403. [State reasons]:
e) Contractor shall include the substance of this clause, including this paragraph (e), in each subcontract or purchase under this contract that may involve international air transportation.

INCORPORATION OF FEDERAL TRANSIT ADMINISTRATION (FTA) TERMS Incorporation of Federal Transit Administration (FTA) Terms ­ The provisions within include, in part, certain Standard Terms and Conditions required by DOT, whether or not expressly set forth in the preceding contract provisions. All contractual provisions required by DOT, as set forth in the current FTA Circular 4220 are hereby incorporated by reference. Anything to the contrary herein notwithstanding, all FTA mandated terms shall be deemed to control in the event of a conflict with other provisions contained in this Contract. The Contractor shall not perform any act, fail to perform any act, or refuse to comply with any request which would cause a violation of the FTA terms and conditions.

NO GOVERNMENT OBLIGATION TO THIRD PARTIES
The Agency and Contractor acknowledge and agree that, notwithstanding any concurrence by the Federal Government in or approval of the solicitation or award of the underlying Contract, absent the express written consent by the Federal Government, the Federal Government is not a party to this Contract and shall not be subject to any obligations or liabilities to the Agency, Contractor or any other party (whether or not a party to that contract) pertaining to any matter resulting from the underlying Contract. The Contractor agrees to include the above clause in each subcontract financed in whole or in part with Federal assistance provided by the FTA. It is further agreed that the clause shall not be modified, except to identify the subcontractor who will be subject to its provisions.

NOTIFICATION TO FTA
If a current or prospective legal matter that may affect the Federal Government emerges, the Recipient must promptly notify the FTA Chief Counsel and FTA Regional Counsel for the Region in which the Recipient is located. The Recipient must include a similar notification requirement in its Third Party Agreements and must require each Third Party Participant to include an equivalent provision in its sub agreements at every tier, for any agreement that is a “covered transaction” according to 2 C.F.R. §§ 180.220 and 1200.220. (1) The types of legal matters that require notification include, but are not limited to, a major dispute, breach, default, litigation, or naming the Federal Government as a party to litigation or a legal disagreement in any forum for any reason. (2) Matters that may affect the Federal Government include, but are not limited to, the Federal Government’s interests in the Award, the accompanying Underlying Agreement, and any Amendments thereto, or the Federal Government’s administration or enforcement of federal laws, regulations, and requirements.
(3) The Recipient must promptly notify the U.S. DOT Inspector General in addition to the FTA Chief Counsel or Regional Counsel for the Region in which the Recipient is located, if the Recipient has knowledge of potential fraud, waste, or abuse occurring on a Project receiving assistance from FTA. The notification provision applies if a person has or may have submitted a false claim under the False Claims Act, 31 U.S.C. § 3729 et seq., or has or may have committed a criminal or civil violation of law pertaining to such matters as fraud, conflict of interest, bribery, gratuity, or similar misconduct. This responsibility occurs whether the Project is subject to this Agreement or another agreement between the Recipient and FTA, or an agreement involving a principal, officer, employee, agent, or Third Party Participant of the Recipient. It also applies to subcontractors at any tier. Knowledge, as used in this paragraph, includes, but is not limited to, knowledge of a criminal or civil investigation by a Federal, state, or local law enforcement or other investigative agency, a criminal indictment or civil complaint, or probable cause that could support a criminal indictment, or any other credible information in the possession of the Recipient.

PROCUREMENT OF RECOVERED MATERIALS
(1) In the performance of this contract, the Contractor shall make maximum use of products containing recovered materials that are EPA­ designated items unless the product cannot be acquired—
i. Competitively within a timeframe providing for compliance with the contract performance schedule; ii. Meeting contract performance requirements; or
iii. At a reasonable price.
(2) Information about this requirement, along with the list of EPA­designate items, is available at EPA’s Comprehensive Procurement Guidelines web site, https://www.epa.gov/smm/comprehensive­procurement­guideline­cpg­program.” PROGRAM FRAUD AND FALSE OR FRAUDULENT STATEMENTS AND RELATED ACTS The contractor acknowledges that 31 U.S.C. Chap. 38 (Administrative Remedies for False Claims and Statements) applies to the contractor’s actions pertaining to this contract.”
PROHIBITION ON CERTAIN TELECOMMUNICATIONS AND VIDEO SURVEILLANCE SERVICES OR EQUIPMENT. a.  Recipients and subrecipients are prohibited from obligating or expending loan or grant funds to:

1.  Procure or obtain;

2.  Extend or renew a contract to procure or obtain;or

3.  Enter into a contract (or extend or renew a contract) to procure or obtain equipment, services, or systems that uses covered telecommunications equipment or services as a substantial or essential component of any system, or as critical technology as part of any system. As described in Public Law 115­232, section 889, covered telecommunications equipment is telecommunications equipment produced by Huawei Technologies Company or ZTE Corporation (or any subsidiary or affiliate of such entities). i.  For the purpose of public saftey, security of government facilities, physical security surveillance of critical infrastructure, and other national security purposes, video surveillance and telecommunications equipment produced by Hytera Communications Corporation, Hangzhou Hikvision Digital Technology Company, or Dahua Technology Company(or any subsidiary or affiliate of such entities). ii.  Telecommunications or video surveillance services provided by such entities or using such equipment. iii.  Telecommunications or video surveillance equipment or services procuced or provided by an entity that the Secretary of Defense, in consultation with the Director of the National Intelligence or the Director of the Federal Bureau of Investigation, reasonably believes to be an entity owned or controlled by, or otherwise connected to, the government of a covered foreign country. b.  In implementing the prohibition under Public Law 115­232, section 889, subsection (f), paragraph (1), heads of executive agencies administering loan, grant, or subsidy programs shall prioritize available funding and technical support to assist affected businesses, institutions and organizations as is reasonably necessary for those affected entities to transition from covered communications equipment and services, to procure replacement equipment and services, and to ensure that communications service to users and customers is sustained. c.  See Public Law 115­232,section 889 for additional in formation. d.  See also $ 200.471.

PROMPT PAYMENT
The contractor is required to pay its subcontractors performing work related to this contract for satisfactory performance of that work no later than 30 days after the contractor’s receipt of payment for that work. In addition, the contractor is required to return any retainage payments to those subcontractors within 30 days after the subcontractor's work related to this contract is satisfactorily completed.

The contractor must promptly notify the Agency, whenever a DBE subcontractor performing work related to this contract is terminated or fails to complete its work and must make good faith efforts to engage another DBE subcontractor to perform at least the same amount of work. The contractor may not terminate any DBE subcontractor and perform that work through its own forces or those of an affiliate without prior written consent of the Agency.

SAFE OPERATION OF MOTOR VEHICLES
Seat Belt Use
The Contractor is encouraged to adopt and promote on­the­job seat belt use policies and programs for its employees and other personnel that operate company­owned vehicles, company rented vehicles, or personally operated vehicles. The terms “company­owned” and “company­leased” refer to vehicles owned or leased either by the Contractor or Agency.

Distracted Driving
The Contractor agrees to adopt and enforce workplace safety policies to decrease crashes caused by distracted drivers, including policies to ban text messaging while using an electronic device supplied by an employer, and driving a vehicle the driver owns or rents, a vehicle Contactor owns, leases, or rents, or a privately­owned vehicle when on official business in connection with the work performed under this Contract.

SPECIAL NOTIFICATION REQUIREMENTS FOR STATES
Applies to States –
a. To the extent required under federal law, the State, as the Recipient, agrees to provide the following information about federal assistance awarded for its State Program, Project, or related activities:
(1) The Identification of FTA as the federal agency providing the federal assistance for a State Program or Project; (2) The Catalog of Federal Domestic Assistance Number of the program from which the federal assistance for a State Program or Project is authorized; and
(3) The amount of federal assistance FTA has provided for a State Program or Project. b. Documents ­ The State agrees to provide the information required under this provision in the following documents: (1) applications for federal assistance, (2) requests for proposals or solicitations, (3) forms, (4) notifications, (5) press releases, and (6) other publications.

TERMINATION
Termination for Convenience (General Provision)
The Agency may terminate this contract, in whole or in part, at any time by written notice to the Contractor when it is in the Agency’s best interest. The Contractor shall be paid its costs, including contract close­out costs, and profit on work performed up to the time of termination. The Contractor shall promptly submit its termination claim to Agency to be paid the Contractor. If the Contractor has any property in its possession belonging to Agency, the Contractor will account for the same, and dispose of it in the manner Agency directs.

Termination for Default [Breach or Cause] (General Provision) If the Contractor does not deliver supplies in accordance with the contract delivery schedule, or if the contract is for services, the Contractor fails to perform in the manner called for in the contract, or if the Contractor fails to comply with any other provisions of the contract, the Agency may terminate this contract for default. Termination shall be effected by serving a Notice of Termination on the Contractor setting forth the manner in which the Contractor is in default.

The Contractor will be paid only the contract price for supplies delivered and accepted, or services performed in accordance with the manner of performance set forth in the contract. If it is later determined by the Agency that the Contractor had an excusable reason for not performing, such as a strike, fire, or flood, events which are not the fault of or are beyond the control of the Contractor, the Agency, after setting up a new delivery of performance schedule, may allow the Contractor to continue work, or treat the termination as a Termination for Convenience.

Opportunity to Cure (General Provision)
The Agency, in its sole discretion may, in the case of a termination for breach or default, allow the Contractor [an appropriately short period of time] in which to cure the defect. In such case, the Notice of Termination will state the time period in which cure is permitted and other appropriate conditions If Contractor fails to remedy to Agency's satisfaction the breach or default of any of the terms, covenants, or conditions of this Contract within [10 days] after receipt by Contractor of written notice from Agency setting forth the nature of said breach or default, Agency shall have the right to terminate the contract without any further obligation to Contractor. Any such termination for default shall not in any way operate to preclude Agency from also pursuing all available remedies against Contractor and its sureties for said breach or default.

Waiver of Remedies for any Breach
In the event that Agency elects to waive its remedies for any breach by Contractor of any covenant, term or condition of this contract, such waiver by Agency shall not limit Agency’s remedies for any succeeding breach of that or of any other covenant, term, or condition of this contract.

Termination for Convenience (Professional or Transit Service Contracts) The Agency, by written notice, may terminate this contract, in whole or in part, when it is in the Agency’s interest. If this contract is terminated, the Agency shall be liable only for payment under the payment provisions of this contract for services rendered before the effective date of termination.

Termination for Default (Supplies and Service)
If the Contractor fails to deliver supplies or to perform the services within the time specified in this contract or any extension, or if the Contractor fails to comply with any other provisions of this contract, the Agency may terminate this contract for default. The Agency shall terminate by delivering to the Contractor a Notice of Termination specifying the nature of the default. The Contractor will only be paid the contract price for supplies delivered and accepted, or services performed in accordance with the manner or performance set forth in this contract. If, after termination for failure to fulfill contract obligations, it is determined that the Contractor was not in default, the rights and obligations of the parties shall be the same as if the termination had been issued for the convenience of the Agency.

Termination for Default (Transportation Services)
If the Contractor fails to pick up the commodities or to perform the services, including delivery services, within the time specified in this contract or any extension, or if the Contractor fails to comply with any other provisions of this contract, the Agency may terminate this contract for default. The Agency shall terminate by delivering to the Contractor a Notice of Termination specifying the nature of default. The Contractor will only be paid the contract price for services performed in accordance with the manner of performance set forth in this contract.

If this contract is terminated while the Contractor has possession of Agency goods, the Contractor shall, upon direction of the Agency, protect and preserve the goods until surrendered to the Agency or its agent. The Contractor and Agency shall agree on payment for the preservation and protection of goods.

Failure to agree on an amount will be resolved under the Dispute clause.

If, after termination for failure to fulfill contract obligations, it is determined that the Contractor was not in default, the rights and obligations of the parties shall be the same as if the termination had been issued for the convenience of the Agency.

Termination for Default (Construction)
If the Contractor refuses or fails to prosecute the work or any separable part, with the diligence that will ensure its completion within the time specified in this contract or any extension or fails to complete the work within this time, or if the Contractor fails to comply with any other provision of this contract, Agency may terminate this contract for default. The Agency shall terminate by delivering to the Contractor a Notice of Termination specifying the nature of the default.

In this event, the Agency may take over the work and compete it by contract or otherwise, and may take possession of and use any materials, appliances, and plant on the work site necessary for completing the work. The Contractor and its sureties shall be liable for any damage to the Agency resulting from the Contractor's refusal or failure to complete the work within specified time, whether or not the Contractor's right to proceed with the work is terminated. This liability includes any increased costs incurred by the Agency in completing the work.

The Contractor's right to proceed shall not be terminated nor shall the Contractor be charged with damages under this clause if: 1. The delay in completing the work arises from unforeseeable causes beyond the control and without the fault or negligence of the Contractor. Examples of such causes include: acts of God, acts of Agency, acts of another contractor in the performance of a contract with Agency, epidemics, quarantine restrictions, strikes, freight embargoes; and 2. The Contractor, within [10] days from the beginning of any delay, notifies Agency in writing of the causes of delay. If, in the judgment of Agency, the delay is excusable, the time for completing the work shall be extended. The judgment of Agency shall be final and conclusive for the parties, but subject to appeal under the Disputes clause(s) of this contract. 3. If, after termination of the Contractor's right to proceed, it is determined that the Contractor was not in default, or that the delay was excusable, the rights and obligations of the parties will be the same as if the termination had been issued for the convenience of Agency.

Termination for Convenience or Default (Architect and Engineering) The Agency may terminate this contract in whole or in part, for the Agency’s convenience or because of the failure of the Contractor to fulfill the contract obligations. The Agency shall terminate by delivering to the Contractor a Notice of Termination specifying the nature, extent, and effective date of the termination. Upon receipt of the notice, the Contractor shall (1) immediately discontinue all services affected (unless the notice directs otherwise), and (2) deliver to the Agency ‘s Contracting Officer all data, drawings, specifications, reports, estimates, summaries, and other information and materials accumulated in performing this contract, whether completed or in process. Agency has a royalty­free, nonexclusive, and irrevocable license to reproduce, publish or otherwise use, all such data, drawings, specifications, reports, estimates, summaries, and other information and materials.

If the termination is for the convenience of the Agency, the Agency’s Contracting Officer shall make an equitable adjustment in the contract price but shall allow no anticipated profit on unperformed services. If the termination is for failure of the Contractor to fulfill the contract obligations, the Agency may complete the work by contact or otherwise and the Contractor shall be liable for any additional cost incurred by the Agency. If, after termination for failure to fulfill contract obligations, it is determined that the Contractor was not in default, the rights and obligations of the parties shall be the same as if the termination had been issued for the convenience of Agency Termination for Convenience or Default (Cost­Type Contracts) The Agency may terminate this contract, or any portion of it, by serving a Notice of Termination on the Contractor. The notice shall state whether the termination is for convenience of Agency or for the default of the Contractor. If the termination is for default, the notice shall state the manner in which the Contractor has failed to perform the requirements of the contract. The Contractor shall account for any property in its possession paid for from funds received from the Agency, or property supplied to the Contractor by the Agency. If the termination is for default, the Agency may fix the fee, if the contract provides for a fee, to be paid the Contractor in proportion to the value, if any, of work performed up to the time of termination. The Contractor shall promptly submit its termination claim to the Agency and the parties shall negotiate the termination settlement to be paid the Contractor.

If the termination is for the convenience of Agency, the Contractor shall be paid its contract close­out costs, and a fee, if the contract provided for payment of a fee, in proportion to the work performed up to the time of termination.

If, after serving a Notice of Termination for Default, the Agency determines that the Contractor has an excusable reason for not performing, the Agency, after setting up a new work schedule, may allow the Contractor to continue work, or treat the termination as a Termination for Convenience.

GOVERNMENT­WIDE DEBARMENT AND SUSPENSION
(NONPROCUREMENT)
Instructions for Certification:   By signing and submitting this bid or proposal, the prospective lower tier participant is providing the signed certification set out below.
(1) It will comply and facilitate compliance with U.S. DOT regulations, “Nonprocurement Suspension and Debarment,” 2 CFR part 1200, which adopts and supplements the U.S. Office of Management and Budget (U.S. OMB) “Guidelines to Agencies on Governmentwide Debarment and Suspension (Nonprocurement),” 2 CFR part 180,
(2) To the best of its knowledge and belief, that its Principals and Subrecipients at the first tier:
a.  Are eligible to participate in covered transactions of any Federal department or agency and are not presently:

1.  Debarred,

2.  Suspended,

3.  Proposed for debarment,

4.  Declared ineligible,

5.  Voluntarily excluded, or

6.  Disqualified,
b.  Its management has not within a three­year period preceding its latest application or proposal been convicted of or had a civil judgment rendered against any of them for:

1.  Commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or local) transaction, or contract under a public transaction,

2.  Violation of any Federal or State antitrust statute, or,

3.  Commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making any false statement, or receiving stolen property,
c.  It is not presently indicted for, or otherwise criminally or civilly charged by a governmental entity (Federal, State, or local) with commission of any of the offenses listed in the preceding subsection 2.b of this Certification, d.  It has not had one or more public transactions (Federal, State, or local) terminated for cause or default within a three­year period preceding this Certification,
e.  If, at a later time, it receives any information that contradicts the statements of subsections 2.a – 2.d above, it will promptly provide that information to FTA,
f.  It will treat each lower tier contract or lower tier subcontract under its Project as a covered lower tier contract for purposes of 2 CFR part 1200 and 2 CFR part 180 if it:

1.  Equals or exceeds $25,000,,

2.  Is for audit services, or,

3.  Requires the consent of a Federal official, and
g.  It will require that each covered lower tier contractor and subcontractor:

1.  Comply and facilitate compliance with the Federal requirements of 2 CFR parts 180 and 1200, and

2.  Assure that each lower tier participant in its Project is not presently declared by any Federal department or agency to be:
a.  Debarred from participation in its federally funded Project, b.  Suspended from participation in its federally funded Project, c.  Proposed for debarment from participation in its federally funded Project, d.  Declared ineligible to participate in its federally funded Project, e.  Voluntarily excluded from participation in its federally funded Project, or f.  Disqualified from participation in its federally funded Project, and

3.  It will provide a written explanation as indicated on a page attached in FTA’s TrAMS platform or the Signature Page if it or any of its principals, including any of its first tier Subrecipients or its Third­Party Participants at a lower tier, is unable to certify compliance with the preceding statements in this Certification Group.
(3) It will provide a written explanation as indicated on a page attached in FTA’s TrAMS platform or the Signature Page if it or any of its principals, including any of its first tier Subrecipients or its Third­Party Participants at a lower tier, is unable to certify compliance with the preceding statements in this Certification Group.

Certification
Contractor:________________________________________________________________________________________ Signature of Authorized Official:______________________________________________Date_______/_______/_______ Name and Title of Contractor's Authorized Official:_________________________________________________________ Delta Motor Co., Inc.
08/16/2022
Owner/ President / CEO

PLANNING AND ENVIRONMENTAL

QUALITY COMMISSION
Regular PEQC Meeting Notice and Agenda
Website: www.cityofgardena.org
Tuesday, September 6, 2022 – 7:00 PM
1700 W. 162nd Street, Gardena, California

5. PUBLIC HEARING ITEMS

5. A Zone Text Amendment #2-22 (Ordinance No. 1844)
The Planning Commission considered an Ordinance amending Title 18, Zoning, of the Gardena Municipal Code to prohibit short-term rentals of residences for lodging purposes and short-term rentals of residences for other commercial uses not listed as allowed uses under the Gardena Municipal Code. The Ordinance is exempt from the provisions of the California Environmental Quality Act pursuant to the commonsense exemption set forth in Guidelines section 15061(b)(3).

APPLICANT: City
LOCATION: Citywide
Staff Report.pdf
Attachment A - Council Agenda Staff Report.pdf
Attachment B - Council PowerPoint Presentation.pdf
Attachment C - Public Comment 08.22.2022.pdf
Attachment C - Public Comments Received 09.06.2022.pdf
Attachment D - Resolution No. PC 11-22_Draft Ordinance.pdf

Commission Action: The Planning Commission adopted Ordinance No. P C 11- 22, by vote of 3-1-0, recommending the City Council adopt Ordinance No. 1844 to prohibit short-term rentals.

City of Gardena
Gardena City Council Meeting

AGENDA REPORT SUMMARY
Agenda Item No. 11.A
Section: DEPARTMENTAL

ITEMS - ADMINISTRATIVE

SERVICES
Meeting Date: September 13,
2022

TO: THE HONORABLE MAYOR AND MEMBERS OF THE GARDENA CITY COUNCIL AGENDA TITLE:

Worker's Compensation Third-Party Administrator (TPA) Professional Services Agreement
COUNCIL ACTION REQUIRED:

Staff Recommendation: Authorize and Execute a Professional Services Agreement RECOMMENDATION AND STAFF SUMMARY:

Staff respectfully recommends that City Council authorize and execute an agreement with LWP Claims Solutions, Inc (LWP) for professional services as the Third Party Administrator (TPA) of the City's self-insured workers' compensation for the period from November 1, 2022 through October 31, 2025,with two additional one-year options at the City's direction to exercise.

On June 3, 2022 the City issued a request for proposal (RFP) for Third Party Workers' Compensation Claims Administration and received five responses, which the City and its consultant did a comprehensive review of each of these proposals and invited the top three candidates; LWP, Intercare Holdings Inc, and Acclamation Insurance Management Services (AIMS) to be interviewed by City staff and our consultant. The City considered various factors in making a final selection, including the annual claims administration fee to the City, the cost for additional services (including bill review and utilization review) , the staffing levels offered by the TPA as part of the flat annual claims administration fee, the TPA's approach to claims management, the management team assigned to the account and the TPA's recommendation for reducing the City's overall expenditures on workers compensation claims. Based on these factors, staff recommends LWP as the best qualified candidate to meet the City's needs and administer the workers' compensation program.

LWP has been in business for over thirty years, has extensive experience with self-insured municipalities and based on a review of LWP's detailed written proposal, the presentation by LWP and discussions with current public entity LWP clients, staff believes entering into an agreement with LWP, will over the course of the agreement promote financial stability by reducing the current inventory of open claims, resolving future claims before the litigation stage and ensuring that injured City employees receive the medical treatment they need in a timely efficient manner.

LWP will replace the City's current TPA; Adminsure who's contract expires on October 31, 2022 and has been the City's TPA since 2007. The City has had a long satisfactory relationship with Adminsure, a competitive proposal process was completed in order to ensure that the City is obtaining the best price for the most efficient services.

Staff therefore recommends that the City Council approve the professional services agreement with LWP.

FINANCIAL IMPACT/COST:

Fiscal
Year
Total
Fixed
Costs
Funding
Source
2022-
23 $172,833
Workers'
Comp
Fund 13
2023-
24 $255,460
Workers'
Comp
Fund 13
2024-
25 $263,049
Workers'
Comp
Fund 13
2025-
26 $270,865
Workers'
Comp
Fund 13
2026-
27 $278,916
Workers'
Comp
Fund 13
2027-
28 $93,042
Workers'
Comp
Fund 13
TOTAL
$1,334,165

ATTACHMENTS:

Staff_Report_-_RFP_ TPA_SEP 13 2022.pdf
LWP Claims Solutions, Inc- Agreement.pdf

APPROVED:
___________________________________
Clint Osorio, City Manager

City of Gardena Department: Administrative Services City Council Meeting Meeting Date: September 13, 2022

AGENDA STAFF REPORT

AGENDA TITLE: WORKER’S COMPENSATION THIRD-PARTY ADMINSTRATOR (TPA)

PROFESSIONAL SERVICES AGREEMENT

RECOMMENDATION:

Staff respectfully recommends that City Council authorize and execute an agreement with LWP Claims Solutions, Inc (LWP) for professional services as the Third- Party Administrator (TPA) of the City's self-insured workers' compensation program for the period from November 1, 2022, through October 31, 2025, with two additional one-year options at the City's direction to exercise.

BACKGROUND:

Worker’s compensation, which is mandated by the State Labor Code, provides medical treatment coverage, temporary and permanent disability payments, survivor’s death benefits and total disability pension benefits for employees, officers and elected officials suffering from an industrial injury or illness. The City self -insures for workers’ compensation and contracts with a TPA to administer claims. The TPA model allows the City to benefit from professional, experienced claims handlers who are able to draw on a large knowledge pool, past experiences, and current trends to assist in reducing outside litigation costs.

The City issued a request for proposal (RFP) for a Third- Party Administrator (TPA) for Workers’ Compensation claims and received five (5) responses:

1. Acclamation Insurance Management Services (AIMS)

2. Intercare Holdings Inc.

3. LWP Claims Solutions, Inc. (LWP)

4. ICS

5. Tristar

City Administrative Services Staff and the City’s consultant for workers compensation, Tony Su with TCS Risk Management Services, LLC, reviewed the proposals. The analysis included annual claims administration fee to the City, cost for additional services (including bill review and utilization review), staffing levels offered by the TPA as part of the flat annual claims administration fee, the TPA's approach to claims management, the management team assigned to the account, the TPA's recommendation for reducing the City's overall expenditures on workers ’ compensation claims, the overall total projected five-year costs, Municipal Clients and Client references. Three (3) firms were selected to move forward and participate in an in-person interview on Monday August 29, 2022, with City Staff and our consultant. The staff included on the interview panel was Ray Beeman, Director of Administrative Services, Diana Schnur, Human Resources Manager, Jessica Anderson, Human Resources Analyst, Todd Fox, Police Captain, Ernie Crespo, Director of Transportation and Tony Su, Consultant with TCS Risk Management Services, LLC.

The three (3) firms interviewed, and their projected 5-Year Total Fixed Fees were as follows:
1) AIMS – Estimated 5-Year Annual Fixed Fees - $1,420,993 2) Intercare Holdings, Inc - Estimated 5-Year Annual Fixed Fees - $1,659,482 3) LWP - Estimated 5-Year Annual Fixed Fees - $1,334,165

The panel interview consiste d of an applicant presentation on the specifics of what their company had to offer the City, followed by a question and answer round table with the applicants. At the conclusion of the interviews, the panel discussed the specifics of each of the distinctiv e services offered by each company, the companies’ fit with the City and the relative cost of each. Based on this analysis, staff is recommending the contract be awarded to LWP. LWP will replace the City's current TPA, Adminsure; Adminsure ’s contract expires on October 31, 2022 and has been the City's TPA since 2007. The City has had a long satisfactory relationship with Adminsure. A competitive proposal process was completed in order to ensure that the City is obtaining the best price for the most efficient services.

LWP has been in business for over thirty years and has extensive experience with self -insured municipalities. Based on a review of LWP’s detailed written proposal, the presentation by LWP and discussion with current public entity LWP clients, staff believes entering into an agreement with LWP, will over the course of the agreement, promote financial stability by reducing the current inventory of open claims, resolving future claims before the litigation stage and ensuring that injured City employees receive the medical treatment they need in a timely efficient manner. LWP has significant experience with transportation and police operations.

CONCLUSION:

Based on all the factors of service, cost and fit with the City of Gardena, and the extensive process the City completed to select a new TPA, staff recommends that City Council approve a professional agreement with LWP Claims Solutions, Inc (LWP) for professional services as the Third- Party Administrator (TPA) of the City's self -insured workers' compensation program for the period from November 1, 2022, through October 31, 2025, with two (2) additional one-year options at the City's discretion to exercise.

Submitted by: Ray Beeman, Director of Administrative Services Date: September 13, 2022

AGREEMENT BETWEEN THE

THE CITY OF GARDENA
AND
LWP Claims Solutions, Inc.

FOR THIRD PARTY WORKERS’ COMPENSATION CLAIMS ADMINISTRATION

This contract, hereinafter referred to as Agreement is entered into this October 17, 2022, by and between THE CITY OF GARDENA (“City”) and LWP Claims Solutions, Inc., a California corporation (“Consultant”). Based on the mutual promises and covenants contained herein, the Parties hereto agree, as follows.

1. Recitals.

A. City is desirous of obtaining services necessary to provide third party workers’ compensation claims administration.

B. Consultant is qualified by virtue of experience, training, education, and expertise to provide these services.

C. City has determined that the public interest, convenience, and necessity require the execution of this Agreement.

2. Services.

A. Consultant shall provide the professional services described in the City’s Request for Proposal (“RFP”), attached hereto as Exhibit “A,” and Consultant’s Response to City’s RFP (the “Response”) attached hereto as Exhibit “B,” both incorporated herein by this reference, unless otherwise instructed by City.

B. Consultant shall not be liable for any failure or delay in furnishing proposed services resulting from fire, explosion, flood, storm, Act of God, governmental acts, orders or regulations, hostilities, civil disturbances, strikes, labor difficulties, difficulty in obtaining parts, supplies, or shipping facilities, inability to obtain or delays in obtaining suitable material or facilities required for performance, temporary unavailability of qualified personnel, failure by City to provide appropriate access to equipment or personnel, or other causes beyond Consultant’s reasonable control.

3. Additional Services. If City determines that additional services are required to be provided by the Consultant in addition to the Services set forth above, City shall authorize the Consultant to perform such additional services in writing (“Additional Services”). Such Additional Services shall be specifically described and approved by City in writing prior to the performance thereof. Consultant shall be compensated for

such Additional Services in accordance with the amount agreed upon in writing by the Parties. No compensation shall be paid to Consultant for Additional Services which are not specifically approved by City in writing.

4. Agreement Administrator. For purposes of this Agreement, City designates Ray Beeman as the Agreement Administrator who shall monitor Consultant’s performance under this Agreement. All notices, invoices or other documents shall be addressed to the Agreement Administrator, as well as all substantive issues relating to this contract.

City reserves the right to change this designation upon written notice to Consultant.

5. Consultant’s Proposal. This Agreement shall include Consultant’s proposal or bid which is incorporated herein as Exhibit B. In the event of any inconsistency between the terms of the proposal and this Agreement, this Agreement shall govern.

6. Timing of Performance. Time is of the essence with respect to Consultant’s performance of the Services required by this Agreement. Consultant shall diligently and timely pursue and complete the performance of the Services required of it by this Agreement as set forth in Exhibit A. City, in its sole discretion, may extend the time for performance of any Service.

7. Compensation. City shall pay to Consultant an annual fee of two hundred forty- eight thousand dollars ($248,000) for year one (1); two hundred fifty-five thousand, four hundred and forty dollars ($255,440) for year two (2); two hundred sixty-three thousand, one hundred and three dollars ($263,103) for year three (3); two hundred seventy thousand, nine hundred and ninety-six dollars ($270,996) for optional renewal year four (4), should the City exercise that option; and two hundred seventy-nine thousand, one hundred twenty-six-two dollars ($279,126) for optional renewal year five (5), should the City exercise that option; as set forth in Exhibit “B”. Additionally, there will be a one-time Transition Fee of five thousand dollars ($5,000) and an annual administration fee of two thousand and five hundred dollars ($2,500). Additionally, City and Consultant have agreed to streamline the managed care costs associated with all workers’ compensation claims. Therefore, fees for managed care services will be charged in accordance with Exhibit “B” and may be in addition to the annual fee described above. It is hereby mutually understood by City and Consultant that the fees specified in this Agreement for Consultant’s services are all-inclusive. Accordingly, there will be no additional payments made to Consultant for additional services, supplies, etc., other than as set forth in this Agreement.

8. Term of Agreement/Termination.

A. The term of this Agreement shall be for three (3) years commencing November 1, 2022, and expiring October 31, 2025 (notwithstanding, Consultant agrees to begin accepting new claims from CITY two (2) weeks prior to November 1, 2022, in an effort to effectuate the transition of services – all terms herein apply during this transition period – covered in part by the Transition Fee described herein). At the

conclusion of the initial three (3) years, the CITY shall have two (2) options to renew this Agreement for additional one (1) year terms. If the terms, conditions, and pricing of any renewal remain as set forth herein, the parties shall execute an amendment to this Agreement approved by the City Manager. If the parties renegotiate the terms, conditions or pricing of the Agreement, the parties shall execute an amendment to this Agreement approved by the City Council. If after the conclusion of the initial or renewed term the parties decide to renew but have not completed renegotiations on a renewed agreement, the term of this Agreement or renewed agreement, as applicable, shall be on a month-to-month basis until a renewed agreement becomes effective. The month- to-month term shall be on the same terms and conditions of this Agreement or renewed agreement, as applicable

B. City may terminate this Agreement without cause by providing written notice to Consultant not less than three days prior to an effective termination date.

City’s only obligation in the event of termination will be payment of fees and allowed expenses incurred up to and including the effective date of termination.

C. Unless for cause, Consultant may not terminate this Agreement. If Consultant is terminating this Agreement for cause, it must provide the City with thirty (30) days written notice.

D. Upon receipt of a termination notice, Consultant shall: (1) promptly discontinue all Services, unless the notice directs otherwise; and (2) within ten (10) days, deliver to City all files, data, reports, estimates, summaries, and such other information and materials as may have been accumulated or prepared to date by Consultant in performing the Services under this Agreement, whether completed or in progress. Consultant shall provide these documents by both hard copy and in electronic format if available. In the event of termination for other than cause attributable to Consultant, Consultant shall be entitled to reasonable compensation for the services it performs up to the date of termination and shall be deemed released from liability for any work assigned but not completed as of the effective date of termination.

9. Invoices and Payments.

A. Payment shall be made upon receipt and approval of invoices for Services rendered. In order for payment to be made, Consultant’s invoice must include an itemization as to the services rendered, date(s) of service, direct and/or subcontract costs, and be submitted on an official letterhead or invoice with Consultant’s name, address, and telephone number referenced.

B. The Agreement Administrator shall review the invoices to determine whether services performed and documents submitted are consistent with this Agreement. Payment shall be made within forty-five (45) days following receipt of the invoice or the Agreement Administrator shall provide Consultant with a written statement objecting to the charges and stating the reasons therefore.

C. P
ayment by City under this Agreement shall not be deemed a waiver of defects, even if such defects were known to City at the time of payment.

10. Records/Audit.

A. C
onsultant shall be responsible for ensuring accuracy and propriety of all billings and shall maintain all supporting documentation for a minimum of three (3) years from the completion date of the Services under this agreement the following records:

1. A
ll accounts and records, including personnel, property and financial, adequate to identify and account for all costs pertaining to this Agreement and assure proper accounting for all funds;

2. R
ecords which establish that Consultant and any subconsultant who renders Services under this Agreement are in full compliance with the requirements of this Agreement and all federal, state and local laws and regulations

3. A
ny additional records deemed necessary by City to assume verification of full compliance with this Agreement.

B. C
ity shall have the right to audit Consultant’s invoices and all supporting documentation for purposes of compliance with this Agreement for a period of three years following the completion of Services under this Agreement.

C. U
pon reasonable notice from City or any other governmental agency, Consultant shall cooperate fully with any audit of its billings conducted by, or of, City and shall permit access to its books, records and accounts as may be necessary to conduct such audits.

11. Successors and Assignment. This Agreement covers professional services of a specific and unique nature. Except as otherwise provided herein, Consultant shall not assign or transfer its interest in this Agreement or subcontract any services to be performed without amending this Agreement. This Agreement shall be binding upon the heirs, executors, administrators, successors and assigns of the parties hereto.

12. Change in Name, Ownership or Control. Consultant shall notify the Agreement Administrator, in writing, of any change in name, ownership or control of Consultant’s firm or subconsultant. Change of ownership or control of Consultant’s firm may require an amendment to the Agreement.

13. Key Personnel. City has relied upon the professional training and ability of Consultant to perform the services hereunder as a material inducement to enter into this Agreement. Consultant shall provide properly skilled professional and technical personnel to perform all services under this Agreement. In the event that City, in its sole discretion, at any time during the Agreement, desires the removal of any person or persons assigned by Consultant to perform Services pursuant to this Agreement, Consultant shall remove any such person immediately upon receiving notice from City.

14. Use of Materials.

A. C
ity shall make available to Consultant such materials from its files as may be required by Consultant to perform Services under this Agreement. Such materials shall remain the property of City while in Consultant’s possession. Upon termination of this Agreement and payment of outstanding invoices of Consultant, or completion of work under this Agreement, Consultant shall return to City any property of City in its possession and any calculations, notes, reports, electronic files, or other materials prepared by Consultant in the course of performance of this Agreement.

B. C
ity may utilize any material prepared or work performed by Consultant pursuant to this Agreement, including computer software, in any manner, which City deems proper without additional compensation to Consultant. Consultant shall have no responsibility or liability for any revisions, changes, or corrections made by City, or any use or reuse pursuant to this paragraph unless Consultant accepts such responsibility in writing.

15. Nonuse of Intellectual Property of Third Parties. Consultant shall not use, disclose or copy any intellectual property of any third parties in connection with work carried out under this Agreement, except for intellectual property for which Consultant has a license. Consultant shall indemnify and hold City harmless against all claims raised against City based upon allegations that Consultant has wrongfully used intellectual property of others in performing work for City, or that City has wrongfully used intellectual property developed by Consultant pursuant to this Agreement.

16. Ownership of Work Product. All documents or other information created, developed, or received by Consultant shall, for purposes of copyright law, be deemed worked made for hire for City by Consultant and shall be the sole property of City.

Consultant shall provide City with copies of these items upon demand, and in any event, upon termination of this Agreement.

17. Legal Requirements.

A. Consultant shall secure and maintain all licenses or permits required by law, including a City business license, and shall comply with all ordinances, laws, orders, rules, and regulations pertaining to the work.

B. Consultant warrants that it shall perform the services required by this Agreement in compliance with all applicable Federal and California employment laws, including, but not limited to, those laws related to minimum hours and wages; occupational health and safety; fair employment and employment practices; workers’ compensation insurance and safety in employment; and all other Federal, State and local laws and ordinances applicable to the services required under this Agreement. Consultant shall indemnify and hold harmless City from and against all claims, demands, payments, suits, actions, proceedings, and judgments of every nature and description including attorneys’ fees and costs, presented, brought, or recovered against City for, or on account of any liability under any of the above-mentioned laws, which may be incurred by reason of Consultant’s performance under this Agreement.

C. Consultant covenants that thee shall be no discrimination based upon race, color, creed, religion, sex, marital status, age, handicap, national origin or ancestry, or any other category forbidden by law in performance of this Agreement.

18. Conflict of Interest and Reporting.

A . Consultant shall at all times avoid conflicts of interest or the appearance of a conflict of interest in the performance of this Agreement. If required, Consultant shall comply with the City’s Conflict of Interest reporting requirements. Consultant understands that pursuant to Gardena Municipal Code sections 2.24.020H and

2.24.025G, it is forbidden to make any contribution to a candidate or committee of a candidate for a municipal office of the City, or to an officeholder, until the completion of services to be performed under this Agreement.

B. Consultant and its representatives shall refrain from lobbying City of Gardena officials, employees and representatives for the duration of this Agreement.

19. Guarantee and Warranty. Consultant warrants to City that the material, analysis, data, programs and SERVICES to be delivered or rendered hereunder will be of the kind and quality designated and will be performed by qualified personnel. Without waiver of City’s other rights or remedies, City may require Consultant to re-perform any of said services, which were not performed in accordance with these standards.

Consultant shall perform the remedial services at its sole expense.

20. Insurance.

A. Commencement of Work. Consultant shall not commence work under this Agreement until it has obtained City approved insurance. Before beginning work hereunder, during the entire period of this Agreement, for any extensions hereto, and for periods after the end of this Agreement as may be indicated below, Consultant must have and maintain in place all of the insurance coverage required in this Section.

Consultant’s insurance shall comply with all items specified by this Agreement. Any subcontractors shall be subject to all of the requirements of this Section and Consultant shall be responsible to obtain evidence of insurance from each subcontractor and provide it to City before the subcontractor commences work. Alternatively, Consultant’s insurance may cover all subcontractors.

B. Insurance Company Requirements. All insurance policies used to satisfy the requirements imposed hereunder shall be issued by insurers admitted to do business in the State of California. Insurers shall have a current Best’s rating of not less than A-:VII, unless otherwise approved by City.

C. Coverage, Limits and Policy Requirements. Consultant shall maintain the types of coverage and limits indicated below:

1. Commercial General Liability Insurance - a policy for occurrence coverage for bodily injury, personal injury and property damage, including all coverage provided by and to the extent afforded by Insurance Services Office Form CG 2010 ed. 10/93 or 11/85, with no special limitations affecting City. The limit for all coverage under this policy shall be no less than one million dollars ($1,000,000.00) per occurrence.

2. Commercial Auto Liability Insurance - a policy including all coverage provided by and to the extent afforded by Insurance Services Office form CA 0001, ed. 12/93, including Symbol 1 (any auto) with no special limitations affecting City.

The limit for bodily injury and property damage liability shall be no less than one million dollars ($1,000,000.00) per accident.

3. Policy Requirements. The policies set forth above shall comply with the following, as evidenced by the policies or endorsements to the policies:

a. The City, its appointed and elected officers, employees, agents and volunteers shall be added as additional insured to the policy.

b. The insurer shall agree to provide City with thirty (30) days prior written notice, return receipt requested, of any cancellation, non-renewal or material change in coverage.

c. For any claims with respect to the Services covered by this Agreement, Consultant’s insurance coverage shall be primary insurance as respects the City, its elected and appointed officers, employees, agents and volunteers. Any insurance or self-insurance maintained by the City, its elected and appointed officers, employees, agents and volunteers shall be excess of Consultant’s insurance and shall not contribute with it.

4. Worker’s Compensation and Employer’s Liability Insurance - a policy which meets all statutory benefit requirements of the Labor Code, or other applicable law, of the State of California. The minimum coverage limits for said insurance shall be no less than one million dollars per claim. The policy shall be issued by an insurance company which is admitted to do business in the State of California and shall contain a clause that the policy may not be canceled without thirty (30) days prior written notice, return receipt requested, is mailed to City.

5. Professional Errors & Omissions - a policy with minimum limits of one million dollars ($1,000,000.00) per claim and aggregate. This policy shall be issued by an insurance company which is admitted to do business in the State of California and shall contain a clause that the policy may not be canceled until thirty (30) days written notice, return receipt requested, is mailed to City.

D. Additional Requirements. The procuring of such required policies of insurance shall not be construed to limit Consultant’s liability hereunder or to fulfill the indemnification provisions and requirements of this Agreement. There shall be no recourse against City for payment of premiums or other amounts with respect thereto.

City shall notify Consultant in writing of changes in the insurance requirements. If Consultant does not deposit copies of acceptable insurance policies or endorsements with City incorporating such changes within sixty (60) days of receipt of such notice, Consultant shall be deemed in default hereunder.

E. Deductibles. Any deductible or self-insured retention over $25,000 per occurrence must be declared to and approved by City. Any deductible exceeding an amount acceptable to City shall be subject to the following changes: either the insurer shall eliminate or reduce such deductibles or self-insured retentions with respect to City, its officers, employees, agents and volunteers (with additional premium, if any, to be paid by Consultant); or Consultant shall provide satisfactory financial guarantee for

payment of losses and related investigations, claim administration and defense expenses.

F. Verification of Compliance. Consultant shall furnish City with original policies or certificates and endorsements effecting coverage required by this Agreement. The endorsements are to be signed by a person authorized by the insurer to bind coverage on its behalf. All endorsements are to be received and approved by City before work commences. Not less than fifteen (15) days prior to the expiration date of any policy of insurance required by this Agreement, Consultant shall deliver to City a binder or certificate of insurance with respect to each renewal policy, bearing a notation evidencing payment of the premium therefore, or accompanied by other proof of payment satisfactory to City. Consultant shall provide full copies of any requested policies to City within three (3) days of any such request by City.

G. Termination for Lack of Required Coverage. If Consultant, for any reason, fails to have in place, at all times during the term of this Agreement, including any extension hereto, all required insurance and coverage, City may immediately obtain such coverage at Consultant’s expense and/or terminate this Agreement.

21. Indemnity.

A. Consultant assumes all risk of injury to its employees, agents, and contractors, including loss or damage to property.

B. Consultant agrees to defend, indemnify, hold free and harmless the City, its elected officials, officers, agents, employees and volunteers, at Consultant’s sole expense, from and against any and all claims, actions, suits or other legal proceedings brought against the City, its elected officials, officers, agents, employees and volunteers arising out of the performance of the Consultant, its employees, and/or authorized subcontractors, of the work undertaken pursuant to this Agreement. The defense obligation provided for hereunder shall apply without any advance showing of negligence or wrongdoing by the Consultant, its employees, and/or authorized subcontractors, but shall be required whenever any claim, action, complaint, or suit asserts as its basis the negligence, errors, omissions or misconduct of the Consultant, its employees, and/or authorized subcontractors, and/or whenever any claim, action, complaint or suit asserts liability against the City, its elected officials, officers, agents, employees and volunteers based upon the work performed by the Consultant, its employees, and/or authorized subcontractors under this Agreement, whether or not the Consultant, its employees, and/or authorized subcontractors are specifically named or otherwise asserted to be liable. Notwithstanding the foregoing, the Consultant shall not be liable for the defense or indemnification of the City for claims, actions, complaints or

suits arising out of the sole negligence or willful misconduct of the City. This provision shall supersede and replace all other indemnity provisions contained either in the City’s specifications or Consultant’s Proposal, which shall be of no force and effect.

C. N
o official, employee, agent or volunteer of City shall be personally liable for any default or liability under this Agreement.

22. Independent Contractor. Consultant agrees to furnish consulting services in the capacity of an independent contractor and neither Consultant nor any of its employees shall be considered to be an employee or agent of City.

23. PERS Eligibility Indemnification. In the event that Consultant or any employee, agent, or subcontractor of Consultant providing services under this Agreement claims or is determined by a court of competent jurisdiction or the California Public Employees Retirement System (PERS) to be eligible for enrollment in PERS as an employee of the City, Consultant shall indemnify, defend, and hold harmless City for the payment of any employee and/or employer contributions for PERS benefits on behalf of Consultant or its employees, agents, or subcontractors, as well as for the payment of any penalties and interest on such contributions, which would otherwise be the responsibility of City.

N
otwithstanding any other agency, state or federal policy, rule, regulation, law or ordinance to the contrary, Consultant and any of its employees, agents, and subcontractors providing service under this Agreement shall not qualify for or become entitled to, and hereby agree to waive any claims to, any compensation, benefit, or any incident of employment by City, including but not limited to eligibility to enroll in PERS as an employee of City and entitlement to any contribution to be paid by City for employer contribution and/or employee contributions for PERS benefits.

24. Notices. Any notice or communication given under this Agreement shall be effective when deposited, postage prepaid, with the United States Postal Service and addressed to the contracting parties. Name, address and telephone numbers of the parties are as follows:

C
ity of Gardena: Consultant: LWP Claims Solutions
1700 West 162nd Street 35 Miller Ave. #214
Gardena, California 90247-3732 Mill Valley, Ca. 94941
Attn: Ray Beeman Attn: Judy Adlam
E-mail: [email protected] E-mail: [email protected] Telephone Number: (415) 384-0370
E
ither party may change the information to which notice or communication is to be sent by providing advance written notice to the other party.

25. Severability. If any provision of this Agreement shall be held illegal, invalid, or unenforceable, in whole or in part, such provision shall be modified to the minimum extent necessary to make it legal, valid, and enforceable, and the legality, validity, and enforceability of the remaining provisions shall not be affected thereby.

26. Jurisdiction and Venue. This Agreement shall be deemed a contract under the laws of the State of California and for all purposes shall be interpreted in accordance with such laws. Both parties hereby agree and consent to the exclusive jurisdiction of the courts of the State of California and that the venue of any action brought hereunder shall be Los Angeles County, California.

27. Waiver. No delay or failure by either Party to exercise or enforce at any time any right or provision of this Agreement shall be considered a waiver thereof or of such Party’s right thereafter to exercise or enforce each and every right and provision of this Agreement. To be valid a waiver shall be in writing but need not be supported by consideration. No single waiver shall constitute a continuing or subsequent waiver.

28. Entire Agreement.

A. T
his writing contains the entire agreement of the Parties relating to the subject matter hereof; and the Parties have made no agreements, representations, or warranties either written or oral relating to the subject matter hereof which are not set forth herein. Except as provided herein, this Agreement may not be modified or altered without formal amendment thereto.

B. N
otwithstanding the foregoing, and to realize the purpose of this Agreement, the Agreement Administrator may issue a written modification to the Scope of Work, if this modification will not require a change to any other term of this Agreement.

29. Joint Drafting. Each party acknowledges that it has had an adequate opportunity to review each and every provision in this Agreement and to submit the same to counsel and other consultants for review and comment and that the parties jointly drafted this Agreement. No provision of this Agreement or any Assignment shall be construed more strictly against one party than the other party by reason that one or the other party proposed, drafted or modified such provision or any other existing or proposed provision.

30. Public Records Act Disclosure. Consultant has been advised and is aware that this Agreement and all reports, documents, information and data, including, but not limited to, computer tapes, discs or files furnished or prepared by Consultant, or any of its subcontractors, pursuant to this Agreement and provided to City may be subject to public disclosure as required by the California Public Records Act (California

Government Code section 6250 et seq.). Exceptions to public disclosure may be those documents or information that qualify as trade secrets, as that term is defined in the California Government Code section 6254.7, and of which Consultant informs City of such trade secret. The City will endeavor to maintain as confidential all information obtained by it that is designated as a trade secret. The City shall not, in any way, be liable or responsible for the disclosure of any trade secret including, without limitation, those records so marked if disclosure is deemed to be required by law or by order of the Court.

31. Authority to Execute. The persons executing this Agreement on behalf of the parties warrant that they are duly authorized to execute this Agreement.

32. Attorney’s Fees. In the event that legal action is necessary to enforce the provisions of this Agreement, or to declare the rights of the parties hereunder, the parties agree that the prevailing party in the legal action shall be entitled to recover attorney’s fees and court costs from the opposing party.

33. Section Headings. The Section headings used in this Agreement are for reference purposes only and shall have no binding effect.

34. Counterparts. This Agreement may be executed in one or more counterparts, each of which shall be deemed an original. All counterparts shall be construed together and shall constitute one agreement.

IN WITNESS WHEREOF, the parties have hereunto affixed their names as of the day and year written below.

"City"
City of Gardena
By: ________ _
Tasha Cerda
Mayor
Date: _____ _
ATTEST:

Mina Semenza, City Clerk
APPROVED AS TO FORM:
"Consultant''
LWP Claims Solutions, Inc.

By:��
Name� A-d ¼a(\
Title: Pce.srd..£.,..;t- � C ClJ
Date: 9 /4 /z.,, 2.-J
I 1
By:�
Name3fu.bG
Title: CF-o
Date: q I u } i.oi. 2. -----+. --------

EXHIBIT A
R

EQUEST FOR PROPOSALS
for
Third Party Workers’ Compensation Claims Administration R
FP Release Date: June 3, 2022
RFP Submission Deadline: July 6, 2022, 5:00 p.m.

RFP #2022-001

EXHIBIT A
1 | Page
1 General Information ....................................................................................................................2 2 Over view of City of Gardena– City of Opportunity ......................................................................... 2 3 Workers’ Compensation Excess Program...................................................................................... 3 4 Terms of Agreement and Insurance requirements ........................................................................3 5 General rules governing RFP......................................................................................................... 6 6 Proposal timetable and submission requirements ......................................................................... 7 7 TPA company overview and client references................................................................................ 8 8 Account Management.................................................................................................................. 9 9 Key Claims Administration Requirements (Please refer to Addendum A and B for more details) .......9 10 Claim Staffing expectations and Claim Handling Philosophies ....................................................... 10 11 Risk Management Information System (RMIS) ............................................................................. 11 12 Pricing....................................................................................................................................... 11 13 Ancillary Services ....................................................................................................................... 12 14 Workers’ Compensation Trust Fund ............................................................................................ 12 15 Bid Protest Pr ocedures .............................................................................................................. 13 16 Addendum A- PRISM Claim Standards......................................................................................... 15 17 Addendum B– Gardena Claim Service Instructions......................................................................... 1 18 Addendum C - City of Gardena Professional Ser vices Agr eement ....................................................5 2 | Page
1 General Information
T
he purpose of this RFP is to provide prospective Third-Party Administrators (TPA) with information that will enable them to prepare and submit a proposal for third party workers’ compensation claims administration services for City of Gardena’s (the City) self-insured workers’ compensation program.

T
PAs responding to this proposal must be appropriately licensed and approved to provide workers’ compensation claims administration services in the State of California and recognized by OSIP (Office of Self Insurance Plans, California Department of Insurance) as a current valid TPA for self-insured WC programs. Examiners assigned to this account must also possess a valid self- insured administrator certification issued by the California Office of Self-Insurance Plans, Department of Insurance.

T
he City seeks a TPA partnership that will deliver objective and measurable results that will reduce its total WC program cost. This RFP process will result in an award of a service agreement that will include the takeover of all existing City WC claims (including existing closed claims that reopen) and all new claims beginning Nov 1, 2022. The term of the contract will be for three years with the option of two additional one-year extensions for a total of five years. Quality of claim administration and client service is paramount in this program thus all respondents will be requested to propose fees based on a fixed staffing model. Companies are encouraged to describe why they are uniquely qualified to best assist The City to achieve its goals and cite examples of similar quantifiable successes.
2 Overview of City of Gardena – City of Opportunity
The City of Gardena, California, is a full-service city of 5.9 square miles with an ethnically mixed population of just under 59,000. Located in the South Bay region of Los Angeles County, The City has a population of 58,829 (per the 2010 census). The City has active “Sister City” affiliations with Ichikawa, Japan and Huatabampo, Mexico. Gardena is known for its rich cultural diversity and beautiful landscaping. Gardena is a family-oriented City with many programs to meet the needs of both the family and single population. The city is proud of its high quality of life.

Primary City departments include City Manager, Administrative Services, Community Development, Police, Public Works, Recreation and Human Services, and GTrans (City Bus line).

The City reported 521 employees on the 2021 OSIP report with a total payroll of $34 million.

Ga
rdena workers’ compensation claims have been administered by Adminsure for a number of years. Currently, The City has approximately 180 open workers’ compensation claims with annual claim frequency of approximately 64 claims per year (three-year average). Total WC liabilities is $8 million with annual benefit payments totaling $2.4 million. 3 | Page
3 Workers’ Compensation Excess Program
As a self-insured employer, The City has secured specific excess insurance through PRISM since 2018 to limit its per claim workers’ compensation losses. Prior to PRISM, excess insurance was maintained for most years from a verity of carriers with different retention levels. As such, the selected TPA will be required to appropriately report to the applicable excess carrier any claim which qualifies and when appropriate request reimbursement for amounts in excess of the specific retention. The selected TPA is expected to document excess reports and reimbursement requests in the appropriate claim file . All recovery checks must be documented in the claim file (date, check numbers, amount or a scanned image) before forwarding the checks to The City.

Detailed excess policy information will be provided to the selected TPA. 4 Terms of Agreement and Insurance requirements
The Service agreement shall be effective on Nov 1, 2022 and shall run for three (3) years from Nov 1st, 2022 through Oct 31st, 2025. The terms may be extended for two additional one-year terms for a total of five years. Please provide separate annual service fee quotes for each additional year (years four and five).

A
sample copy of the City’s Professional Services Agreement is contained in Addendum C.

I
nsurance requirements
W
ith submittal of bid documents, bidder shall show evidence of levels and type of all insurance required. Prior to execution of a contract, the successful bidder shall furnish an original insurance certificate to meet minimum standards as set forth by the City and shall name the City of Gardena as additionally insured.

A. Commencement of Work. Subcontractor shall not commence work under the Agreement until it has obtained City approved insurance. Before beginning work hereunder, during the entire period of the Agreement, for any extensions hereto, and for periods after the end of the Agreement as may be indicated below, Subcontractor must have and maintain in place all of the insurance coverage required in this Section. Subcontractor’s insurance shall comply with all items specified by the Agreement.

B. Insurance Company Requirements. All insurance policies used to satisfy the requirements imposed hereunder shall be issued by insurers admitted to do business in the State of California. Insurers shall have a current Best’s rating of not less than A-:VII, unless otherwise approved by City.
4 | Page

C. Coverage, Limits and Policy Requirements. Contractor shall maintain the types of coverage and limits no less than indicated below:

1. Commercial General Liability Insurance - a policy for occurrence coverage for bodily injury, personal injury and property damage, including all coverage provided by and to the extent afforded by Insurance Services Office Form CG 2010 ed. 10/93 or 11/85, with no special limitations affecting City. The limit for all coverages under this policy shall be no less than one million dollars ($1,000,000) per occurrence.

General Aggregate $2 Million
Products/Completed Operations Aggregate: $1 Million Personal and Advertising Injury $1 Million
Each Occurrence: $1 Million

2. Commercial Auto Liability Insurance - a policy including all coverage provided by and to the extent afforded by Insurance Services Office form CA 0001, ed. 12/93, including Symbol 1 (any auto) with no special limitations affecting City. The limit for bodily injury, death and property damage liability shall be no less than One Million ($1,000,000.00) per occurrence.

3. Worker’s Compensation and Employer’s Liability Insurance – a policy that meets all statutory benefit requirements of the Labor Code, or other applicable law, of the State of California. The minimum coverage limits for said insurance shall be:

Worker’s Compensation - statutory limits; Employer’s Liability - no less than one million dollars ($1,000,000) per claim. The policy shall be issued by an insurance company which is admitted to do business in the State of California and shall contain a clause that the policy may not be canceled without thirty (30) days prior written notice, return receipt requested, is mailed to City.

4. Policy Requirements. The policies set forth above shall comply with the following, as evidenced by the policies or endorsements to the policies:

a. “The City of Gardena, its appointed and elected officers, employees, agents, and volunteers” shall be named as additional insured.

b. The subcontractor’s insurer shall agree to provide CITY with “thirty (30) days prior written notice, return receipt requested, of any cancellation, non- renewal or material change in coverage”.

c. For any claims with respect to the Services covered by this Agreement, Subcontractor’s insurance coverage shall be primary insurance as respects the City, its elected and appointed officers, employees, agents and volunteers. Any insurance or self-insurance maintained by City, its appointed 5 | Page

and elected officers, employees, agents and volunteers shall be excess of Subcontractor’s insurance and shall not contribute with it.

d. Coverage shall state that the Subcontractor’s insurance shall apply separately to each insured against whom claim is made or suit is brought, except with respect to the limits of the insurer’s liability.

D. Additional Requirements.

a. The procuring of such required policies of insurance shall not be construed to limit Subcontractor’s liability hereunder or to fulfill the indemnification provisions and requirements of the Agreement. There shall be no recourse against City for payment of premiums or other amounts with respect thereto. City shall notify Subcontractor in writing of changes in the insurance requirements. If Subcontractor does not deposit copies of acceptable insurance policies or endorsements with City incorporating such changes within sixty (60) days of receipt of such notice, Subcontractor shall be deemed in default hereunder.

b. Deductibles. Any deductible or self-insured retention over $25,000 per occurrence must be declared to and approved by City. Any deductible exceeding an amount acceptable to City shall be subject to the following changes: either the insurer shall eliminate or reduce such deductibles or self-insured retentions with respect to City, its officers, employees, agents and volunteers (with additional premium, if any, to be paid by Subcontractor); or Subcontractor shall provide satisfactory financial guarantee for payment of losses and related investigations, claim administration and defense expenses.

c. Verification of Compliance. Subcontractor shall furnish original policies or certificates and endorsements effecting coverage required by the Agreement. The endorsements are to be signed by a person authorized by the insurer to bind coverage on its behalf. All endorsements are to be received and approved by City before work commences. Not less than fifteen (15) days prior to the expiration date of any policy of insurance required by the Agreement, Subcontractor shall deliver to City a binder or certificate of insurance with respect to each renewal policy, bearing a notation evidencing payment of the premium therefore, or accompanied by other proof of payment satisfactory to City. Subcontractor shall provide full copies of any requested policies to CITY within three (3) days of any such request by City.

d. Termination for Lack of Coverage. If Subcontractor, for any reason, fails to have in place, at all times during the term of the Agreement, including any extension hereto, all required insurance and coverage, City may immediately obtain such coverage at Subcontractor’s expense and/or terminate the Agreement.

6 | Page

TPA must be in full compliance with all statutory and applicable regulatory agencies at all times.

5 General rules governing RFP
Any questions concerning this RFP must be submitted by email on or before June 17, 2022 to both:

Tony Su, MBA, ARM Raymond Beeman, CPA
TCS Risk Management Director, Administrative Services, City of Gardena [email protected] [email protected]

Responses to written questions shall be provided via email to all RFP recipients as detailed in Section 6 of the RFP. If TPA discovers any significant ambiguity, error, conflict, discrepancy, or omission in this RFP, the TPA should immediately notify TCS Risk Management and the City of any error and request modification or clarification of the RFP document. TPA will not be entitled to additional compensation or time by reason of the error or its later correction.

The City reserves the right to reject any and all proposals, to award the service agreement in whole or part, and to negotiate the terms of the service agreement, including the award amount, with the selected TPA prior to entering into a service agreement.

TPAs with any conflict of interest or potential conflict of interest must be clearly disclose to The City within the proposal and if awarded the service agreement, throughout the life of the service agreement immediately upon development of a potential conflict.

All costs associated with responding to this RFP are the sole responsibility of the TPA.

The City may modify this RFP, before the date scheduled for submission of proposals, by issuance of an addendum to all parties who have been furnished the RFP for the purpose of submitting a proposal.

Potential TPAs may request withdrawal of sealed proposal prior to the scheduled proposal opening time provided the request for withdrawal is submitted to the City's RFP Point of Contact in writing. Proposals must be re-submitted and time-stamped in accordance with the RFP document to be accepted.

No proposal may be withdrawn for a period of 120 calendar days after the date of proposal opening. All proposals received are considered firm offers during this period. The Potential TPAs offer will expire after 120 calendar days. If a Potential TPA intended for award withdraws their proposal, that Potential TPA may be deemed non-responsible if responding to future solicitations.

Proposals shall become the property of the City and will not be returned. Any decision of The City with respect to the award of a TPA contract is final.
7 | Page

6 Proposal timetable and submission requirements

Listed below are specific dates related to the RFP process. These dates must be observed during the selection process unless otherwise changed by the City.

RFP/Timeline
June 3, 2022 - RFP issue date
June 17, 2022 - Last day to submit to TCS Risk or the City any questions related to the RFP June 24, 2022 – Responses to written questions to be provided via email to all RFP recipients July 6, 2022 – Proposals due by 5pm
Week of July 29, 2022 - Selection of TPA finalists
Week of Aug 22, 2022 - Oral presentations by finalists and may include visits to finalists claim offices
Sept 9, 2022 - Notification of intent to award sent to selected TPA Sept 12 - 30, 2022 – Contract negotiations, Submittal of final transition plan by the TPA awarded the service agreement
Oct 2022 - City Council Approval of TPA Contract. Begin data conversion/migration Nov 1, 2022 - existing claims takeover

Proposals must be submitted no later than July 6, 2022 by 5pm. TPA must mail four (4) hard copies of their proposal responses, and clearly mark the box or package with “City of Gardena Proposal for Workers’ Compensation TPA Services” and one electronic version (via email). Each recipient named below should receive the number of copies indicted next to their name, and one electronic version (PDF format) emailed to:

Raymond Beeman, CPA (3 copies) Tony Su (1 copy)
Director, Administrative Services TCS Risk Management Services City of Gardena
[email protected]
[email protected]

Late proposals will be rejected and returned to the TPA. TPA must select a method of delivery that ensures proposals will be delivered to the correct location by the due date and time.

Proposals should be typed, organized and presented in the order and by the number assigned in the RFP, along with copies of requested documents, policies and samples of TPA reports and forms.

Failure to meet mandatory requirements will result in the proposal being rejected.

The evaluation and selection of a TPA will be based on the information submitted in the TPA’s proposal, pricing, services, compatibility with the City’s needs, oral presentations, references and any on- site visits.

The City and TCS Risk are not obligated to disclose its specific findings ratings; evaluation or comparison to any of the TPA’s who submit a proposal.
8 | Page

7 TPA company overview and client references
Please include in your proposal the following information.

• Company Profile - -Years in business
• Revenue or other financial data if able to disclose or other metrics of size and stability • Company Officers/Management staff that will be directly involved with the City program • Total number of employees and number of employees in handling claim office • Recommended Claims Handling Office
• Merger and Acquisition activity in past 3 years or planned in the next year • Clients
- # of public transit clients
- # of public agency clients
- percent self-insured clients

• Confirm your company is a currently licensed claims administrator of self- insured WC programs licensed to do such business in California and approved by OSIP • Provide a copy of your company’s internal claims management standards and outline your company initial investigation guidelines and requirements • Describe any financial and/or ownership relationship with any other company that may pose a conflict of interest and provide a conflict of interest statement and/or confidential agreement.
• Describe your company’s claims quality control program and the frequency of internal operational audits.
• Provide a list of workers’ compensation insurance carriers for which you are approved as a Workers’ Compensation TPA.
• Provide information on the circumstances and status of any disciplinary action taken or pending against your company during the last 3 years by any state regulatory bodies or professional organizations.
• Describe your policy regarding penalties resulting from your company’s failure to perform according to the California Labor Code.
• Provide three (3) client references with similar operations with dates of service, client’s name and contact person with telephone numbers and email addresses for which you currently provide workers’ compensation TPA services. In addition, provide (2) references and contact information of past clients. (By providing these references, you agree that neither the City, TCS Risk, nor the clients referenced shall have any liability regarding the provision of such references or the City use of such references in making the selection under the RFP)
• Identify any service(s) you intend to sub-contract to others and identify the proposed sub- contractors including names, phone numbers and the qualifications of the sub-contractors company.
• Provide a proposed transition plan and implementation timetable. 9 | Page

8 Account Management

The City will require an account manager for this program. This individual will play an essential role in the successful administration of this program and should have authority and overall responsibility for the following key components of the program:
• Service agreement administration and management of TPA staffing on the City’s account • Trouble shooting and providing effective solutions to resolve issues or problems with the service agreement and/or claims management services.
• Identify key outcome based measurements that are tracked and deliver program improvements and cost reduction results.
• Monitor claim trends and audit claim handling procedures to ensure a high level of customer service and best in class claim service deliverables. • Coordinate regular claim reviews for the City, with participation of the appropriate dedicated claim staff, City representatives and as needed; defense attorneys. • Assist in coordination of an annual stewardship meeting to present/discuss program changes, performance metrics, benchmarking and claim trending/loss analysis reports. • Provide or facilitate any custom data download, report requests of the City or its agents

9 Key Claims Administration Requirements
(Please refer to Addendum A and B for more
details)

• Fraud Control - Gardena requires the claims administrator to aggressively investigate and control fraud and report all claims meeting the State Fraud reporting guidelines.

The City desires to pursue restitution in all fraud cases. The City shall be notified of all claims involving potential fraud and initiation of fraud investigation activities. SIU referrals should be approved by the City prior to referral and only to firms on the City’s approved list.

• Claim Reviews - Quarterly claim reviews on-site at the City is required. The TPA is expected to send dedicated claim staff to attend claim reviews. Litigation reviews are required on a semi-annual basis and the presence of defense counsel at these reviews will be required. The City anticipates that claim reviews will be held at Gardena City Hall in the City of Gardena.

• Loss Reporting and Claim System Access – The City requires, on a monthly basis, basic loss reports detailing claim frequency, open inventory, paid and incurred costs.

Gardena may need to obtain other reports for various purposes including but not limited to actuarial studies, OSIP reporting, audits, program and injury analysis. Please 10 | Page

provide details on your system’s reporting capabilities, availability of internal IT staff to respond to custom report requests and client access to your system’s reporting tool.

The Gardena will also require claim system access for a minimum of two users to review and monitor its claims, review file notes and reserves.

• MMI and Permanent Disability – the City feels it is imperative that its claims be managed proactively to achieve a finding of MMI or P&S as soon as practical in order to help reduce temporary disability exposures. This may require the TPA to actively seek P&S determinations from the treating or QME physician when the medical reports do not document any change in status with ongoing treatment. the City also expects the selected TPA to aggressively pursue apportionment of PD to prior claims or pre- existing conditions/disabilities. This will require that the selected TPA conduct investigation into prior claims and/or pre-existing conditions and promptly secure the needed medical records to support apportionment on all applicable claims well before permanent disability evaluations occur.

• The City may amend requirements as needed, with 30 days written notice to claims administrator. These requirements will become part of the City’s contract with the selected bidder. the City may conduct claims performance audits to measure TPA performance and compliance with claims administration standards and requirements. 10 Claim Staffing expectations and Claim Handling Philosophies

• The City desires a dedicated senior claim examiner for its program in order to foster a partnership approach to its workers’ compensation program. Senior examiner(s) must have at least 5 years of California public sector claim adjusting experience and possess a valid California Self-Insurer certification from OSIP
• Staffing – the City’s objective is to secure a proactive claims management service to ensure that its claims are managed actively and resolved promptly. Examiner (s) assigned to handle indemnity claims for the Gardena program must have a minimum of five years’ experience handling public entity Workers’ Compensation claims including LC4850 and presumption claims. Supervisors assigned to Gardena claims must have a minimum of 5 years experience supervising Workers’ Compensation claims and possess a OSIP Certificate. The City maintains the right to interview and review evidence of work experience of all personnel to be assigned to its account and to approve such personnel.

The City desires dedicated claims personnel to facilitate a partnership approach to program management. the City recognizes its service requirements may be higher than that of other customers and in recognition of the higher service burden seeks to keep its examiner caseload to a maximum level of 120 open indemnity claims (including FM cases).

Medical-only examiner(s) assigned to the City should have no more than 180 MO cases in total.
• Identify your proposed manager and supervisor and their experience and expertise and the proposed adjusting claim office.
11 | Page
• If workloads increase or decrease over the life of the Service agreement, propose how your company would meet the increased/decreased staffing needs. the City will require pre-approval of any examiner or supervisor to be assigned to its account. • Disclose the examiner/supervisor turnover ratio in the last 3 years. • Describe your staffing back up plan in cases when the team is not available. Describe any flex time scheduling that is available.
• Describe your index bureau process and what are the adjuster’s requirements to follow up on index bureau’s ‘hits’?
• Describe your process for detecting duplicate medical bills. 11 Risk Management Information System (RMIS)
Indicate the number of user access that are included in your proposal and the associated fees for that access, if any. Please describe your systems capabilities around • claim system with access to view claim adjuster and supervisor notes, generate loss runs or other pre-scheduled or adhoc loss management/claim reports. • Provide RMIS technical support for questions, problems or development of customized reporting.
• Quality control program to ensure data integrity and claimant confidentiality. Any RMIS problems will be resolved within 24 hours or less. Please provide a list of occupation codes, injury codes and payment type codes.
• Image system to scan all documents received pertaining to the case. • Describe you system security protocols to protect client and employee data, including but not limited to; security audits, protected by intrusion prevention and intrusion detection systems, communications of any claimant’s personal information or personal health information is protected (i.e. monitoring of email and internet traffic, encrypted email, access restricted by user ID and password, or other similar security methods). • Describe your disaster recovery plan to ensure continuation of your claims management and risk management information system in the event of disaster or system compromise. • What standard reports are provided within your service fee? Describe them in detail and provide sample reports.
• What type of customized reports are available, any fees charged for customization and provide a few samples of these customized reports.
12 Pricing
Based on the staffing model described in section 10 above, please provide a 3-year quote delineated by an annual fee for each of the three years. Include pricing for two one-year extensions beyond the initial three years for a total of five years. Including a quote does not obligate the City to consider an extension. If more than one pricing alternative is available, describe in detail each option.
12 | Page

13 Ancillary Services
Complete the following table and identify the associated fees and service providers. If the service is included in the quoted claims administration fee in Section 12 above, indicate this by placing “Included” in the Fee field of the table below. Describe any products or services not specifically associated with staffing model for which there is an additional charge or that you intend to charge to the claim files as ALAE.

Program Component Service Provider Subsidiary
/Affiliate
of TPA
(Y/N)
Fee (explain if fee is
per case, per year,
per bill, etc.)
MPN
Index/Edex
Physician Peer Review
RX review/Pharmacy program
Nurse Case Management
UR Provider
Bill Review Provider
Investigations/Subrosa
MSA
Other (describe)

14 Workers’ Compensation Trust Fund

Please describe your internal process for reconciling the trust fund, securing and crediting recovery payments (whether subrogation recovery, excess or overpayments, etc.).

What check and financial security procedures are in place to protect against misappropriation of funds, insure check and payment security and to verify and validate vendors and other payees?

Do you have internal controls over authority levels for check approval, issuance, etc.? Please describe.

13 | Page

15 Bid Protest Procedures

Gardena Municipal Code Chapter 2.60 specifies the policies and procedures to be used to ensure that all purchases, franchises and services are obtained through fair and open competition. The Contract Administrator has the authority and the responsibility to ensure that all procurement is in compliance with this policy. The Contract Administrator shall also ensure that all prospective bidders are informed of the procedures to file a “Bid Protest”.

Should any individual, organization or group believe that these policies have been violated they may make an appeal in writing to the Contract Administrator who is obligated to investigate the protest and provide an official response to the protest.

Protests must be submitted in writing within fourteen (14) calendar days of notification that a bid has been awarded. All protests must state specifically:

1) The bid title, opening or award date, purchase order or other identifying data; 2) The specific policy that is alleged to have been violated; 3) The adverse effect alleged to have resulted from the policy violation; and 4) The corrective action being sought as a remedy.

The Contract Administrator will respond in writing to the protester no later than fourteen (14) calendar days from receipt of the protest. The response shall include:

1) Review of the policy as applied in the transaction being questioned. 2) Response to each material issue raised in the protest. 3) Statement of whether a violation has indeed occurred. 4) Corrective action to be taken if any is warranted.

A copy of the complaint and the response will be forwarded to the City Manager for review prior to submittal to the protester.

According to City policies the decision of the Contract Administrator is appealable to the City Manager. If no appeal has been received in the office of the City Manager, the decision of the Contract Administrator shall be considered final on the fifth working day following the date of notification to the protester. Should an appeal be received by the City Manager, a response will be provided to the protester within 5 working days and shall be considered final.

Whenever possible, the award of procurement will not be made final until all bid protests have been satisfactorily resolved. Final award will not be made until five (5) calendar days after 14 | Page
notification of protest decision has been provided to the protesting parties. The City does reserve the right to proceed with the award pending the resolution of the bid protest when it is determined that:
a. T
he items to be procured are urgently required;
b. Delivery or performance will be unduly delayed by failure to make the award promptly; or c. Failure to make prompt award will otherwise cause undue harm to the City or funding agent.

I
nquiries and correspondence shall be directed to:

C
ity of Gardena
Attention: Ray Beeman, Administrative Services Director Bid Protest – Third Party Workers’ Compensation Claims Administration 1700 W 162nd Street, Room 104
Gardena, CA 90247
F
ormal protest must state on the outside of the envelope:
“B
ID PROTEST – THIRD PARTY WORKERS’ COMPENSATION CLAIMS ADMINISTRATION 16 Addendum A- PRISM Claim Standards
Addendum
A – PRISM Claim Standards
ADDEN

DUM A WORKERS' COMPENSATION

CLAIMS ADMINISTRATION STANDARDS
The following Standards have been adopted by Public Risk Innovation, Solutions, and Management (hereinafter PRISM) in accordance with Article 18(b) of the PRISM Joint Powers Agreement. It is the intent of these Standards to ensure compliance with all applicable Labor Code and California Code of Regulations Sections. In the event that there exists a conflict between the Standards, the Labor Code or the Code of Regulations, the most stringent requirement shall apply.

I. CLAIMS HANDLING - ADMINISTRATIVE
A. Case Load

1. Each claims examiner assigned to the Member should handle a targeted caseload of 150 but not to exceed 165 claims. In situations where caseloads include future medical and medical only claims, these claims shall be counted as 2:1 in the caseload limit.

2. Supervisory personnel should not handle a caseload, although they may handle specific issues or a small number of conflict claims.

B. Case Review and Documentation

1. Documentation shall reflect any significant developments in the file and include a plan of action. Plan of action statements shall be updated at the time of examiner diary review.

2. The examiner shall review indemnity and medical-only files at intervals not to exceed 45 calendar days. Future medical files shall be reviewed at intervals not to exceed 90 calendar days.

3. The supervisor shall review all new claims within 60 calendar days of initial set up and subsequently monitor activity on indemnity files at intervals not to exceed 120 calendar days. Future medical files shall be reviewed by the supervisor at intervals not to exceed 180 calendar days.

4. File contents shall comply with Code of Regulations Sections 10101, 10101.1 and 15400, and be kept in a neat and orderly fashion. If claims are maintained in a paperless system, documents shall be clearly identified (e.g., medical report, WCAB Orders, legal, etc.).

5. Medical Only Claims
a. If a medical-only claim is still open at 90 calendar days, it shall be transferred to an indemnity examiner.
b. If, at any time, it is anticipated there will be indemnity benefits paid, the claim shall be transferred to an indemnity claim type.
c. If the medical-only claim remains open at 180 days, the claim shall be converted to an indemnity claim type, unless there is documentation showing that medical treatment will be ending and the claimant will be discharged from care within the next 30 days, or the claimant is only seeking treatment for a blood- borne pathogen exposure protocol.

C. Communication

1. Telephone Inquiries
Ret
urn calls shall be made within 1 working day of the original telephone inquiry. All documentation shall reflect these efforts.

2. Incoming Correspondence
All c
orrespondence received shall be clearly stamped with the date of receipt.

3. Return Correspondence
All
correspondence requiring a written response shall have such response completed and transmitted within 5 working days of receipt.

4. Ongoing Claimant Contact
On c
ases involving unrepresented injured workers who are off work, telephone contact shall be made at a minimum of once every 30 days and within 3 working days after discharge from the hospital or outpatient facility following a surgical procedure. This is in addition to nurse case management involvement on claims where nurse case managers are assigned.

D. Fiscal Handling

1. Fiscal handling for indemnity benefits on active cases shall be balanced with appropriate file documentation on a semi-annual basis and prior to sending a benefit termination notice to verify that statutory benefits are paid appropriately.

Balancing is defined as, “an accounting of the periods and amounts due in comparison with what was actually paid”.

2. In cases of multiple losses with the same person, payments shall be made on the appropriate claim file.

E. Medicare Reporting
Ma
ndatory reporting to the Center for Medicaid Services (CMS) shall be completed directly or through a reporting agent in compliance with Section
111 of the Medicare Medicaid and SCHIP Extension Act of 2007 (“MMSEA”). Medicare eligibility shall be documented in the claim file at time of settlement evaluation.

II. CLAIM CREATION
A. Three-Point Contact
Th
ree-point contact shall be conducted on all claims with the non- represented injured worker, employer representative and treating physician within 3 working days of receipt of the claim by the third party administrator or self-administered entity. If a nurse case manager is assigned to the claim, initial physician contact may be conducted by either the claims examiner or the nurse case manager. This initial contact should be substantive and clearly documented in the claim file. In the event a party is non-responsive, there shall be evidence of at least three documented attempts to reach the individual.

B. Compensability

1. The initial compensability determination (accept claim, deny claim or delay acceptance pending the results of additional investigation) and the reasons for such a determination shall be made and documented in the file within 14 calendar days of the filing of the claim with the employer. In the event the claim is not received by the third party administrator or self-administered entity within 14 calendar days of the filing of the claim with the employer, the third party administrator or self-administered entity shall make the initial compensability determination within 7 calendar days of receipt of the claim.

2. Delay of benefit letters shall be mailed in compliance with the Division of Workers’ Compensation (DWC) guidelines. In the event the employer does not provide notice of lost time to the third party administrator or self-administered entity timely to comply with DWC guidelines, the third party administrator or self-administered entity shall mail the benefit letters within 7 calendar days of notification.

3. The final compensability determination shall be made by the claims examiner or supervisor within 90 calendar days of employer receipt of the claim form.

C. AOE/COE Investigation
I
f a decision is made to delay benefits on a claim, an AOE/COE investigation shall be initiated within 3 working days of the decision to delay. This may include, but is not limited to, assigning out for witness/injured worker statements, initiating the QME/AME process, requesting medical records, etc.

D. Reserves

1. Using the information available at claim file set up, an initial reserve shall be established for the most probable case value.

2. The initial reserve shall be electronically posted to the claim within 14 calendar days of receipt of the claim.

E. Indexing
A
ll claims shall be reported to the Index Bureau at time of initial set up and re-indexed on an as needed basis thereafter. Blood borne pathogen exposure claims are an exception to this requirement.

P
RISM maintains membership with the Index Bureau that members can access.

III. CLAIM HANDLING – TECHNICAL
A. Payments

1. Initial Temporary and Permanent Disability Indemnity Payment a. The initial indemnity payment shall be issued to the injured worker within 14 calendar days of knowledge of the injury and disability. In the event the third party administrator or self- administered entity is not notified of the injury and disability

within 14 calendar days of the employer’s knowledge, the third party administrator or self-administered entity shall make payment within 7 calendar days of notification. Initial permanent disability payments shall be issued within 14 calendar days after the date of last payment of temporary disability. Effective 1/1/2013, permanent disability payments shall be issued upon approval of an Award pursuant to Labor Code Section 4650(b)(2). Prior to a PD Award, advances may be due if the employer has not offered the employee a position paying at least 85% of their wages and compensation at time of injury or the employee is not employed in a position paying at least 100% of their wages and compensation at time of injury. This shall not apply with salary continuation.
b. The properly completed DWC Benefit Notice shall be mailed to the employee within 14 calendar days of the first day of disability. In the event the third party administrator or self- administered entity is not notified of the first day of disability until after 14 calendar days, the DWC Benefit Notice shall be mailed within 7 calendar days of notification. c. Self-imposed penalty shall be paid on late payments in accordance with Section III. A.7 of this document.
d. Overpayments shall be identified and reimbursed timely where appropriate. The third party administrator or self- administered entity shall request reimbursement of overpaid funds from the party that received the funds. If necessary, a credit shall be sought as part of any resolution of the claim.

2. Subsequent Temporary and Permanent Disability Payments a. Eligibility for indemnity payments subsequent to the first payment shall be verified, except for established long-term disability. b. Ongoing indemnity payments shall be paid in accordance with Labor Code Section 4650(c).
c. Subsequent DWC benefit notices shall be issued in accordance with CCR 9812.
d. Self-imposed penalty shall be paid on late payments in accordance with Section III. A.7 of this document.

3. Final Temporary and Permanent Disability Payments

a. All final indemnity payments shall be issued timely. b. The appropriate DWC benefit notices shall be issued in accordance with CCR 9812.
c. Self-imposed penalty shall be paid on late payments in accordance with Section III. A.7. of this document.

4. Award Payments
a. The claim file shall reflect demonstrated efforts to initiate/batch payments on undisputed Awards, Commutations, or Compromise and Release agreements within 10 working days following receipt of the appropriate document, unless the Award indicates payment is due sooner.
b. For all claims in the Primary Workers’ Compensation (PWC) Program and/or excess reportable claims, copies of all Awards shall be provided to PRISM at time of payment.

5. Medical Payments
a. Medical treatment billings (physician, pharmacy, hospital, physiotherapist, etc.) shall be reviewed for correctness, approved for payment and paid within 60 days of receipt.
b. The medical provider shall be notified in writing within 30 days of receipt of an itemized bill if a medical bill is contested, denied or incomplete. c. A bill review process should be utilized whenever possible. There should be participation in a PPO and/or MPN whenever possible.

6. Injured Worker Reimbursement Expense
a. Reimbursements to injured workers shall be issued within 15 working days of the receipt of the claim for reimbursement.
b. Advance travel expense payments shall be issued to the injured worker 10 working days prior to the anticipated date of travel.

7. Penalties

a. Penalties shall be coded so as to be identified as a penalty payment. b. If the Member utilizes a third party administrator, the Member shall be advised of the assessment of any penalty for delayed payment and the reason thereof, and the administrator’s plans for payment of such penalty, on a monthly basis.
c. If the Member utilizes a third party administrator, the Member, in their contract with the administrator, shall specify who is responsible for specific penalties.

B. Medical Treatment

1. Each Member shall have in place a Utilization Review process as set forth in Labor Code Section 4610.

2. Disputes regarding utilization review determinations shall be resolved using the Independent Medical Review process set forth in Labor Code Section 4610.5.

3. Nurse case managers shall be utilized where appropriate. Rationale for assignment and continued necessity shall be documented in the claim notes at each regular diary review.

4. If enrolled in a Medical Provider Network, the network shall be utilized whenever appropriate.

C. Apportionment

1. Investigation into the existence of apportionment shall be documented.

2. If potential apportionment is identified, all efforts to reduce exposure shall be pursued.

D. Disability Management

1. The third party administrator or self-administered entity shall work proactively to obtain work restrictions and/or a release to full duty on all cases. The TPA or self- administered entity shall notify a designated Member representative immediately upon receipt of temporary work restrictions or a release to full duty, and work closely with the Member to establish a return to work as soon as possible.

2. The third party administrator or self-administered entity shall notify a designated Member representative immediately upon receipt of an employee’s permanent work restrictions so that the Member can determine the availability of alternative, modified or regular work.

3. If there is no response within 20 calendar days, the third party administrator or self-administered entity shall follow up with the designated Member representative.

4. Members shall have in place a process for complying with laws preventing disability discrimination, including Government Code Section 12926.1, which requires an interactive process with the injured worker when addressing a return to work particularly with permanent work restrictions.

5. Third party administrators or self-administered claims professional shall cooperate with members to the fullest extent, in providing medical and other information the member deems necessary for the member to meet its obligations under federal and state disability laws.

E. Supplemental Job Displacement Benefits

1. Supplemental Job Displacement Benefits – Dates of injury on or after 1/1/04 and before 1/1/13: Benefits pursuant to Labor Code Section 4658.5 shall be timely provided. Dates of injury on or after 1/1/13: Benefits pursuant to Labor Code 4658.7 shall be timely provided.

2. The third party administrator or self-administered entity shall secure the prompt conclusion of SJDB.

F. Reserving

1. Reserves shall be reviewed at regular diary and at time of any significant event, e.g. - surgery, P&S/MMI, return to work, etc., and adjusted accordingly. This review shall be documented in the file regardless of whether a reserve change was made. Where the SIP model does not apply, claims shall be reserved for the most probable value.

2. Indemnity reserves shall reflect actual temporary disability indemnity exposure with 4850 differential listed separately.

3. Permanent disability indemnity exposure shall include life pension reserve if appropriate.

4. Future medical claims shall be reserved in compliance with CCR 15300 (b)(4) allowing adjustment for reductions in the approved medical fee schedule, undisputed utilization review, medically documented non-recurring treatment costs and medically documented reductions in life expectancy.

5. Allocated expense reserves shall include medical cost containment, legal, investigation, copy service and other related fees.

6. A reserve worksheet shall be utilized and/or detailed rationale substantiating reserve levels shall be documented within the claim file.

G. Resolution of Claim

1. Within 10 working days of receiving medical information indicating that a claim can be finalized, the claims examiner shall begin appropriate action to finalize the claim.

2. Follow up finalization efforts shall continue and be documented at regular diary reviews until resolution is complete.

3. Settlement value shall be documented appropriately utilizing all relevant information.

4. Where settlement includes resolution of future medical for a Medicare beneficiary or an expected Medicare beneficiary, the settlement shall document the strategy to protect Medicare’s secondary payer status.

5. Pursuant to CCR15400.2, claim files with awards for future benefits shall be reviewed for administrative closure two years after the last provision of benefits.

H. Settlement Authority

1. No agreement shall be authorized involving liability, or potential liability, of PRISM without the advance written consent of PRISM. The member shall be notified of any settlement request submitted to PRISM.

2. The third party administrator shall obtain the Member’s authorization on all settlements or stipulations in excess of the settlement authority provided in any provision of the individual contract between the Member and the claims administrator.

3. Proof of settlement authorization(s) shall be maintained in the claim file.

IV. LITIGATED CASES
The
third party administrator or self-administered entity shall establish written guidelines for the handling of litigated cases. The guidelines should, at a minimum, include the points below, which may be adopted and incorporated by reference as "the Guidelines".

1. The third party administrator or self-administered entity shall promptly initiate investigation of issues identified as material to potential litigation. The Member shall be alerted to the need for in-house investigation, or the need for a contract investigator who is acceptable to the Member. The Member shall be kept informed on the scope and results of investigations.

2. The third party administrator or self-administered entity shall, in consultation with the Member, assign defense counsel from a list approved by the Member.

Initial referral and ongoing litigation management shall be timely and appropriate. The third party administrator or self-administered entity shall maintain control of the ongoing claim activities.

3. Settlement proposals directed to the Member shall be forwarded by the third party administrator, self-administered entity or defense counsel in a concise and clear written form with a reasoned recommendation. Settlement proposals shall be presented to the Member as directed so as to insure receipt in sufficient time to process the proposal.

4. Knowledgeable Member personnel shall be involved in the preparation for medical examinations and trial, when appropriate or deemed necessary by the Member so that all material evidence and witnesses are utilized to obtain a favorable result for the defense.

5. The third party administrator or self-administered entity shall comply with any reporting requirement of the Member.

V. SUBROGATION

1. In all cases where a third party (other than a Member employee or agent) is responsible for the injury to the employee, attempts to obtain information regarding the identity of the responsible party shall be made within 14 calendar days of recognition of subrogation potential.

2. Once identified, the third party shall be contacted within 14 calendar days with notification of the Member's right to subrogation and the recovery of certain claim expenses.

3. If the third party is a governmental entity, a claim shall be filed with the governing board (or State Board of Control as to State entities) within 6 months of the injury or notice of the injury. If the third party is a non- governmental entity, a complaint shall be filed in civil court within two years in order to preserve the statute of limitations.

4. Periodic contact shall be made with the responsible party and/or insurer to provide notification of the amount of the estimated recovery to which the Member shall be entitled.

5. If the injured worker brings a civil action against the party responsible for the injury, the claims administrator shall consult with the Member about the value of the subrogation claim and other considerations. Upon Member authorization, subrogation counsel shall be assigned to file a Lien or a Complaint in Intervention in the civil action.

6. Whenever practical, the claims administrator shall aggressively pursue recovery in any subrogation claim. They should attempt to maximize the recovery for benefits paid, and assert a credit against the injured worker’s net recovery for future benefit payments.

7. Member (and PRISM if applicable) approval is required to waive pursuit of subrogation or agree to a settlement of a third party recovery. This approval shall be documented in the claim file. In cases of self-administered entities, a process shall be documented noting the authority levels within the member organization to waive pursuit of subrogation or agree to a settlement of a third party recovery.

VI. EXCESS COVERAGE
A. Claims meeting the definition of reportable excess workers’ compensation claims as defined by the Memorandum of Coverage Conditions Section shall be reported to PRISM within five working days of the day on which it is known the criterion is met. Utilize the Excess Workers’ Compensation First Report Form available through PRISM’s website.

B. Subsequent reports shall be transmitted to PRISM on a quarterly basis on all indemnity claims and on a semi-annual basis on all future medical claims or sooner if claim activity warrants, or at such other intervals as requested by PRISM, in accordance with Underwriting and Claims Administration Standards. Utilize the Excess Workers’ Compensation Status Report Form
available through PRISM’s website, or a comparable form to be approved by PRISM.

C. Reimbursement requests shall be submitted in accordance with PRISM’s reporting and reimbursement procedures on a quarterly or semi-annual basis depending on claims payment activity. Utilize the Excess Workers’ Compensation Claim Reporting and Reimbursement Procedures available through PRISM’s website.

D. A closing report with a copy of any settlement documents not previously sent shall be sent to PRISM.

Fol
lowing is the history of amendments to this document:

Am
ended: March 4, 1988
Amended: October 7, 1988
Amended: October 6, 1995
Amended: October 1, 1999
Amended: June 6, 2003
Amended: March 2, 2007
Amended: July 1, 2009
Amended: July 1, 2011
Amended: March 2, 2012
Amended: October 4, 2013
Amended: July 1, 2019 Page 12 of 12
1 17 Addendum B– Gardena Claim Service Instructions
A
ddendum B – Gardena Claim Service Instructions
Client Contacts
R
ay Beeman, CPA – Director of Administrative Services, City of Gardena ([email protected]) D
iana Schnur – Acting Human Resource Manager, City of Gardena ([email protected]) M
r. Beeman and Ms. Schnur should be copied in on all outgoing claims correspondence. This will include both email and mailed letters to and from claimant, defense attorney, physicians, etc. Assignment of cases to defense counsel should be run by the City for concurrence prior to assignment to defense counsel.

A
ll SAR requests must be in writing and sent to Mr. Beeman and Ms. Schnur with sufficient time for City Council approval as needed (City Council meets twice per month-2nd and 4th Tuesday of the month).

S
ettlement authority levels
Up to $24,999 - City Manager
$25,000 and above – City Council Approval is required.

Police Department Claims
Todd Fox – Captain, City of Gardena Police Dept – ([email protected]) P
D requires bi-monthly meeting to review their active cases to discuss status of PD employees out on 4850 benefits and/or mod-duty/return to work/IDR options.

GTrans Claims
Ernie Crespo – Director GTrans – ([email protected]) G
Trans requires monthly claim status meet6ing to go over any pending case issues, updates on AOE/COE investigation results including review of bus videos, cases with pending decision dates, third-party subrogation status, etc.

Banking
Danny Rodriguez – Deputy City Treasurer ([email protected]) Mr. Rodgriguez manages the City’s bank account, replenishment, reconciliation, and voids/stop payments. Daily check register is required and TPA is expected to provide positive pay report directly to the bank.
2 WC Defense Attorney Panel
Dave Thomas, Esq
Hanna, Brophy
1500 Iowa Ave
Riverside, CA 92507
951-824-2984
Vanessa Coe, Esq
Coleman, Chavez
320 W. 4th St, 9th Floor
Los Angeles, CA 90013
213-212-6004
Andrew Yen, Esq
Coleman, Chavez
320 W. 4th St, 9th Floor
Los Angeles, CA 90013
213-212-6004
SIU/Subrosa
SI
U Consultant Group
Siuconsultantgroup.com
888-748-1130
R
JN Investigations
Rjninv.com
888-323-3832
General Claims Administration Requirements
I
n addition to the claims management standards required by PRISM (the City’s excess insurance carrier), Gardena also requires the following:
3 A. R
TW/Modified Duty - Gardena has implemented a disability management program. The selected TPA will be required to assist with securing clear work restriction in the form of physical capabilities from the treating physician. This information will be used in placing the injured employees in suitable job duties. Any changes in the work restrictions should be communicated promptly to Gardena so that modifications to temporary or permanent work assignments can be made consistent with medical restrictions and physical capabilities. This may involve coordination of benefits with individual department payroll contact.

B. P
ermanent Disability - The claims administrator, as soon as it receives notice of P&S status, shall secure clarification of the permanent physical limitations and communicate this information to Gardena so that permanent accommodation consideration can be initiated.

C. Fr
aud Control - Gardena requires the claims administrator to aggressively control fraud and pursue restitution in all fraud cases. Risk Management shall be notified of all claims involving potential fraud and recommendations for initiation of fraud investigation activities. Gardena requires all cases meeting the State Fraud reporting guidelines be reported.

D. C
laim Reviews - Quarterly claim reviews on-site at the City of Gardena is required. The TPA is expected to send dedicated claim staff to attend claim reviews, coordinate defense counsel participation when it litigated claims are reviewed and prepare written claim summary reports.

E
. Loss Reporting and Data - Gardena requires that the claims administrator provide electronically, on a monthly basis, basic loss reports detailing claim frequency, paid and incurred costs. In addition, Gardena may have need on occasion to obtain other reports for various purposes including but not limited to actuarial studies, OSIP reporting, audits, program, injury and departmental analysis. Please provide details on your system’s reporting capabilities, availability of internal IT staff to respond to custom report requests and client access to your system’s reporting tool. Gardena will also require claim system access for multiple users (up to 3 users) to review and monitor its claims, review file notes and reserves.

F
. Claims Personnel Qualifications - The claim assistant(s) assigned to handle medical only claims for Gardena must have a minimum of three years’ experience in the Workers’ Compensation field. Examiners assigned to handle Gardena’s indemnity claims must have a minimum of five years’ experience handling public entity Workers’ Compensation claims, LC4850 and presumptions, and possess a Self-Insured Plans (SIP) Certificate. Supervisors serving Gardena must have a minimum of 5 years’ experience handling or supervising Workers’ Compensation claims and possesses an OSIP Certificate. It is desirable that the claim assistants, examiners and supervisors have experience with a multiple-location, public 4 sector client. Gardena maintains the right to interview and review evidence of work experience of all personnel to be assigned to its account and to approve such personnel.

Gardena desires dedicated claims personnel to facilitate a partnership approach to program management.

G. T
ransmission of Injury Reports and Claims Access - The claims administrator must be able to receive initial injury reports (5020 form) from Gardena via fax or electronically.

H. G
ardena may amend requirements as needed, with 30 days written notice to claims administrator. These requirements will become part of Gardena’s contract with the selected bidder. Gardena may conduct claims performance audits to measure TPA performance and compliance with claims administration standards and requirements.

I. E
xcess – Gardena has maintained excess insurance for most of the last 25 years, the most recent five years through PRISM (formerly CSAC-EIA). The selected TPA will be required to report on all qualifying excess claims as required by the excess policy to the applicable excess carrier, provide to Gardena and document in the claim file a copy of each excess report completed and, purse when appropriate excess reimbursements from the carrier. All recovery checks must be documented in the claim file (date, check numbers, amount or a scanned image) before forwarding the checks to the City of Gardena’s Risk Management Department. Gardena will provide a list of applicable excess policy info, carrier and retention levels to the successful TPA.

J
. Settlement Authorization - Prepare and submit settlement authorization request (SAR) for approval by Gardena prior to initiating settlement negotiations. City Council approval is required on all settlements in excess of $25,000 thus the successful TPA will need to plan for this delay in authorization on all claims requiring City Council approval. Settlements under $25,000 must be approved by the City Manager. Written settlement authorization request are required on all settlements.

K
. Gardena may implement various programs (RTW, ADA, ergonomics, etc.) that may require special coordination between the selected TPA and the applicable City function. TPA will be required to provide documentation and information as needed for Gardena to effectively implement these programs.
1 18 Addendum C - City of Gardena Professional Services Agreement Adde
ndum C - City of Gardena Professional Services Agreement

AGREEMENT BETWEEN THE

THE CITY OF GARDENA
AND
xxxxxxxxxx
FOR THIRD PARTY WORKERS’ COMPENSATION CLAIMS ADMINISTRATION Th
is contract, hereinafter referred to as Agreement, is entered into by and between THE CITY OF GARDENA (“City”) and xxxxx, a CORPORATION (“Consultant”). Based on the mutual promises and covenants contained herein, the Parties hereto agree as follows:

1. Recitals.

A. C
ity is desirous of obtaining services necessary to provide third party workers’ compensation claims administration .

B. C
onsultant is qualified by virtue of experience, training, education, and expertise to provide these services.

C. Ci
ty has determined that the public interest, convenience, and necessity require the execution of this Agreement.

2. Services.

A. T
he services to be performed by the Consultant shall consist of the following (“Services”): As specified in Exhibit “A”, attached hereto, and incorporated herein by reference, unless otherwise instructed by City.

B. Th
e Services shall be performed in accordance with the Project Schedule set forth in Exhibit A. Consultant shall not be liable for any failure or delay in furnishing proposed services resulting from fire, explosion, flood, storm, Act of God, governmental acts, orders or regulations, hostilities, civil disturbances, strikes, labor difficulties, difficulty in obtaining parts, supplies, or shipping facilities, inability to obtain or delays in obtaining suitable material or facilities required for performance, temporary unavailability of qualified personnel, failure by City to provide appropriate access to equipment or personnel, or other causes beyond Consultant’s reasonable control.

3. Additional Services. If City determines that additional services are required to be 2 provided by the Consultant in addition to the Services set forth above, City shall authorize the Consultant to perform such additional services in writing (“Additional Services”). Such Additional Services shall be specifically described and approved by City in writing prior to the performance thereof. Consultant shall be compensated for such Additional Services in accordance with the amount agreed upon in writing by the Parties. No compensation shall be paid to Consultant for Additional Services which are not specifically approved by City in writing.

4. Agreement Administrator. For purposes of this Agreement, City designates Ray Beeman as the Agreement Administrator who shall monitor Consultant’s performance under this Agreement. All notices, invoices or other documents shall be addressed to the Agreement Administrator, as well as all substantive issues relating to this contract.

City reserves the right to change this designation upon written notice to Consultant.

5. Consultant’s Proposal. This Agreement shall include Consultant’s proposal or bid which is incorporated herein as Exhibit A. In the event of any inconsistency between the terms of the proposal and this Agreement, this Agreement shall govern.

6. Timing of Performance. Time is of the essence with respect to Consultant’s performance of the Services required by this Agreement. Consultant shall diligently and timely pursue and complete the performance of the Services required of it by this Agreement as set forth in Exhibit A. City, in its sole discretion, may extend the time for performance of any Service.

7. Compensation. Compensation for the Services shall be billed as set forth in Exhibit A, attached hereto. The Compensation is inclusive of all costs that may be incurred by Consultant in performance of the Services, including but not limited to such items as travel, copies, delivery charges, phone charges, and facsimile charges, unless otherwise noted.

8. Term of Agreement/Termination.

A
. This Agreement shall be effect until all Services are completed as specified in Exhibit A or until terminated as provided for herein.

B
. City may terminate this Agreement without cause by providing written notice to Consultant not less than three days prior to an effective termination date.

City’s only obligation in the event of termination will be payment of fees and allowed expenses incu rred up to and including the effective date of termination.

C. U
nless for cause, Consultant may not terminate this Agreement. If Consultant is terminating this Agreement for cause, it must provide the City with thirty (30) days written notice.
3 D. U pon receipt of a termination notice, Consultant shall: (1) promptly discontinue all Services, unless the notice directs otherwise; and (2) within ten (10) days, deliver to City all files, data, reports, estimates, summaries, and such other information and materials as may have been accumulated or prepared to date by Consultant in performing the Services under this Agreement, whether completed or in progress. Consultant shall provide these documents by both hard copy and in electronic format if available. In the event of termination for other than cause attributable to Consultant, Consultant shall be entitled to reasonable compensation for the services it performs up to the date of termination and shall be deemed released from liability for any work assigned but not completed as of the effective date of termination.

9. Invoices and Payments.

A
. Payment shall be made upon receipt and approval of invoices for Services rendered. In order for payment to be made, Consultant’s invoice must include an itemization as to the services rendered, date(s) of service, direct and/or subcontract costs, and be submitted on an official letterhead or invoice with Consultant’s name, address, and telephone number referenced.

B. T
he Agreement Administrator shall review the invoices to determine whether services performed and documents submitted are consistent with this Agreement. Payment shall be made within forty-five (45) days following receipt of the invoice or the Agreement Administrator shall provide Consultant with a written statement objecting to the charges and stating the reasons therefore.

C. P
ayment by City under this Agreement shall not be deemed a waiver of defects, even if such defects were known to City at the time of payment.

10. Records/Audit.

A
. Consultant shall be responsible for ensuring accuracy and propriety of all billings and shall maintain all supporting documentation for a minimum of three (3) years from the completion date of the Services under this agreement the following records:

1. A
ll accounts and records, including personnel, property and financial, adequate to identify and account for all costs pertaining to this Agreement and assure proper accounting for all funds;
4 2. R ecords which establish that Consultant and any subconsultant who renders Services under this Agreement are in full compliance with the requirements of this Agreement and all federal, state and local laws and regulations

3. A
ny additional records deemed necessary by City to assume verification of full compliance with this Agreement.

B
. City shall have the right to audit Consultant’s invoices and all supporting documentation for purposes of compliance with this Agreement for a period of three years following the completion of Services under this Agreement.

C. U
pon reasonable notice from City or any other governmental agency, Consultant shall cooperate fully with any audit of its billings conducted by, or of, City and shall permit access to its books, records and accounts as may be necessary to conduct such audits.

11. Successors and Assignment. This Agreement covers professional services of a specific and unique nature. Except as otherwise provided herein, Consultant shall not assign or transfer its interest in this Agreement or subcontract any services to be performed without amending this Agreement. This Agreement shall be binding upon the heirs, executors, administrators, successors and assigns of the parties hereto.

12. Change in Name, Ownership or Control. Consultant shall notify the Agreement Administrator, in writing, of any change in name, ownership or control of Consultant’s firm or subconsulta nt. Change of ownership or control of Consultant’s firm may require an amendment to the Agreement.

13. Key Personnel . City has relied upon the professional training and ability of Consultant to perform the services hereunder as a material inducement to enter into this Agreement. Consultant shall provide properly skilled professional and technical personnel to perform all services under this Agreement. In the event that City, in its sole discretion, at any time during the Agreement, desires the removal of any person or persons assigned by Consultant to perform Services pursuant to this Agreement, Consultant shall remove any such person immediately upon receiving notice from City.

14. Use of Materials.

A
. City shall make available to Consultant such materials from its files as may be required by Consultant to perform Services under this Agreement. Such materials shall remain the property of City while in Consultant’s possession. Upon termination of this Agreement and payment of outstanding invoices of Consultant, or completion of work under this Agreement, Consultant shall return to City any property of 5 City in its possession and any calculations, notes, reports, electronic files, or other materials prepared by Consultant in the course of performance of this Agreement.

B. C
ity may utilize any material prepared or work performed by Consultant pursuant to this Agreement, including computer software, in any manner, which City deems proper without additional compensation to Consultant. Consultant shall have no responsibility or liability for any revisions, changes, or corrections made by City, or any use or reuse pursuant to this paragraph unless Consultant accepts such responsibility in writing.

15. Nonuse of Intellectual Property of Third Parties. Consultant shall not use, disclose or copy any intellectual property of any third parties in connecti on with work carried out under this Agreement, except for intellectual property for which Consultant has a license. Consultant shall indemnify and hold City harmless against all claims raised against City based upon allegations that Consultant has wrongful ly used intellectual property of others in performing work for City, or that City has wrongfully used intellectual property developed by Consultant pursuant to this Agreement.

16. Ownership of Work Product. All documents or other information created, developed, or received by Consultant shall, for purposes of copyright law, be deemed worked made for hire for City by Consultant and shall be the sole property of City.

Consultant shall provide City with copies of these items upon demand, and in any event, upon termination of this Agreement.

17. Legal Requirements.

A. Con
sultant shall secure and maintain all licenses or permits required by law, including a City business license, and shall comply with all ordinances, laws, orders, rules, and regulations pertaining to the work.

B. Con
sultant warrants that it shall perform the services required by this Agreement in compliance with all applicable Federal and California employment laws, including, but not limited to, those laws related to minimum hours and wages; occupational health and safety; fair employment and employment practices; workers’ compensation insurance and safety in employment; and all other Federal, State and local laws and ordinances applicable to the services required under this Agreement. Consultant shall indemnify and hold harmless City from and against all claims, demands, payments, suits, actions, proceedings, and judgments of every nature and description including attorneys’ fees and costs, presented, brought, or recovered against City for, or on account of any liability under any of the above-mentioned laws, which may be incurred by reason of Consultant’s performance under this Agreement. 6 C. Con sultant covenants that thee shall be no discrimination based upon race, color, creed, religion, sex, marital status, age, handicap, national origin or ancestry, or any other category forbidden by law in performance of this Agreement.

18. Conflict of Interest and Reporting.

A. Con
sultant shall at all times avoid conflicts of interest or the appearance of a conflict of interest in the performance of this Agreement. If required, Consultant shall comply with the City’s Conflict of Interest reporting requirements. Consultant understands that pursuant to Gardena Municipal Code sections 2.24.020H and

2.24.025G, it is forbidden to make any contribution to a candidate or committee of a candidate for a municipal office of the City, or to an officeholder, until the completion of services to be performed under this Agreement.

B. Con
sultant and its representatives shall refrain from lobbying City of Gardena officials, employees and representatives for the duration of this Agreement.

19. Guarantee and Warranty. Consultant warrants to City that the material, analysis, data, programs and SERVICES to be delivered or rendered hereunder will be of the kind and quality designated and will be performed by qualified personnel. Without waiver of City’s other rights or remedies, City may require Consultant to re-perform any of said services, which were not performed in accordance with these standards.

Consultant shall perform the remedial services at its sole expense.

20. Insurance.

A. C
ommencement of Work. Consultant shall not commence work under this Agreement until it has obtained City approved insurance. Before beginning work hereunder, during the entire period of this Agreement, for any extensions hereto, and for periods after the end of this Agreement as may be indicated below, Consultant must have and maintain in place all of the insurance coverage required in this Section.

Consultant’s insurance shall comply with all items specified by this Agreement. Any subcontractors shall be subject to all of the requirements of this Section and Consultant shall be responsible to obtain evidence of insurance from each subcontractor and provide it to City before the subcontractor commences work. Alternatively, Consultant’s insurance may cover all subcontractors.

B. I
nsurance Company Requirements. All insurance policies used to satisfy the requirements imposed hereunder shall be issued by insurers admitted to do business in the State of California. Insurers shall have a current Best’s rating of not less than A-:VII, unless othe rwise approved by City.
7 C. Coverage, Limits and Policy Requirements. Consultant shall maintain the types of coverage and limits indicated below:

1. C
ommercial General Liability Insurance - a policy for occurrence coverage for bodily injury, personal injury and property damage, including all coverage provided by and to the extent afforded by Insurance Services Office Form CG 2010 ed. 10/93 or 11/85, with no special limitations affecting City. The limit for all coverage under this policy shall be no less than one million dollars ($1,000,000.00) per occurrence.

2. C
ommercial Auto Liability Insurance - a policy including all coverage provided by and to the extent afforded by Insurance Services Office form CA 0001, ed. 12/93, including Symbol 1 (any auto) with no special limitations affecting City.

The limit for bodily injury and property damage liability shall be no less than one million dollars ($1,000,000.00) per accident.

3. P
olicy Requirements. The policies set forth above shall comply with the following, as evidenced by the policies or endorsements to the policies:
a. T
he City, its appointed and elected officers, employees, agents and volunteers shall be added as additional insured to the policy. b. T
he insurer shall agree to provide City with thirty (30) days prior written notice, return receipt requested, of any cancellation, non -renewal or material change in coverage.
c. F
or any claims with respect to the Services covered by this Agreement, Consultant’s insurance coverage shall be primary insurance as respects the City, its elected and appointed officers, employees, agents and volunteers. Any insurance or self-insurance maintained by the City, its elected and appointed officers, employees, agents and volunteers shall be excess of Consultant’s insurance and shall not contribute with it.

4. W
orker’s Compensation and Employer’s Liability Insurance - a policy which meets all statutory benefit requirements of the Labor Code, or other applicable law, of the State of California. The minimum coverage limits for said insurance shall be no less than one million dollars per claim. The policy shall be issued by an insurance company which is admitted to do business in the State of California and shall contain a clause that the policy may not be canceled without thirty (30) days prior written notice, return receipt requested, is mailed to City. 8 5. Professional Errors & Omissions - a policy with minimum limits of one million dollars ($1,000,000.00) per claim and aggregate. This policy shall be issued by an insurance company which is admitted to do business in the State of California and shall contain a clause that the policy may not be canceled until thirty (30) days written notice, return receipt requested, is mailed to City.

D. Addi
tional Requirements. The procuring of such required policies of insurance shall not be construed to limit Consultant’s liability hereunder or to fulfill the indemnification provisions and requirements of this Agreement. There shall be no recourse against City for payment of premiums or other amounts with respect thereto.

City shall notify Consultant in writing of changes in the insurance requirements. If Consultant does not deposit copies of acceptable insurance policies or endorsements with City incorporating such changes within sixty (60) days of receipt of such notice, Consultant shall be deemed in default hereunder.

E. D
eductibles. Any deductible or self-insured retention over $25,000 per occurrence must be declared to and approved by City. Any deductible exceeding an amount acceptable to City shall be subject to the following changes: either the insurer shall eliminate or reduce such deductibles or self-insured retentions with respect to City, its officers, employees, agents and volunteers (with additional premium, if any, to be paid by Consultant); or Consultant shall provide satisfactory financial guarantee for payment of losses and related investigations, claim administration and defense expenses.

F. Ver
ification of Compliance. Consultant shall furnish City with original policies or certificates and endorsements effecting coverage required by this Agreement. The endorsements are to be signed by a person authorized by the insurer to bind coverage on its behalf. All endorsements are to be received and approved by City before work commences. Not less than fifteen (15) days prior to the expiration date of any policy of insurance required by this Agreement, Consultant shall deliver to City a binder or certificate of insurance with respect to each renewal policy, bearing a notation evidencing payment of the premium therefore, or accompanied by other proof of payment satisfactory to City. Consultant shall provide full copies of any requested policies to City within three (3) days of any such request by City.

G. Ter
mination for Lack of Required Coverage. If Consul tant, for any reason, fails to have in place, at all times during the term of this Agreement, including any extension hereto, all required insurance and coverage, City may immediately obtain such coverage at Consultant’s expense and/or terminate this Agreement. 9 21. Indemnity.

A. C
onsultant assumes all risk of injury to its employees, agents, and contractors, including loss or damage to property.

B. C
onsultant agrees to defend, indemnify, hold free and harmless the City, its elected officials, officers, agents, employees and volunteers, at Consultant’s sole expense, from and against any and all claims, actions, suits or other legal proceedings brought against the City, its elected officials, officers, agents, employees and volunteers arising out of the performance of the Consultant, its employees, and/or authorized subcontractors, of the work undertaken pursuant to this Agreement. The defense obligation provided for hereunder shall apply without any advance showing of negligence or wrongdoing by the Consultant, its employees, and/or authorized subcontractors, but shall be required whenever any claim, action, complaint, or suit asserts as its basis the negligence, errors, omissions or misconduct of the Consultant, its employees, and/or authorized subcontractors, and/or whenever any claim, action, complaint or suit asserts liability against the City, its elected officials, officers, agents, employees and volunteers based upon the work performed by the Consultant, its employees, and/or authorized subcontractors under this Agreement, whether or not the Consultant, its employees, and/or authorized subcontractors are specifically named or otherwise asserted to be liable. Notwithstanding the foregoing, the Consultant shall not be liable for the defense or indemnification of the City for claims, actions, complaints or suits arising out of the sole negligence or willful misconduct of the City. This provision shall supersede and replace all other indemnity provisions contained either in the City’s specifications or Consultant’s Proposal, which shall be of no force and effect.

C. No
official, employee, agent or volunteer of City shall be personally liable for any default or liability under this Agreement.

22. Independent Contractor. Consultant agrees to furnish consulting services in the capacity of an independent contractor and neither Consultant nor any of its employees shall be considered to be an employee or agent of City.

23. PERS Eligibility Indemnification. In the event that Consultant or any employee, agent, or subcontractor of Consultant providing services under this Agreement claims or is determined by a court of competent jurisdiction or the California Public Employees Retirement System (PERS) to be eligible for enrollment in PERS as an employee of the City, Consultant shall indemnify, defend, and hold harmless City for the payment of any employee and/or employer contributions for PERS benefits on behalf of Consultant or its employees, agents, or subcontractors, as well as for the payment of any penalties and interest on such contributions, which would otherwise be the responsibility of City. 10 N
otwithstanding any other agency, state or federal policy, rule, regulation, law or ordinance to the contrary, Consultant and any of its employees, agents, and subcontractors providing service under this Agreement shall not qualify for or become entitled to, and hereby agree to waive any claims to, any compensation, benefit, or any incident of employment by City, including but not limited to eligibility to enroll in PERS as an employee of City and entitlement to any contribution to be paid by City for employer contribution and/or employee contributions for PERS benefits.

24. Notices. Any notice or communication given under this Agreement shall be effective when deposited, postage prepaid, with the United States Postal Service and addressed to the contracting parties. Name, address, telephone and facsimile numbers of the parties are as follows:

C
ity of Gardena:
1700 West 162nd Street
Gardena, California 90247-3732
Attn:

Telephone Number:

E-mail:

C
onsultant:

Attn:

Telephone Number:

Facsimile Number:

E-mail:

E
ither party may change the information to which notice or communication is to be sent by providing advance written notice to the other party.

25. Severability. If any provision of this Agreement shall be held illegal, invalid, or unenforceable, in whole or in part, such provision shall be modified to the minimum extent necessary to make it legal, valid, and enforceable, and the legality, validity, and enforceability of the remaining provisions shall not be affected thereby.

26. Jurisdiction and Venue. This Agreement shall be deemed a contract under the laws of the State of California and for all purposes shall be interpreted in accordance with such laws. Both parties hereby agree and consent to the exclusive jurisdiction of the courts of the State of California and that the venue of any action brought hereunder shall be Los Angeles County, California.

27. Waiver. No delay or failure by either Party to exercise or enforce at any time any 11 right or provision of this Agreement shall be considered a waiver thereof or of such Party’s right thereafter to exercise or enforce each and every right and provision of this Agreement. To be valid a waiver shall be in writing but need not be supported by consideration. No single waiver shall constitute a continuing or subsequent waiver.

28. Entire Agreement.

A. T
his writing contains the entire agreement of the Parties relating to the subject matter hereof; and the Parties have made no agreements, representations, or warranties either written or oral relating to the subject matter hereof which are not set forth herein. Except as provided herein, this Agreement may not be modified or altered without formal amendment thereto.

B. N
otwithstanding the foregoing, and to realize the purpose of this Agreement, the Agreement Administrator may issue a written modification to the Scope of Work, if this modification will not require a change to any other term of this Agreement.

29. Joint Drafting. Each party acknowledges that it has had an adequate opportunity to review each and every provision in this Agreement and to submit the same to counsel and other consultants for review and comment and that the parties jointly drafted this Agreement. No provision of this Agreement or any Assignment shall be construed more strictly against one party than the other party by reason that one or the other party proposed, drafted or modified such provision or any other existing or proposed provision.

30. Public Records Act Disclosure . Consultant has been advised and is aware that this Agreement and all reports, documents, information and data, including, but not limited to, computer tapes, discs or files furnished or prepared by Consultant, or any of its subcontractors, pursuant to this Agreement and provided to City may be subject to public disclosure as required by the California Public Records Act (California Government Code section 6250 et seq.). Exceptions to public disclosure may be those documents or information that qualify as trade secrets, as that term is defined in the California Government Code section 6254.7, and of which Consultant informs City of such trade secret. The City will endeavor to maintain as confidential all information obtained by it that is designated as a trade secret. The City shall not, in any way, be liable or responsible for the disclosure of any trade secret including, without limitation, those records so marked if disclosure is deemed to be required by law or by order of the Court.

31. Authority to Execute. The persons executing this Agreement on behalf of the parties warrant that they are duly authorized to execute this Agreement.

32. Attorney’s Fees. In the event that legal action is necessary to enforce the provisions of this Agreement, or to declare the rights of the parties hereunder, the 12 parties agree that the prevailing party in the legal action shall be entitled to recover attorney’s fees and court costs from the opposing party.

33. Section Headings. The Section headings used in this Agreement are for reference purposes only and shall have no binding effect.

EXHIBIT B
Re
sponse to RFP – City of Gardena
P age 1
Revision Date – September 1, 2022
`
LWP Claims Solutions, Inc
Workers’
Workers’ Compensation Claims Management
City of Gardena
Response to Request for Proposal 2022-001
J
udy Adlam
President and CEO
Revised September 1, 2022
Delivering
What We Promise
[email protected] | 35 Miller Ave #214 Mill Valley, CA 94941 | 415-384-0370

EXHIBIT B

Response to RFP – City of Gardena

Revision Date – September 1, 2022

Table of Contents

Cover Letter ...................................................................................................................................... 3 Executive Summary ........................................................................................................................ 5 TPA Company Overview and Client References ............................................................... 17 Account Management .................................................................................................................. 31 Key Claims Administration Requirements .......................................................................... 33 Claims Staffing expectations and Claim Handling Philosophies ................................. 39 RMIS ................................................................................................................................................... 43 Pricing ............................................................................................................................................... 49 Ancillary Services ........................................................................................................................ 53 Workers’ Compensation Trust Fund ..................................................................................... 55

Attachments

1. General Claims Administration Requirements

2. PRISM Claims Standards

Addenda

A. Preliminary Transition Plan
B. Claims Best Practices
C. Litigation Best Practices
D. Sample Reports
E. Payment and Injury Code Tables

Re
sponse to RFP – City of Gardena
P age 3
R evision Date – September 1, 2022
City of Gardena
Raymond Beeman CPA
Director, Administrative Services
T
ony Su
TCS Risk Management
Deli
vered via USPS and by email to [email protected] and [email protected] R
e: City of Gardena– Request for Proposal Workers’ Compensation Claims Administration and Managed Care Services RFP 2022-001
T
hank you for the opportunity to propose Workers’ Compensation claims and Managed Care services for the City of Gardena’s Workers’ Compensation program. We are very interested in the opportunity to reduce your claims costs while properly supporting the needs of your employees. We believe that our focus on sound best practices together with our track record for building very productive relationships makes us uniquely qualified to support your needs.

In
business for 32 years, LWP is a results- oriented Third Party Claims Administrator with extensive experience in self-insured administration. The Company is properly licensed and in good standing with the State of California. We have a proven track record for delivering measurable improvements in our cli ents’ results that are often quite dramatic. The City can expect those improvements to begin during our claims intake process and to continue indefinitely. A few examples of results we have delivered to our clients have included:

Municipal Pool Client- A new client to us in 2013, they had 374 open indemnity claims at time of transfer from their prior TPA. The client was hoping to see this reduced below 350, with a reduction in outstanding loss reserves, as well. At the same time, there were service challenges they hoped to resolve. At the end of 2014, LWP had successfully reduced the open claim inventory to 302 claims (far lower than the client thought was possible) and had reduced the outstanding claim reserves by more than $1.5 million. At the end of 2019, their open inventory was 292 with outstanding claim reserves down another $1 million. Current outstanding reserves are now more than $3Mil lower than upon takeover.

Municipality Client – New to LWP in early 2015, within 7 months, total outstanding pending claim volume had been reduced by 16%, with corresponding reductions in outstanding reserves. Additionally, several future medical claims had very significant course corrections, resulting in very substantial reductions in medical and
transportation expenses. This City’s outstanding reserve was reduced from $5Mil upon intake to its current $2.5 Mil, a reduction of 50%.

I
t is also common for LWP to identify opportunities for claim closure as well as reductions in treatment for future medical claims upon intake. When assuming future medical claims, we will review not only the current treatment patterns, but also the award as well as the medical reports on which the future medical award was based. It is not

Response to RFP – City of Gardena

Revision Date – September 1, 2022

uncommon to find that over time, treatment has evolved beyond the scope of the award, and that bills are being “processed” rather than “adjusted”. LWP can often impact those future medical claims by either reintroducing controls, or even by lump sum settlements, if agreeable to the client.

LWP is aggressive, disciplined, and we deliver results! Our tag line is not just marketing “spin”. By choosing LWP, the City will not be choosing an “administrator”. You will be choosing a “partner”. We will make it our mission to improve the City’s results by preventing litigation, by aggressively moving claims to early closure and by shutting down claims before they develop.

In particular, we recognize that we are an extension of the client’s risk management team and that improving the cost-efficiency of your program is a continuing need. Our approach is:

a) Start by tackling the issues and concerns that are currently known to the City b) Work closely with the City to analyze any additional savings opportunities that might be identified during the SWAT intake process
c) Develop and implement a plan to capture those savings d) Continue process throughout the life of the relationship

Be assured that if the City selects LWP to be their Claims Partner, we will work diligently to earn your business each and every day. We are confident that we can reduce your Workers’ Compensation claims costs while easing the process at the same time. We promise to listen to the City’s requests and needs, and to tailor our program to meet those precise requests. And above all else, LWP is known for “Delivering What We Promise!”

Note that we have thoroughly considered all materials provided by the City and are prepared to adhere to all requirements described in the RFP, without exception. Claims services will be provided from our office in Glendale.

We look forward to hearing about next steps.

Sincerely,

Judy

Judy Adlam
President & CEO
LWP Claims Solutions, Inc.

Response to RFP – City of Gardena

Revision Date – September 1, 2022

Executive Summary

LWP is prepared to hit the ground running. We are confident that we can reduce the City of Gardena ’s Workers’ Compensation costs while easing the process at the same time. We recognize that you are seeking a partner with a good understanding of the princip les that differentiate excellence in Workers’ Compensation from mediocrity and require a partner who can deliver. LWP is that partner!

Our exclusive focus on Workers’ Compensation claims coupled with our results-oriented culture allow us to balance the n eed for customization with the discipline to execute our Best Practices and deliver superior results. We are confident that we can deliver services that will provide you with a distinct financial advantage. In addition to providing initial programs that are tailored to the client’s needs, LWP is committed to providing access to new programs and strategies that are developed to meet the ever-changing Workers’ Compensation environment. Based on our understanding of the program, we believe that the ability of a new TPA to succeed will boil down primarily to the following:

 Selecting the best staff for the City of Gardena
 Installing the Programs: (including the Clinical Component, Medical Provider Network, Disability Management, Litigation Support, Subrogation Support, and Special Investigations)  Managing the IT Component
 Assimilating the Claims and Providing the Transition Support  Disciplined Execution of Best Practices
 Effective Cost Containment Strategies
 Client Support

Because our service model is based on the principle of customizing our services to meet the unique characteristics and needs of our clients, we offer a menu of possible services. We expect to further fine tune our recommendations and customize and tailor our services by working with you to identify particular areas of need.

Staffing the Team Properly

At LWP, we recognize that identifying the right staff for any particular client is part art, part science. LWP takes very seriously the process of matching the proper Examiner with the client. We consider

 Client culture and objectives
 Relevant experience
 Examiner’s caseload (both new loss volume and pending)  Feedback from the client

We expect to utilize the following staffing model:

Response to RFP – City of Gardena

Revision Date – September 1, 2022

Identifying Staff for the City of Gardena : It would be disingenuous to suggest that hiring and retaining talented future employees is an easy task. It is, in fact, the most difficult challenge we face. While there is always a stream of candidates in the marketplace, the pool of high -quality prospects is much more limited.

And every TPA and Insurance Carrier is looking for good people.

We have identified David Bomberger as the Claims Manager/Account Manager. David served 19 years as the manager of the self-administered program at the City of Santa Monica before joining LWP in early 2020.

His depth of experience in support of cities makes him an ideal “fit” for the City of Gardena. He understands the ins and outs of workers’ compensation issues in municipalities.

In his role, he will ensure that our programs and protocols meet the City’s needs and are followed. He will attend all claim reviews, City meetings, will present cases to the City Council , if that is of interest, and will provide training and stewardship to the City staff. David has unlimited authority to resolve issues on LWP’s behalf.

We further offer Amber Davis to serve as transition/implementation manager for the City. Amber is a very experienced manager at LWP who offers a wealth of experience in transitions and implementati ons of municipalities, in particular.

We have not yet identified supervisor or examiner candidates for the City to consider. Upon contract award, we will develop a list of candidates and would be happy to make them available for the City to interview.

Team Orientation

LWP proposes to schedule a team orientation meeting to take place prior to the arrival of the claim files. We propose to conduct a session to involve your management, and LWP management and staff. The purpose of the session would be:

 Build team camaraderie amongst all parties
 Educate the team on the fundamentals and details of the Program  Jump start the transition process

Installing the Programs
Proposed Staffing

1 Account Manager – partially dedicated
1 Claims Supervisor – partially dedicated
1 Sr. Claims Examiner partially dedicated
1 MO/Future Medical Examiner - partially dedicated
1 Claims Assistant – partially dedicated

Additional support (to include mail room, scanning, check printing, bill payment, trust fund replenishment and balancing and loss reporting) will be provided by our Centralized Services Team)

Response to RFP – City of Gardena

Revision Date – September 1, 2022

Immediately upon selection of LWP, we recommend a meeting with the City of Gardena and LWP to ensure that all claim management programs are properly tailored to meet your specific needs. We are confident that our processes will support those programs that are working well, and through collaboration we can strengthen results in other areas. We believe in continually refining our approach to stay ahead of the ever- changing external legislative, judicial and clinical factors that can drive costs up. Our initial recommendations on an approach to the major claims programs are:

The Clinical Component
At LWP, we believe that excellence in clinical management is the best way to shorten disability durations and speed both return-to-work and claims closure. Our track record for excellent outcomes is the result of our focus on aggressive up -front m edical treatment, a reliance on evidence- based protocols and very aggressive return-to-work efforts. We subscribe to the sports medicine philosophy of medical treatment. We advocate immediate diagnostics and early aggressive treatment to shorten the treatment timetables and keep the injured worker focused on recovery and return to work. Additionally, we know that passive treatment and delays can also lead to dependence on pain medications and the resulting “disability” syndrome. We are willing to “think outside the box” when treatment alternatives are presented that have a likelihood of a productive return to work.

Upon contract award, we will want to schedule a meeting with the City of Gardena to accomplish the following:

 Gain a full understanding of your network preferences (including discussing your perspective about MPN as well as identifying any providers with whom the City of Gardena has concerns)  Agree on UR protocols (which we view as related to the network choice)  Determine the City of Gardena ’s Preferred providers for Pharmacy Benefits, Diagnostic, Transportation, Translation, Durable Medical Goods (LWP has programs available for all, if there is interest)

Some of our differentiators include:
 UR plan that accommodates adjusters approving needed treatments without delay – roughly 93% of all treatment requests are approved by the Examiner without the delay and expense of Utilization Review
 Diagnostic testing program that gives us access to preferential testing appointments at vario us providers at discounted rates
 Three-pronged approach to preventing prescription drug overutilization (including Pharmacy Benefit Network that includes first -fill, Opiate Drug screening and physician peer- to-peer wean down support)
 Very judicious use of Nurse Case Managers with many assignments limited to one-time tasks

Medical Provider Network
LWP offers a proprietary Medical Provider network that is available to the City of Gardena, if there is interest.

We strongly recommend this network as an impor tant tool in litigation prevention as well as a method to contain medical costs.

Response to RFP – City of Gardena

Revision Date – September 1, 2022

Our network, developed by Signature Networks Plus, offers clients a very distinct advantage, both in quality of care and in cost. The network is offered in two forms- one including Kaiser and one excluding Kaiser, with all other features of the networks being identical. Some advantages to our network include:

 Statewide Network developed by industry leading network developers  Providers were carefully chosen based on extensive data that measures outcomes (return-to-work and treatment durations)
 Need for utilization review is significantly reduced by quality of physicians (saving time and expense)
 Significantly deeper discounts than most MPNs
 No access fee (client pays only the PPO % of savings BELOW fee schedule without any separate access fee.)
 Litigation rates are reduced through use of a good network

Upon contract award, we hope to meet with you to better understand your perspective toward Medical Provider Networks and any interest you may have.

Disability Management
LWP is committed to proactive disability management that is focused on early and sustained Return -to- Work. We recognize the need for early aggressive medical treatment so as to minimize disability and facilitate case resolution. We know that claims resolve quicker when the injured worker is returned to work.

While an injured worker is disabled, we contact the treating physicians no less frequently than every two weeks. During the call, we attempt to coordinate release to full duty or, failing that, a return to modified or alternate work. Our staff is trained to probe for information about what an employee is physically ABLE to do, rather than accepting “unable to return to work” as a status. We f ocus on activities of daily living to determine whether we can work with the employer to create modified duties based on those abilities.

Upon contract award, we would like to meet with you to fully understand the City of Gardena ’s Return-to- Work Program so that we can most effectively interface. Although we have extensive experience with various Return-to-Work programs, we recognize that each program is designed slightly differently, and want to ensure we design our workflows to interface seamlessly with the City of Gardena.

Litigation Support
LWP believes in aggressive litigation management focused first on avoiding the process and then limiting the use of counsel to task assignments when appropriate. As a result, our clients enjoy litigation rates that are more than 50% below the state average. We believe, and have proven, that prompt and appropriate file handling reduces the number of claims that go into litigation. By involving the injured worker and employer as key members of the claim management team, conflicts and disputes are avoided and/or minimized.

Our litigation management strategies include:
 Referrals to counsel are limited, and when needed, are issue-specific  Litigation budgets are required of counsel
 All case activity requires the Examiner’s approval
 LWP Examiners maintain control of the file at every step of the process  LWP Examiners are trained to manage basic legal issues without attorney involvement  LWP recommends litigation claim reviews to review all litigated cases with the attorney(s), client and Claims staff.

Response to RFP – City of Gardena

Revision Date – September 1, 2022

Through these practices we have been able to successfully control our clients’ allocated loss adjustment expenses and the impact that litigation has on average claim duration. When litigation commences, we evaluate the case for resolution at every step of the process. Upon contract award, we will work with the City of Gardena to fine tune our litigation management program to fit your EXACT needs.

Subrogation Support
Upon contract award, LWP will discuss subrogation in depth to learn more about the City of Gardena ’s philosophies relative to subrogation, particularly relative to your vendors and residents. Our approach to subrogation is to ensure we fully understand the relationships and expectations before we receive the claims. It is our philosophy to aggressively pursue subrogation when appropriate without interfering with any client relationships. Once we have a clear understanding of the expectations, we will custo mize our protocols and training to support you.

Special Investigations Unit (SIU)
Our approach to SIU is consistent with our approach in all other areas. We do not paint all injured workers with a broad brush. We strive for balance, knowing that fraud must be taken very seriously, yet also recognizing that unfounded accusations and mistrust lead to unnecessary litigation and expense.

Our staff receives regular training in how to identify potential fraud without becoming suspicious of honest and well- meaning injured workers. We utilize a list of Key Fraud Indicators that assist the Examiner in identifying claims that may require additional investigation. Whenever red flags are identified, the Examiner will immediately contact the Employer to discuss and agree on an appropriate plan of action.

On occasion, the SIU investigation raises issues that do not rise to the level of prosecution, but which could still result in expedited return -to-work. Often, surveillance films can be shown to a treating physician that will result in the physician releasing the injured worker to return to modified or full duty. Films that show some moderate activity can be successfully used to prompt a release from care or return to work even if they are not sufficient for an SIU prosecution.

In the absence of a specific recommendation from our client, we work with Probe Information Services (now a division of VRC) as our SIU partner. LWP and Probe formed a strategic partnership in 2004 to create a pro- active team to fight fraud and create positive claim outcomes. Probe provides LWP with both a compliant and committed Special Investigation Unit (SIU). Probe’s SIU provides annual anti-fraud training as well as reviews suspicious claims during their weekly visits to LWP’s offices. LW P’s claim professionals strategize with Probe’s SIU to develop a pro -active plan of action to utilize innovative investigative solutions to get malingerers back to work, stop exaggerators, identify abuse and successfully convict those who commit insurance fraud. During our partnership, we have had 28 convictions for insurance fraud and over $1mil in restitution ordered.

Managing the IT Component

The IT component of this program is very manageable, and we are committed to making a smooth transition.

We will want to meet with the City of Gardena immediately upon contract award to develop a step-by-step transition plan for the various IT components of this project. Based on our current understanding, we would expect the following to be required:
 Data conversion and document intake from the City of Gardena ’s TPA’s current claims system (including claims, documents and Bill Review history)
 Access to our claim system

Response to RFP – City of Gardena

Revision Date – September 1, 2022

 Set up regular data extracts and reports to meet the City of Gardena’s needs  Any required performance data, metrics and stewardship reports

Assimilating the Claims and Providing the Transition Support

LWP has extensive experience in ass imilating claims that have been previously handled by other administrators. We understand that claims handlers can make a very significant impact on the bottom-line results of a book of business. Although it is always ideal to manage a claim from day one, we do recognize that it is very possible to impact outcomes, even long after the claim arises. Our staff is trained to look for missed opportunities to impact outcomes, and to focus on accurate reserving, coding and outcome -based adjusting. We have a track record for focusing quickly on the right things, including:
 Identifying any claims that can still have major course corrections and produce savings  Accurately coding claims to allow trending of litigation, subrogation, etc.  Quickly identifying and pursuing subrogation/contribution opportunities before statutes run  Systematically evaluating all claims for closure and cost-effectively closing down exposures

We understand that the challenge of implementing the new program cannot distract us from also closing down those older files that can be resolved in the near term. We are very experienced at doing both things simultaneously. Some recent successes have included reducing the pending claims of a Joint Powers District from 374 indemnity claims (received from their prior TPA upon transfer) to 302 within 18 months and now to less than 290 claims.

Our experience with managing takeover files enables us to commit to the following:
 Within 15 business days of claim data intake, all claims will be on diary and all disability calls will have been made
 Within 45-days all initial plans of action will be updated  Within 60 days, we’ll be prepared to meet with the City of Gardena to review all open claims to discuss any issues identified, followed by transition to an ongoing claim review schedule.  At 70 days, we’ll be prepared to meet with Defense Counsel to conduct a litigation review.

We have attached a preliminary transition plan as Addendum A . Upon contract award, we will meet with the client to finalize the plan, and then will provide weekly updates until the transition is complete.

Disciplined Execution of Best Practices

LWP has a proven track record for disciplined execution. We have documented those practices that we are confident facilitate achievement of outstanding results. Upon contract award, we work with our clients to compare our best practices with those of the client. In all cases, we will hold ourselves to the higher of the two standards in each performance area.

We measure and monitor our Examiners’ performance to be sure that the agreed Best Practices are utilized.

We know that the difference between excellence and mediocrity is in the blocking and tackling that occurs each and every day. Yet, we also recognize that even tried and true techniques are not always the best course for any particular claim. Our Examiners are empowered to evaluate the circumstances of a claim and to consider an alternate course of action that is likely to lead to a better result for a particular claim. We want our Examiners to “do the right thing,” rather than merely “doing things right.” If at any time, the Exam iner proposes an alternative strategy, this will be discussed with the client prior to embarking on an alternative path.

Response to RFP – City of Gardena

Revision Date – September 1, 2022

At LWP, we recognize that our core responsibility is to investigate, adjust and settle claims.

LWP has extensive protocols to ensure that we determine eligibility for, and then process both medical and indemnity benefits in a timely manner.

Included in our core responsibility is timely payment of benefits and notices to employees. Through careful hiring and training practices working hand in a hand with a claims system specifically designed to move claims toward conclusion while complying with all regulations we are able to effectively meet this responsibility. Our unique approach to supervision and management also ensure compli ance with the California Labor Code.

Integral to our approach to claims handling is client involvement. The BCJPIA will maintain final control of each item requested. Communications will be established to ensure that you are always aware of claim status and approval is sought when appropriate.

LWP’s contact is focused on determining what activities the employee is ABLE to perform. We do not accept “unable to work” as a status. We look for the activities that CAN be performed, including activities of daily living. We then work with the Employer to determine whether temporary modified work can be available to keep the employee at work.

LWP has a proven track record for disciplined execution. We go well beyond the legal requirements in order to ensure that we accomplish the goal of minimizing the disruption both to the injured worker and to the employer that is caused by an industrial injury. We want our Examiners to “do the right thing,” rather than merely “doing things right.”

We have documented those practices that we are confident facilitate achievement of outstanding results. We measure and monitor our Examiners’ performance to be sure that our Best Practices are utilized. We know that the difference between excellence and mediocrity is in the blocking and tackling that occurs each and every day. Yet, we also recognize that even tried and true techniques are not always the best course for any particular claim. Our Examiners are empowered to evaluate the circumstances of a claim and to document and pursue a course of action that is likely to lead to a better result for a particular claim.

Once the objectives of the program are clearly defined and the BCJPIA-specific work flows and Best Practices have been created, LWP will manage the claims according to those handling guidelines. We anticipate the life of an indemnity claim to be represented by the graph below;

Indemnity Claim Timeline

CLAIM REPORTED
TO LWP

SUPERVISOR

REVIEWS AND

ASSIGNS CLAIM
3 POINT CONTACT
MADE

INITIAL RESERVES
SET

PLAN OF ACTION

CREATED

SUPERVISOR
REVIEW

FIRST CASE

RESOLUTION
DIARY

PLAN OF ACTION

REVIEWED

SUPERVISOR
REVIEW

SUPERVISOR
REVIEW
Day 1 Day 1 24 hours Day 5 Day 14 Day 28 Day 30 Every 45 Days Day 90 Every 90 Days

Response to RFP – City of Gardena

Revision Date – September 1, 2022

LWP will set up a claim and begin the three -point contact process immediately upon receipt of ANY notice of a claim. LWP Examiners are required to make three-point contact on all Indemnity claims within 24 hours of receipt, with the first contact always be ing the employer. If voice -to-voice contact is not achieved, the Examiner will continue efforts to reach the parties until accomplished.

Once the three-point contact in completed the claim begins a cycle of processing that is continually focused towards closure.

During the initial case evaluation and no later than five business days from the date the claim is originally reported to us, the Claims Examiner establishes a reserve that reflects the likely cost of the case based on the available factual and medical information. Subsequent reserve changes are made within five business days of receipt of any additional information supporting a reserve adjustment. It is our philosophy to ensure that the reserves represent the likely outcome based on available information. The Examiner will review reserves every 30 days in addition to reevaluating them every time new information is received.

Our supervisors review reserves each time they touch a file. After assigning the claim and providin g initial direction to the Examiner, they first see the reserves at their 28 day review, and then subsequently at each touch point and on each oversight diary. Supervisors maintain oversight diaries no longer than 90 days apart, and more frequently for files with significant issues. Additionally, they must approve all reserve changes that meet the client thresholds as well as reviewing the reserves in preparation for each client claim review. Beginning with this review and continually through the life of the claims the supervisor and adjuster will work at each touch of the claim to move toward closure.

Our protocols include regular plan of action updates. For each claim issue, the Examiner will enter a status update as well as a Plan for the Steps necessary to resolve that issue. The scheduled review and update of this plan will allow the City to immediately review the status of the claim at any time through online access.

Continued review by the examiner and the supervisor is maintained using our diary system. Each time a diary is worked another will be set. We consider resolution of the claim at each touch and are constantly working to return the injured worker to work and close the claim. Our Claims and Litigation Best Practices are included as Addenda B and C.

Claim
Reported
Assigned
to adjuster
3 point
contact
completed
Medical and disabilty
managment / Reserves
set or reviewed
Plan of action is
created or updated
Supervisor reviews the
file
Ongoing contact with
employer, employee
and doctor
Interal audit
continually reviews
files for compliance

Response to RFP – City of Gardena

Revision Date – September 1, 2022

Effective Cost Containment Strategies

Independent of the decision to choose a particular vendor/partner for cost containment services, we know that the results are impacted by the utilization strategy much more heavily than they are impacted by the choice of partner. The question to ask is “Wh en UR should be used?” rather than “Who should provide my UR?” Therefore, we offer our cost containment strategies for the City of Gardena’s consideration, so that they can assess our “fit” for their program.

LWP has a proven track record for “doing the right thing”, rather than merely “doing things right”. Our focus is always on the successful outcome, rather than on the savings that can be generated by a single short - sighted transaction.

We maintain extensive cost-containment programs that are designed to first provide access to the best care available, and secondly, to offer cost savings where available. We review our claims and cost containment results regularly to look for patterns that may allow us to fine tune our Best Practices in order to maximize the impact that cost-containment techniques have in the right situations while minimizing the costs and time that can be spent chasing savings that can be less than the cost of the process. Plainly stated, we will not spend a dollar to try to save fifty cents.

LWP’s cost containment program, branded as “SPHERE Solutions,” is flexible and can be adapted to meet the unique needs of the client. We offer a menu of services, as well as interfacing with providers chosen directly by the client. Each service can be customized for each client.

Utilization Review
One of the distinguishing features of LWP’s UR program is our judicious use of UR. As with all other things, LWP does not believe that more is necessarily better. In fact, unnecessary UR can serve to alie nate treating physicians and injured workers and drive up employers’ costs. We continually monitor each Examiner’s utilization to look for training opportunities. Examiners are encouraged to approve diagnostics and treatment that are very unlikely to be denied or modified. This can even include approving surgeries based on positive objective diagnostic findings. This approach is also consistent with our sports medicine philosophy to ensure aggressive, up -front medical care in order to speed the process from diagnosis to recovery.

Nurse Case Management
It is our philosophy to utilize nurse case management on a case-by-case basis. We believe that Case Managers can be an invaluable resource in the right situations. But indiscriminate use drives up claim costs while also diluting the nurse’s effectiveness on the right cases. More is not necessarily better.

Field case management is generally reserved for those claims that are more severe or where face- to- face intervention with both the employee and treating doctor will serve to facilitate an early return to work and recovery. Most field case management assignments are task -specific, with the field case manager assigned to attend a medical appointment or meet with an injured worker and their family, after which t hey close their assignment until/unless requested to take any additional action.

Response to RFP – City of Gardena

Revision Date – September 1, 2022

We recommend case management services be implemented when a need is identified and should end when they are no longer impacting the return to work efforts or ultimate claim ou tcome. The specific guidelines are tailored to each client to be consistent with their return to work program.

Medical Bill Review
At LWP, we believe that the most important component of bill review is identifying the best network for a client. Our clients can access both national and customized networks, and networks can be stacked in order to maximize savings. In order to provide extensive flexibility, we have built an internal system that adds a significant layer of quality control that sits on top of a bill review company’s software. By using this approach, we are able to offer our clients a full assortment of network options while still ensuring accuracy of reviews and payments and consistency across networks and providers. We have a fully integrated interface with accūrō.

Medical Provider Network
LWP offers our client’s access to a proprietary Medical Provider network that we believe offers a very distinct advantage, both in quality of care and in cost. The network is offered in two forms - one including Kaiser and one excluding Kaiser, with all other features of the networks being identical. Some advantages to our network include:
 Network developed by industry leading network developers  Providers were carefully chosen based on extensive data that meas ures outcomes (return-to-work and treatment durations)
 Need for utilization review is significantly reduced by quality of physicians (saving time and expense)
 Significantly deeper discounts than most MPNs
 No access fee (client pays only the per-bill bill review fee, which includes MPN access)  Simplified enrollment
Should the City of Gardena choose to utilize LWP’s network, there is no filing to do. LWP will provide the documents for posting, and the MPN can be utilized on Day 1.

Should the City of Gardena prefer not to use a network, or prefer to choose another network, LWP’s bill review partner can access any network that the City of Gardena makes available.

Prescription Drug Management
LWP has implemented an aggressive, multi-pronged approach to controlling Pharmacy Costs. Our program includes the following:

Pharmacy Benefit Network (PBN) – LWP has a strategic partnership with Optum for pharmacy services.

Optum’s extensive network and pharmacy cards provide accessibility and ease of use for the injured employees. The network pricing and utilization review allow LWP to monitor medical use and control claim costs for our clients. Features include:
 No prescriptions can be filled in physicians’ offices  First Fill cards provided to employer
 Home Delivery service available

Response to RFP – City of Gardena

Revision Date – September 1, 2022

 Brand to generic channeling
 Both network discounts and out-of-network retrospective reviews  Robust database checks for drug interactions, non -formulary prescriptions, over -utilization and prescriptions filed by multiple physicians
Opiate Drug Screening – Through our strategic partnership with Optum, we access their relationships with Drug Screening services. It is our practice to require the prescribing physician to administer drug screening tests based on established protocols.

We test for therapeutic levels of the prescribed drugs and require the testing firm to provide results to the treating physician. We have found the range of results to include:
 Proper utilization of drug at therapeutic level
 Absence of prescribed drug (triggering a non-renewal of the drug)  Presence of illicit drugs
Peer-to-Peer Physician Interventio n- LWP has partnered with PRIUM to offer peer -to-peer physician coaching for treating physicians who are uncomfortable with the wean-down and detox process. They focus on educating physicians on safe methods of weaning, utilizing drug replacement strategie s and detox methods.

Expedited Diagnostic Testing
For diagnostic services, LWP currently has a strategic partnership with One Call Medical and with HomeLink. The benefits of this arrangement are twofold - (1) preferential expedited appointments to speed diagnosis and treatment and (2) reduced fees for these services. Most tests can be scheduled within 24 hours to avoid the protracted delays that interfere with return-to-work and healing. There is no separate pricing for this program. Charges will be no higher than fee schedule, without any additional administrative charge.

Upon receipt of referral, our partner will contact the injured employee t o schedule the diagnostic test at a network facility. Reports are sent to the claims examiner immediately following the diagnostic test.

Durable Medical Goods
LWP has strategic partnerships with One Call Medical and with HomeLink for Durable Medical Good s. We channel to these providers in order to effectively track utilization as well as accessing discounted prices for durable goods (each has its own strengths).

Transportation and Translation Program/Network
LWP has a strategic partnership with One Call Medical. Their Relay -Ride program has resulted in very substantial savings by using an on- demand Lyft transportation model. Their proprietary software allows them to schedule and communicate with drivers and injured workers in real time, offering the inj ured employee seamless services at a much-reduced cost.

Translation services include the availability of language- line telephone translation in all languages, as well as on-site face to face translators for meetings, depositions, and medical appointments.

Physical Therapy

Response to RFP – City of Gardena

Revision Date – September 1, 2022

LWP has formed a strategic partnership with One Call Medical and with HomeLink to offer access to their Physical Therapy Network. The benefits of utilizing a network are:
 Removes the financial incentive for physicians to over-prescribe, since the therapy will be performed at a facility in which the physician has no financial interest  Consistency of reporting
 Discounted fees (16% below fee schedule)
Clinic Oversight Program
LWP’s managers work directly with medical clinics to improve their reporting practices when needed. We visit the business managers at those clinics to reinforce the necessity of providing timely and comprehensive reports that address our very specific requirements, including our requirement to comment on allowable activities of daily living when reporting any work restrictions. LWP has experienced improved reporting from some clinics following their understanding that patients will be directed to other clinics if we cannot obtain the information needed in order to support our clients.

Client Support

Proactive service coupled with responsiveness to clients’ needs is the hallmark of LWP’s service model. We understand that excellent adjusting is at the foundation of all service, yet also recognize that different stakeholders can have distinct needs. Alth ough a larger department may have more claims than a smaller one, each and every department will enjoy customized service to meet their specific needs.

We expect to have very frequent communications with the City of Gardena ’s Risk Management team and staff. We feel that it is very important to involve our clients in both routine and high level issues to ensure the maximum level of claims management is being provided. Successful claim outcomes can be traced very specifically to teamwork between the employer and the administrator.

Communications with our clients is done through a combination of email, telephonic and face-to-face means.

The Manager and your staff will have cell phone numbers for the Claims Supervisor, the Claims Manager, Vice President of Claims and the President/CEO. All will be available to assist with issues, large and small.

Additionally, we expect to provide regular reports that detail the status of various issues. You can expect regular calls from our management and meetings at whatever frequency is preferable to you.

Response to RFP – City of Gardena

Revision Date – September 1, 2022

7 TPA company overview and client references

Please include in your proposal the following information.

 Company Profile - -Years in business

LWP is owned by Judy Adlam, who serves as our President/CEO. Our clients include both public and private employers as well as groups, both self -insured and insured. All Officers are active managers who are intimately involved in the day -to-day operations and bring extensive experience to LWP. LWP has been managed by J udy Adlam since 1998. After having a minority interest since 2002, Judy became the sole owner in 2013. LWP is a Sub -S Chapter California Corporation.

LWP has been in business since 1990.

 Revenue or other financial data if able to disclose or other metrics of size and stability

In business over 30 years LWP has a proven track record for longevity and success. Earnings in most recent years are $1.01M in 2021 and $873K in 2020. Revenues have increased from $14.9 M to over $15.6 M in the same period. It is noteworthy that LWP does not have any debt.

LWP's unique business model allows us to stay small, lean and successful. We have developed a mix of clients including large insurance companies, public and private self - insured entities and smaller very tailored organizations. This allows us to be in a unique position to weather the storms of Workers' Compensation ever changing markets.

Financial Statements are available upon request.

 Company Officers/Management staff that will be directly involved with the City program

Judy Adlam actively manages the Company, serving as President and CEO since 1998. Judy will be available at any time to meet with and assist the City.

Brian Esparza, VP - Claims will be responsible for the success of the program and with oversee the team and relationships with our vendor/partners to assure a smooth process.

David Bomberger, Claims Manager, will act as the Account Manager and will take responsibility for the day-to-day claims handling and directly manager the supervisor assigned to the unit. David has significant experience in the role with large organizations with varied locations and needs and will be a great asset to the team.

Amber Davis, Claims Manager, will act as the Transition Manager. Amber has extensive experience managing public agency clients and overseeing effective and smooth transitions.

Response to RFP – City of Gardena

Revision Date – September 1, 2022

LWP will identify candidates for Supervisor and Senior Examiner positions and make them available for the City to interview if there is interest. We are also happy to interview any candidates with whom the City if familiar, if there is interest.

 Total number of employees and number of employees in handling claim office

LWP employs 97 full time staff members. Currently, 12 work from the Glendale location, which we would expect to serve as the handling claim office for City.

 Recommended Claims Handling Office

Even before Covid, LWP allowed high-performing Examiners to telecommute, opening up the labor pool to many talented Examiners who do not want to commute. We maintain an office in Glendale, which will serve as our official “handling office.” Our manager and supervisors work from that office and can meet clients there at any time.

Regardless of the actual location of the Examiner’s day-to-day work, the entire team will be available to meet with the City at your location, or in our Glendale office at any time.

 Merger and Acquisition activity in past 3 years or planned in the next year

LWP does not share ownership with any entities. There has been no merger or acquisition activity since 2002, and none is planned.

 Clients
o # of public transit clients - 1
o # of public agency clients – 89
o percent self-insured clients – 40%

LWP has managed claims for public agencies (Schools) since 2004 and has managed claims for municipalities (including public safety employees) since 2013.

In order to help the City understand our experience with similar entities, we offer the following list of public agency clients:

 City of Alameda
 City of Burlingame
 City of Eureka
 City of Fremont
 City of Hayward
 City of San Mateo
 City of San Rafael
 City of Santa Rosa
 City of Torrance
 City of Watsonville
 Conejo Valley Unified School District
 Downey Unified School District
 Town of Los Gatos

Response to RFP – City of Gardena