Agenda packet — Finance Committee, May 23, 2022 (part 1 of 2)

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www.modestogov.com
AGENDA
City of Modesto

FINANCE COMMITTEE / COUNCIL WORKSHOP
Held Via Teleconference
(To Access Meeting Please See Instructions Below)
Monday, May 23, 2022 at 3:00 PM
*Roll Call: David Wright, Chair
Rosa Escutia-Braaton, Vice-Chair
Alternate Member
Alternates: Jenny Kenoyer, Tony Madrigal, Chris Ricci, Sue Zwahlen * Please Note: In order to respond to COVID-19, and pursuant to AB 361, the City will hold this meeting via teleconference and Committee Members will be calling in.

THIS MEETING WILL NOT BE PHYSICALLY OPEN TO THE PUBLIC
In order to minimize the spread of the COVID-19 virus, this meeting will be conducted pursuant to AB 361, which amended the Brown Act’s teleconferencing provisions and will not be physically open to the public. You may observe and participate in the meeting via teleconference as indicated below.

PARTICIPATING IN COMMITTEE MEETINGS IN CONFORMANCE
WITH AB 361
The City of Modesto is providing alternatives to observe and participate in Committee meetings.

If you wish to make either a general public comment or to comment on a specific agenda item, you may use one of the following options:

SUBMITTING COMMENTS BY E-MAIL
Written comments may be submitted via email to: [email protected] (include Agenda Item Number in the subject line). All comments will be shared with the Committee Members and placed in the record but will not be read aloud during the meeting. Written - 1 -
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comments must be received by 2:00 p.m. on the day of the meeting.

VIRTUAL PARTICIPATION BY ZOOM VIDEO

CONFERENCING AND TELEPHONE
Joining the Committee meeting via Zoom
The City of Modesto is now offering the ability to view and participate in Committee meetings via telephonic conferencing via “Zoom” video conferencing computer technology. The meeting may be accessed through the use of Zoom using the following options:
 Enter the following link into an Internet Browser
https://us02web.zoom.us/j/86945970570,
 Enter the following link into an Internet Browser https://zoom.us/ and using the Webinar ID 869 4597 0570
 Passcode 84326
To use Zoom, please visit: https://zoom.us/ and either sign-up for a free Zoom account or continue as a guest. Once you have downloaded the app onto your mobile device, joined from your web browser, or downloaded the Zoom software on your computer you will be ready for the upcoming Committee meeting.

Joining the Committee meeting via Telephone
If you don’t have a smart phone or computer to access the meeting via Zoom, you can participate by phone, by calling 1-877-853-5257 (Toll Free) or 1-888-475-4499 (Toll Free) and enter the Webinar ID 869 4597 0570 Passcode 84326
Providing Public Comment on Zoom and by Telephone
The Committee Chairman will request public comment during the Public Comment periods on the meeting agendas and during each Regular Calendar Item on the Committee Agenda. Once the Chairman has announced the public comment period, please do one of the following.

USING A COMPUTER OR SMART PHONE APP:
 Click on the “Raise Hand” feature in the webinar controls. This will notify City staff that you have raised your hand.
 City staff will unmute your microphone when it is your turn to provide public comment.
 A prompt will appear to confirm you would like to be unmuted and then you will have three minutes to provide public comment.
 Once your public comment has ended, you will be muted again.

USING A REGULAR PHONE (not using a computer or smart phone APP):
 Dial *9 (star 9), this will notify City staff that you have “raised your hand” for public comment.
 City staff will unmute your microphone when it is your turn to provide public comment.
 You will hear “you are unmuted” and then you will have three minutes - 2 -
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to provide public comment.
 Once your public comment has ended, you will be muted again.  If your phone is unmuted, and you are unable to be heard, the host may ask that you Dial *6 to toggle mute on/off in Zoom.

Additional Zoom resources/support
Please visit Zoom’s website support page on helpful tips to prepare for the meeting:
https://support.zoom.us/hc/en-us/categories/201146643
Council has not delegated directive or final approval authority to the Committees. Committee actions are recommendations to the full City Council, not final decisions on an issue. This meeting is also noticed as a City Council workshop.

PUBLIC COMMENTS
Please refer to special public comment instructions above.

Three-minute time limit per speaker
Only interested persons in the audience may present these matters. Under State law, Committee members may respond to matters being presented under this item only as follows:
a. Briefly respond to statements made or questions raised. b. Ask a question for clarification.
c. Provide a reference to staff or other resources for factual information. d. Request staff to report back at a subsequent meeting. e. Finally, a Committee member or the Committee itself may take action to direct staff to place a matter of business on a future agenda.

CONSENT ITEMS – ROLL CALL VOTE REQUIRED:

Information concerning the consent items listed below has been forwarded to each Committee member prior to this meeting for study. Unless some member of the audience or Committee member has a question concerning an item and asks that it be withdrawn from the consent list, the Committee approves the items at one time. The action taken by the Committee in approving consent items is set forth in the explanation of this individual item.

Any and all of the following agenda items are subject to action by the Modesto City Council.

This Agenda is on file at the Modesto-Stanislaus Library Reference Room, 1500 I Street, Modesto, in the City Clerk’s Office, Sixth Floor, 10th Street Place, and is available on the City’s Web site at www.modestogov.com.

In accordance with the requirements of Title II of the Americans with Disabilities Act (“ADA”) of 1990, the Fair Employment & Housing Act (“FEHA”), the Rehabilitation Act of 1973 (as amended), Government Code section 11135 and other applicable codes, the City of - 3 -
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Modesto (“City”) will not discriminate against individuals on the basis of disability in the City’s services, programs, or activities. For more information, please visit the City of Modesto website at https://www.modestogov.com/865/Americans-with-Disabilities-Act-ADA In compliance with the Americans with Disabilities Act, if you need special assistance to participate in this meeting, please contact the City Clerk (209) 577-5396. Notification 48 hours prior to the meeting will enable the City to make reasonable arrangements to ensure accessibility to this meeting.

CONSENT
An item may be removed from consent and discussed at the request of an audience member or Committee member.

1. Consider approving the recommended budget adjustments to Fiscal Year 2021-22 Annual Operating and Capital Improvement Program Budgets and forwarding to Council for approval. (Funding Source: Various Funds)
BUDGET; Steve Christensen, 209-577-5390, [email protected]

2. Consider accepting an informational report on the January and February 2022 grant applications and awards and forwarding to Council for approval. (Funding Source: Not Applicable)
FINANCE DEPARTMENT; Maria Garnica, 209-577-5249,
[email protected]

3. Consider accepting a report on upcoming vehicle replacements and new additions planned for bidding. (Funding Source: Various Funds)
FINANCE DEPARTMENT; Cynthia Kline, 209-571-5175, [email protected]

4. Consider approving a First Amendment with Ferguson Waterworks for the Purchase of Circle Clamps, Gaskets, Pipe Couplings, Tapping Sleeves and Sewer Materials for a revised estimated annual amount of $340,000 to $575,000 and a total revised amount not to exceed from $1,700,000 to $2,405,000 over five (5) years, and authorizing the Director of Finance, or her designee, the ability to add parts based on the department’s needs, ensuring the total cost does not exceed the authorized amount, and forwarding to Council for approval. (Funding Source: Water Fund)
FINANCE DEPARTMENT; Cynthia Kline, 209-577-5412, [email protected]

5. Consider approving the First Amendment increasing the Agreement amount with the Public Group aka Public Surplus for the furnishing of online auction services by $12,000 annually from $18,000 to a revised annual estimated amount of $30,000 and for a revised total amount not to exceed $114,000 over five years and forwarding to Council for approval. (Funding Source: Various Funds)
FINANCE DEPARTMENT; Cynthia Kline, 209-577-5412, [email protected]

6. Consider rejecting all bids received for Request for Bid No. 2122-23 for Building - 4 -
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Intrusion Alarm Services, and authorizing staff to re-evaluate and re-issue at a future date and forwarding to Council for approval. (Funding Source: Various Funds) PUBLIC WORKS; Patrick Crowley, 209-402-6812, [email protected]

7. Consider approving a Second Amendment to the Site Lease Agreement with New Cingular Wireless PCS, LLC for Cell Tower Site at the Utilities Water Tank Site for an additional five-year term, with up to four additional five year terms and forward to Council for approval. (Funding Source: Water Fund)
UTILITIES; Jesse Franco, 209-571-5175, [email protected]

UNFINISHED BUSINESS

8. Consider accepting “SB 1383 Collection Program and Compliance Options” report, accepting the recommended waste collection method therein, and forwarding to Council for approval. (Funding Source: Solid Waste Fund, Compost Fund) PUBLIC WORKS; Rosene Salmo, 209-577-5453, [email protected]

NEW BUSINESS

9. Consider approving the Award of Proposal and Agreement for Workers’ Compensation Claims Management Services to Athens Administrators, Inc., Concord, California, for a two-year Agreement with three, one-year extension options, for an estimated annual amount of $480,430 and a total amount not to exceed $2,511,820 over five years; and forwarding to Council for approval. (Funding Source: Workers' Compensation Fund) HUMAN RESOURCES; Joe Rodriguez, 209-577-5446, [email protected]

MATTERS TOO LATE FOR THE AGENDA
These may be presented by members of the City Council and staff upon determination by a majority vote that an emergency exists, as defined by State law, or by a 2/3 vote that (1) there is a need to take immediate action, and (2) that the need for action came to the City’s attention after the agenda was posted.

ADJOURNMENT
Posted pursuant to Government Code Section 54954.2 on the bulletin board at Tenth Street Place on at by
date time signature
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CITY OF MODESTO

COMMITTEE AGENDA REPORT
DATE OF MEETING:

May 23, 2022
Date: May 3, 2022
TO: Finance Committee
David Wright, Chair
Rosa Escutia-Braaton, Vice-Chair
Alternate Member
FROM: Joseph P. Lopez, City Manager
SUBJECT: Monthly Budget Adjustment Report – May 2022
CONTACT: Steve Christensen, Budget Manager, [email protected] 209-577-5390
DESCRIPTION:

Consider approving the recommended budget adjustments to Fiscal Year 2021-22 Annual Operating and Capital Improvement Program Budgets and forwarding to Council for approval. (Funding Source: Various Funds)
STRATEGIC PLAN ELEMENT:

This item supports the City of Modesto 2020-2025 Strategic Plan focus on Governance and Service Delivery under Goal H: Achieve Financial Sustainability.

BACKGROUND:

Each month staff presents a variety of budget adjustments requiring the approval of the City Council. These changes are submitted to the Finance Committee for review prior to submission to Council and include an explanation and justification for each transaction.

This report includes a number of adjustments that have been identified by monitoring department budgets. Due to the number of adjustments, they are included as an attachment to this report (Exhibit A). As in past reports, adjustments are segregated by fund and department as appropriate. The adjustments are reflected in a more summarized version and supporting documentation is available for review upon request.

Also included in this report as an attachment (Exhibit B) is a summary of the budget adjustments approved by the City Manager and/or Budget Manager consistent with the recent change in authority levels that was approved by Council with the passing of the Fiscal Year 2019-20 Operating Budget via Resolution No. 2019-305.
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Monthly Budget Adjustment Report – May 2022

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DISCUSSION:

The monthly budget adjustments attached as Exhibit A in this item include adjustments across various departments. These adjustments are explained in further detail within Exhibit A.

FISCAL IMPACT:

The fiscal impact of each item is noted in the attachments to this report. The adjustments are for Fiscal Year 2021-22.

Approved by:

Joseph P. Lopez, City Manager
Attachments:

1. Exhibit A – Budget Adjustments Requiring Council Approval

2. Exhibit B – Staff Approved Budget Adjustments
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Monthly Budget Adjustment Report

EXHIBIT A
FISCAL YEAR 2021-22

COMMUNITY & ECONOMIC DEVELOPMENT
 A budget adjustment is necessary to transfer $393,780 from Fund 1420 – Surface Transportation/Measure L – SB1 MOE fund to project 101168 – Scenic Dr. Pavement Rehab Phase 1 to satisfy the Fiscal Year 2021-2022 Maintenance of Effort for Measure L. In addition, the transfer from Fund 1410 – Measure L Road Tax Fund to the project is being reduced by the same amount and will be returned to the Measure L Local Road Tax fund – Local Streets and Roads category.

PARKS & RECREATION
 A budget adjustment is needed in the Modesto Convention & Visitors Bureau (CVB) cost center because the TOT collected from lodging establishments over the nine prior months has increased as more people are traveling. This adjustment will increase the revenue budget in cost center 34300 in account 41204 (Transient Occupancy Tax) by $126,635 and the expense budget in the same cost center by $126,641 in account 53505 (Intergovernmental Services – Other). The net of the budget adjustments for this cost centers is an increase of $6 to the budget expense. The City of Modesto has an agreement with Modesto Convention & Visitors Bureau Inc. The City provides 13.33% (thirteen and thirty-three hundredths percent) of the 9% (nine percent) Transient Occupancy Tax (TOT) collect from lodging guests.
 A budget adjustment is needed in the Modesto Tourism Marketing District (MTMD) cost center because the Modesto Tourism Marking Fee collected from hotels has increased as more people are starting to travel more. This adjustment will increase the revenue budget in cost center 34301 by $95,686 in account 47056 (Special Assessments - Modesto Tourism Marketing District) and increase the expense budget in cost center 34301 by $92,603 in account 53505 (Intergovernmental Services – Other) and by $3,083 in account 54501 (Services City Forces – Intrafund). The City of Modesto has an agreement with Modesto Convention & Visitors Bureau (CVB) where the City collects 1% (one percent) Modesto Tourism Marking Fee from hotels. The 1% (one percent) fee collected by the City is then remitted to the CVB minus an admin fee of 0.75% (seventyfive hundredths percent).  A Budget Adjustment is needed in the Downtown Improvement District (DID) Cost center due to the increased DID tax revenue business have remitted over the past 9 months.

This adjustment will increase revenue in cost center 80030 by $47,386 in account 41403 (Business License Tax - Mill Tax DID) and increase the expense budget in cost center 80030 by $49,187 in account 53505 (Intergovernmental Services – Other). The net expense budget increase is $1,801. The City of Modesto has a Memorandum of Understanding and Cooperative agreement (MOU Agreement) with Modesto Downtown Improvement District, Inc. (DID) for the collection and disbursement of DID taxes. The City collects DID taxes from businesses located downtown and then remits the taxes to Modesto Downtown Improvement District minus an annual administration fee. #1..
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Monthly Budget Adjustment Report

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PUBLIC WORKS
 A budget adjustment is necessary in the amount of $420,198 to establish transfers from Fund 4520 – Bus Service Fund - DAR, Fund 4540 - Bus Fixed Route Max Operations Fund, and Fund 4550 - Bus Fixed Route - Alternative Transport Fund to Fund 4510 - Bus Fixed Route Fund and Fund 4530 – Transportation CTR Fund in order to account for the close-out of all City transit funds and move all remaining cash to Stanislaus Regional Transit Authority (StanRTA).
 The following adjustments are being made from the various city Fleet Replacement subfunds to the Fleet Replacement Fund (5409). This action is being done to reimburse the Fleet Replacement Fund (5409) for vehicle purchases that had been made as required by fund accounting rules in FY 21-22 for the activity through March 2022. Below is a table showing the net effect in each sub-fund as a result of the various adjustments.

Fund Fund Name Net Impact
of
Adjustments
1709 Surface Transportation Fleet Replacement $21,158
4109 Water Fleet Replacement $135,199
4489 Storm Drain Fleet Replacement $638,590
4899 Solid Waste Fleet Replacement $620,275
5410 General Fund Equipment Fleet Replacement $223,025
Total Transfer Outs $1,638,247
5409 Transfer In – Fleet Management Fleet Replacement $1,638,247 Total Transfer Ins $1,638,247
A budget adjustment is necessary to establish a transfer in the amount of $21,158 from Surface Transportation Fleet Replacement Fund 1709 to Fleet Replacement Fund 5409 for a purchase made in FY 21/22 for (1) Trailer Tilt bed and (1) Roller Wacker.

A budget adjustment is necessary to establish a transfer in the amount of $135,199 from Water Fleet Replacement Fund 4109 to Fleet Replacement Fund 5409 for a purchase made in FY 21/22 for (1) Tractor Load with backhoe.

A budget adjustment is necessary to establish a transfer in the amount of $638,590 from Storm Drain Fleet Replacement Fund 4489 to Fleet Replacement Fund 5409 for a purchase made in FY 21/22 for (2) full size street sweepers.

A budget adjustment is necessary to establish a transfer in the amount of $620,275 from Solid Waste Fleet Replacement Fund 4899 to Fleet Replacement Fund 5409 for a purchase made in FY 21/22 for (1) High Dump Street Sweep, (1) ¾ Ton Truck, and (1) Windrow Turner.

A budget adjustment is necessary to establish a transfer in the amount of $223,025 from General Fund Equipment Fleet Replacement Fund 5410 to Fleet Replacement Fund 5409 for a purchase made in FY 21/22 for (2) SUV Patrol, (1) SUV Investigation and Police build out equipment.
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Monthly Budget Adjustment Report

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UTILITIES
 A budget adjustment in the amount of $1,303,000 is needed in the Water CIP (4180) to establish Project 101403 – Well 312 Treatment System & Flushline. This project will flush the lines for Well 312 located in the Emprise Service Area. The City is seeking a Drought Relief grant that may fund $1,000,000 of the total expenditures.  A budget adjustment in the amount of $1,035,000 is necessary in the Wastewater Fund (4210) to establish Project 101404 - Recoating Clarifiers 1 & 2. This project will fund the recoating of Clarifiers 1 & 2 at the Sutter Wastewater Treatment Plant and replace the existing lawn area with drought tolerant hardscaping.
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Department Director/Budget Manager/City Manager Approved Budget Adjustments EXHIBIT B For FY2021/22
AT #
Appro
ved by
CM,
BM or
DD Fund Fund Name Cost Ctr/Project Name Account Name
Rev/E
xp/TI/
TO
Accou
nt Current Budget
Increase
(Decrease)
Revised
Budget Description
AT-119 BM 0100 General Fund 33030 - Recreation
Operations
Repair & Maintenance Services -
Real Property Exp $ 24,000 (24,000) $ $ -
AT-119 BM 0100 General Fund 33030 - Recreation
Operations Transfer Out to Fund 3130 Exp $ - 24,000 $ $ 24,000 AT-125 CM 0100 General Fund CMO - Budget Division Budget Only - Salary Adjustment - Decrease Exp $ - (40,130) $ $ (40,130)
AT-125 CM 0100 General Fund CMO - Budget Division Budget Only - Benefit Adjustment - Decrease Exp $ - (17,200) $ $ (17,200)
AT-125 CM 0100 General Fund CMO - City Manager's
Office Professional Services Exp $ 130,000 57,330 $ $ 187,330 AT-138 DD 0100 General Fund CED - Economic
Development
Budget Only - Salary Adjustment
- Decrease Exp $ - (17,500) $ $ (17,500)
AT-138 DD 0100 General Fund CED - Economic
Development
Budget Only - Benefit
Adjustment - Decrease Exp $ - (7,500) $ $ (7,500)
AT-138 DD 0100 General Fund CED - Economic
Development Business Expenses Exp $ 2,000 25,000 $ $ 27,000 AT-144 CM 0100 General Fund MPD - Field Operations Budget Only - Salary Adjustment - Decrease Exp $ (485,746) (56,700) $ $ (542,446)
AT-144 CM 0100 General Fund MPD - Field Operations Budget Only - Benefit Adjustment - Decrease Exp $ (276,549) (24,300) $ $ (300,849) AT-144 CM 0100 General Fund CMO - City Manager's
Office
Budget Only - Salary Adjustment
- Increase Exp $ 22,676 30,800 $ $ 53,476
AT-144 CM 0100 General Fund CMO - City Manager's
Office
Budget Only - Benefit
Adjustment - Increase Exp $ - 13,200 $ $ 13,200
AT-144 CM 0100 General Fund CMO - City Manager's
Office Professional Services Exp $ 187,330 37,000 $ $ 224,330 AT-159 CM 0100 General Fund 19320/02010 Budget Only - Salary Decrease Exp $ (542,446) (10,382) $ $ (552,828) AT-159 CM 0100 General Fund 19320/02010 Budget Only - Benefit Decrease Exp $ (300,849) (6,921) $ $ (307,770) AT-159 CM 0100 General Fund 19320/02010 Professional Services Exp $ 224,329 17,303 $ $ 241,632 AT-160 CM 0100 General Fund 19320/19325 Budget Only - Salary Decrease Exp $ (552,828) (9,600) $ $ (562,428) AT-160 CM 0100 General Fund 19320/19325 Budget Only - Benefit Decrease Exp $ (314,170) (6,400) $ $ (320,570) AT-160 CM 0100 General Fund 19320/19325 Professional Services Exp $ - 16,000 $ $ 16,000 AT-162 CM 0100 General Fund 18210 - MFD Suppression Interfund Charges - Service Credit Labor Charges Rev $ - 200,000 $ $ 200,000
A budget adjustment is necessary to increase the expenditure budget to track the $200,000 that was allocated for the funding to support the development of the Enhanced Infrastructure Financing District (EIFD) Program in the Public Safety Labor task in the ARPA project. This task is used to track the reimbursement of ineligible expenditures and the increase in this adjustment will track costs associated with the EIFD project. The City of Modesto received $45.9 million in total allocated ARPA funds. This project will track costs related to the development of the EIFD program and will be drawn against the Public Safety Payroll task as the costs are part of the ineligible expenditure category. This project was approved as part of the City's ARPA Spending Plan via Council Resolution 2021-194.

A budget adjustment in the amount of $17,303 is needed to move budget from MPD to City Manager's Office to pay for services rendered related to the Forward Together Program, which is a public safety initiative.

A budget adjustment in the amount of $16,000 is needed to cover expenses related to finding a new dispatch delivery service model for the City of Modesto.

A budget adjustment of $57,330 is necessary to move Salary and Benefit savings from the vacant Financial Analyst III position in CMO - Budget to Professional Services in CMO in order to cover Slate expenses, recruitment expenses, and reimbursements.

A budget adjustment of $25,000 is necessary to utilize salary savings to assist with new employee expenses and CoStar Data Services upgrade.

A budget adjustment is necessary to reduce the Recreation Operations budget in the amount of $24,000 for Repair and Maintenance Services - Real Property and reallocate the budget to newly created Project 101389. In addition, a transfer needs to be established to move the budget from the operating budget to the project. The A budget adjustment of $81,000 is necessary to move salary savings from PD to City Manager's Office in order to cover two months of a double-filled Deputy City Manager position, Slate expenses, recruitment expenses, and State and Federal advocacy expenses. Double filling of the Deputy City Manager position is directly related to the completion of the Forward Together project and the movement of funds from the Police Department budget will help to cover this additional cost to the City Manager's budget.
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Department Director/Budget Manager/City Manager Approved Budget Adjustments EXHIBIT B For FY2021/22
AT #
Appro
ved by
CM,
BM or
DD Fund Fund Name Cost Ctr/Project Name Account Name
Rev/E
xp/TI/
TO
Accou
nt Current Budget
Increase
(Decrease)
Revised
Budget Description
AT-164 CM 0100 General Fund 70100 - Transfers Out Transfers Out to Fund 1390 Exp $ - 200,000 $ $ 200,000 A budget adjustment is necessary to establish the transfer out from the General Fund to the ARPA EIFD project budget for the revenue that will be ultimately be reimbursed from ARPA funds to support the development of the Enhanced Infrastructure Financing District (EIFD) Program. This funding is coming from the amounts received from the American Rescue Plan Act of 2021 Funds. The City of Modesto received $45.9 million in total allocated ARPA funds. This project was approved as part of the City's ARPA Spending Plan via Council Resolution 2021-194.

Total Changes for Fund 0100 $ (1,882,253) $ 400,000 $ (1,482,253) AT-122 BM 1120 Grants - PLHA Program 101347 - PLHA 2020-21 Direct Loan Exp $ 371,260 (276,378) $ $ 94,882 AT-122 BM 1120 Grants - PLHA Program 101347 - PLHA 2020-21 Direct Loan - CHS Youth Housing AUC Exp $ - 276,378 $ $ 276,378
AT-123 BM 1120 Grants - PLHA Program 101377 - PLHA 2021-22 Direct Loan Exp $ 1,431,925 (223,622) $ $ 1,208,303 AT-123 BM 1120 Grants - PLHA Program 101377 - PLHA 2021-22 Direct Loan - CHS Youth Housing AUC Exp $ - 173,622 $ $ 173,622
AT-123 BM 1120 Grants - PLHA Program 101377 - PLHA 2021-22 Direct Loan - CHS AD Youth Housing AUC Exp $ - 50,000 $ $ 50,000
Total Changes for Fund 1120 $ 1,803,185 $ - $ 1,803,185 AT-117 BM 1130 Grants - CDBG Direct
Program 101193 - Microenterprise HUD Intergov Federal Revenue Rev $ 110,000 (16,170) $ $ 93,830 AT-117 BM 1130 Grants - CDBG Direct
Program 101193 - Microenterprise Direct Loan Principle Rev $ - 16,170 $ $ 16,170 AT-121 BM 1130 Grants - CDBG Direct
Program 61130 - Transfer In Transfer In From Fund 1155 TI $ - 20,000 $ $ 20,000 An adjustment is necessary to budget a transfer from RLF funding for CDBG expenses. HUD allows for a portion of RLF program income to be used to fund CDBG admin expenses associated with the program.

AT-133 BM 1130 CDBG - Direct Program 101256 - Small Business Assistance Federal Revenue - Activity 1359 Rev $ 546,707 (129,332) $ $ 417,375 AT-133 BM 1130 CDBG - Direct Program 101256 - Small Business Assistance Federal Revenue - Activity 1416 Rev $ - 10,687 $ $ 10,687 AT-133 BM 1130 CDBG - Direct Program 101256 - Small Business Assistance Federal Revenue - Activity 1417 Rev $ - 10,944 $ $ 10,944 AT-133 BM 1130 CDBG - Direct Program 101256 - Small Business Assistance Federal Revenue - Activity 1418 Rev $ - 8,036 $ $ 8,036 AT-133 BM 1130 CDBG - Direct Program 101256 - Small Business Assistance Federal Revenue - Activity 1419 Rev $ - 9,488 $ $ 9,488 AT-133 BM 1130 CDBG - Direct Program 101256 - Small Business Assistance Federal Revenue - Activity 1421 Rev $ - 10,638 $ $ 10,638 AT-133 BM 1130 CDBG - Direct Program 101256 - Small Business Assistance Federal Revenue - Activity 1422 Rev $ - 5,651 $ $ 5,651 AT-133 BM 1130 CDBG - Direct Program 101256 - Small Business Assistance Federal Revenue - Activity 1424 Rev $ - 10,525 $ $ 10,525 AT-133 BM 1130 CDBG - Direct Program 101256 - Small Business Assistance Federal Revenue - Activity 1425 Rev $ - 10,487 $ $ 10,487 AT-133 BM 1130 CDBG - Direct Program 101256 - Small Business Assistance Federal Revenue - Activity 1426 Rev $ - 10,812 $ $ 10,812 AT-133 BM 1130 CDBG - Direct Program 101256 - Small Business Assistance Federal Revenue - Activity 1427 Rev $ - 10,476 $ $ 10,476 AT-133 BM 1130 CDBG - Direct Program 101256 - Small Business Assistance Federal Revenue - Activity 1428 Rev $ - 10,342 $ $ 10,342 AT-133 BM 1130 CDBG - Direct Program 101256 - Small Business Assistance Federal Revenue - Activity 1429 Rev $ - 10,576 $ $ 10,576 A budget adjustment is needed to allocate $276,378 to Permanent Supportive Housing/CHS 1208 9th St. The remaining budget needed for the 9th Street project will be funded by PLHA 2021-22, project 101377.

A budget adjustment is needed to allocate $233,622 to Permanent Supportive Housing/CHS 1208 9th St. The remaining budget needed for the 9th Street project will be funded by PLHA 2020-21, project 101347.

A budget adjustment is needed to adjust the revenue for project 101193, Microenterprise, in order to close the project.
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Department Director/Budget Manager/City Manager Approved Budget Adjustments EXHIBIT B For FY2021/22
AT #
Appro
ved by
CM,
BM or
DD Fund Fund Name Cost Ctr/Project Name Account Name
Rev/E
xp/TI/
TO
Accou
nt Current Budget
Increase
(Decrease)
Revised
Budget Description
AT-133 BM 1130 CDBG - Direct Program 101256 - Small Business Assistance Federal Revenue - Activity 1430 Rev $ - 10,670 $ $ 10,670 AT-133 BM 1130 CDBG - Direct Program 101256 - Small Business Assistance
Services - City Forces - Interfund
AD 1359 Exp $ 10,031 (8,381) $ $ 1,650
AT-133 BM 1130 CDBG - Direct Program 101256 - Small Business Assistance
Services - City Forces - Interfund
AD 1416 Exp $ - 687 $ $ 687
AT-133 BM 1130 CDBG - Direct Program 101256 - Small Business Assistance
Services - City Forces - Interfund
AD 1417 Exp $ - 944 $ $ 944
AT-133 BM 1130 CDBG - Direct Program 101256 - Small Business Assistance
Services - City Forces - Interfund
AD 1418 Exp $ - 789 $ $ 789
AT-133 BM 1130 CDBG - Direct Program 101256 - Small Business Assistance
Services - City Forces - Interfund
AD 1419 Exp $ - 320 $ $ 320
AT-133 BM 1130 CDBG - Direct Program 101256 - Small Business Assistance
Services - City Forces - Interfund
AD 1421 Exp $ - 638 $ $ 638
AT-133 BM 1130 CDBG - Direct Program 101256 - Small Business Assistance
Services - City Forces - Interfund
AD 1422 Exp $ - 1,115 $ $ 1,115
AT-133 BM 1130 CDBG - Direct Program 101256 - Small Business Assistance
Services - City Forces - Interfund
AD 1424 Exp $ - 525 $ $ 525
AT-133 BM 1130 CDBG - Direct Program 101256 - Small Business Assistance
Services - City Forces - Interfund
AD 1425 Exp $ - 487 $ $ 487
AT-133 BM 1130 CDBG - Direct Program 101256 - Small Business Assistance
Services - City Forces - Interfund
AD 1426 Exp $ - 812 $ $ 812
AT-133 BM 1130 CDBG - Direct Program 101256 - Small Business Assistance
Services - City Forces - Interfund
AD 1427 Exp $ - 476 $ $ 476
AT-133 BM 1130 CDBG - Direct Program 101256 - Small Business Assistance
Services - City Forces - Interfund
AD 1428 Exp $ - 342 $ $ 342
AT-133 BM 1130 CDBG - Direct Program 101256 - Small Business Assistance
Services - City Forces - Interfund
AD 1429 Exp $ - 576 $ $ 576
AT-133 BM 1130 CDBG - Direct Program 101256 - Small Business Assistance
Services - City Forces - Interfund
AD 1430 Exp $ - 670 $ $ 670
AT-135 BM 1130 CDBG - Direct Program 101256 - Small Business Assistance Federal Revenue - Activity 1359 Rev $ 427,848 (81,976) $ $ 345,872 AT-135 BM 1130 CDBG - Direct Program 101256 - Small Business Assistance Federal Revenue - Activity 1431 Rev $ - 10,801 $ $ 10,801 AT-135 BM 1130 CDBG - Direct Program 101256 - Small Business Assistance Federal Revenue - Activity 1432 Rev $ - 10,502 $ $ 10,502 AT-135 BM 1130 CDBG - Direct Program 101256 - Small Business Assistance Federal Revenue - Activity 1433 Rev $ - 10,265 $ $ 10,265 AT-135 BM 1130 CDBG - Direct Program 101256 - Small Business Assistance Federal Revenue - Activity 1434 Rev $ - 7,885 $ $ 7,885 AT-135 BM 1130 CDBG - Direct Program 101256 - Small Business Assistance Federal Revenue - Activity 1420 Rev $ - 10,530 $ $ 10,530 AT-135 BM 1130 CDBG - Direct Program 101256 - Small Business Assistance Federal Revenue - Activity 1400 Rev $ - 10,532 $ $ 10,532 AT-135 BM 1130 CDBG - Direct Program 101256 - Small Business Assistance Federal Revenue - Activity 1401 Rev $ - 10,846 $ $ 10,846 AT-135 BM 1130 CDBG - Direct Program 101256 - Small Business Assistance Federal Revenue - Activity 1402 Rev $ - 10,615 $ $ 10,615 AT-135 BM 1130 CDBG - Direct Program 101256 - Small Business Assistance
Services - City Forces - Interfund
AD 1359 Exp $ 1,650 (1,177) $ $ 473
AT-135 BM 1130 CDBG - Direct Program 101256 - Small Business Assistance
Services - City Forces - Interfund
AD 1423 Exp $ 10,000 (10,000) $ $ -
A budget adjustment is necessary to clean up the project budget in order to close the project. There is no change to the total amount budgeted.

A budget adjustment is necessary to clean up the project budget in order to close the project. There is no change to the total amount budgeted. #1..
- 13 -
Department Director/Budget Manager/City Manager Approved Budget Adjustments EXHIBIT B For FY2021/22
AT #
Appro
ved by
CM,
BM or
DD Fund Fund Name Cost Ctr/Project Name Account Name
Rev/E
xp/TI/
TO
Accou
nt Current Budget
Increase
(Decrease)
Revised
Budget Description
AT-135 BM 1130 CDBG - Direct Program 101256 - Small Business Assistance
Services - City Forces - Interfund
AD 1406 Exp $ 1,874 (130) $ $ 1,744
AT-135 BM 1130 CDBG - Direct Program 101256 - Small Business Assistance
Services - City Forces - Interfund
AD 1408 Exp $ 1,384 (561) $ $ 823
AT-135 BM 1130 CDBG - Direct Program 101256 - Small Business Assistance
Services - City Forces - Interfund
AD 1431 Exp $ - 801 $ $ 801
AT-135 BM 1130 CDBG - Direct Program 101256 - Small Business Assistance
Services - City Forces - Interfund
AD 1432 Exp $ - 502 $ $ 502
AT-135 BM 1130 CDBG - Direct Program 101256 - Small Business Assistance
Services - City Forces - Interfund
AD 1433 Exp $ - 265 $ $ 265
AT-135 BM 1130 CDBG - Direct Program 101256 - Small Business Assistance
Services - City Forces - Interfund
AD 1434 Exp $ - 226 $ $ 226
AT-135 BM 1130 CDBG - Direct Program 101256 - Small Business Assistance
Services - City Forces - Interfund
1359 Appr Unit C Exp $ 220,325 10,074 $ $ 230,399
Total Changes for Fund 1130 $ 1,329,819 $ 20,000 $ 1,349,819 AT-121 BM 1155 Grants - RLF Program Income 71155 - Transfer Out Transfer Out to Fund 1130 TO $ - 20,000 $ $ 20,000 An adjustment is necessary to budget a transfer from RLF funding for CDBG expenses. HUD allows for a portion of RLF program income to be used to fund CDBG admin expenses associated with the program.

Total Changes for Fund 1155 $ - $ 20,000 $ 20,000
AT-116 BM 1160 Housing Economic
Development Fund 100829 - Eco Dev CDBG HUD Intergov Federal Revenue Rev $ 81,344 (50,313) $ $ 31,031 AT-116 BM 1160 Housing Economic
Development Fund 100829 - Eco Dev CDBG Direct Loan Principle Rev $ - 30,071 $ $ 30,071 AT-116 BM 1160 Housing Economic
Development Fund 100829 - Eco Dev CDBG Direct Loan Interest RLF Rev $ - 16,900 $ $ 16,900 AT-116 BM 1160 Housing Economic
Development Fund 100829 - Eco Dev CDBG Direct Loan Interest Rev $ - 3,342 $ $ 3,342 Total Changes for Fund 1160 $ 81,344 $ - $ 81,344
AT-115 CM 1170 HOME Investment Partnership
Prgm
101184 - Archway
Commons Phase II Federal Revenue Rev $ 1,480,000 30,000 $ $ 1,510,000 AT-115 CM 1170 HOME Investment Partnership
Prgm
101184 - Archway
Commons Phase II 1282 Activity Delivery Exp $ 85,000 30,000 $ $ 115,000 AT-145 BM 1170 Grants - HOME Investment
Partnership
100918 - 522 Granger
Housing
Federal Housing Urban
Development Revenue Rev $ 621,996 (175,888) $ $ 446,108 AT-145 BM 1170 Grants - HOME Investment
Partnership
100918 - 522 Granger
Housing Direct Loan Principle H & HDPL Rev $ - 33,976 $ $ 33,976 AT-145 BM 1170 Grants - HOME Investment
Partnership
100918 - 522 Granger
Housing Direct Interest H & HDPL Rev $ - 141,912 $ $ 141,912 Total Changes for Fund 1170 $ 2,186,996 $ 60,000 $ 2,246,996 AT-161 CM 1341 Grants-Operation Grants
Reimbursed
101405 - PW-City/County
Payment Program Intergov - State - CA Recycle Rev $ - 54,352 $ $ 54,352 AT-161 CM 1341 Grants-Operation Grants
Reimbursed
101405 - PW-City/County
Payment Program
Appr C - Beverage Container
Collection Exp $ - 16,352 $ $ 16,352
AT-161 CM 1341 Grants-Operation Grants
Reimbursed
101405 - PW-City/County
Payment Program Appr C - Litter Clean-up Exp $ - 500 $ $ 500 AT-161 CM 1341 Grants-Operation Grants
Reimbursed
101405 - PW-City/County
Payment Program Appr C - Advertising Exp $ - 12,500 $ $ 12,500 AT-161 CM 1341 Grants-Operation Grants
Reimbursed
101405 - PW-City/County
Payment Program Appr C - Recycling Education Exp $ - 5,000 $ $ 5,000 AT-161 CM 1341 Grants-Operation Grants
Reimbursed
101405 - PW-City/County
Payment Program Appr C - Svcs City Forces Exp $ - 20,000 $ $ 20,000 Total Changes for Fund 1341 $ - $ 108,704 $ 108,704
The City of Modesto received grant funding in the amount of $54,352.00 from the City/County Payment Program through Cal Recycle. These funds will be utilized to enhance the current recycling program and expand our efforts through education and outreach, advertising and collection programs. In addition, allocated funds will support a designated staff member.

A budget adjustment is needed to clean up the revenue budget for the project. There is no change to the project budget.

A budget adjustment is needed to increase the revenue and expense budgets for project 101184 - Archway Commons Phase II in the amount of $30,000. This increase will capture additional staff time as the project progresses A budget adjustment is needed for the revenue budget for project 100829 in order to close the project. No change to the overall project budget. #1..
- 14 -
Department Director/Budget Manager/City Manager Approved Budget Adjustments EXHIBIT B For FY2021/22
AT #
Appro
ved by
CM,
BM or
DD Fund Fund Name Cost Ctr/Project Name Account Name
Rev/E
xp/TI/
TO
Accou
nt Current Budget
Increase
(Decrease)
Revised
Budget Description
AT-142 CM 1380 Non-Capital Parks Fund (NonGrant)
100880 - Fund
Development/Special
Projects
47005-Misc. Revenue - Spirit of
Giving Rev $ 18,163 10,000 $ $ 28,163
AT-142 CM 1380 Non-Capital Parks Fund (NonGrant)
100880 - Fund
Development/Special
Projects
47005-Misc. Revenue - Leisure
Bucks Rev $ - 24,000 $ $ 24,000
AT-142 CM 1380 Non-Capital Parks Fund (NonGrant)
100880 - Fund
Development/Special
Projects
47031 - Misc.

Donations/Contributions NonIntergovRev $ 3,500 143 $ $ 3,643 AT-142 CM 1380 Non-Capital Parks Fund (NonGrant)
100880 - Fund
Development/Special
Projects
Spirit of Giving-10397-Business
Expenses Exp $ 68,787 10,000 $ $ 78,787
AT-142 CM 1380 Non-Capital Parks Fund (NonGrant)
100880 - Fund
Development/Special
Projects
Leisure Bucks-10398-
Professional Services Exp $ 25,000 24,000 $ $ 49,000
AT-142 CM 1380 Non-Capital Parks Fund (NonGrant)
100880 - Fund
Development/Special
Projects
Movie Night-10390-Professional
Services Exp $ 2,000 143 $ $ 2,143
Total Changes for Fund 1380 $ 117,450 $ 68,286 $ 185,736 AT-163 CM 1390 American Rescue Grants
Fund
101345 - CMO - ARPA
2021 Spending (1st) Appr Unit C (3.1) Exp $ - 200,000 $ $ 200,000 A budget adjustment is necessary to establish the Non-Capital Project expenditure budget to track the $200,000 that was allocated for the funding to support the development of the Enhanced Infrastructure Financing District (EIFD) Program. This funding is coming from the amounts received from the American Rescue Plan Act of 2021 Funds. The City of Modesto received $45.9 million in total allocated ARPA funds. This project will track costs related to the development of the EIFD program and will be drawn against the Public Safety Payroll task as the costs are part of the ineligible expenditure category. This project was approved as part of the City's ARPA Spending Plan via Council Resolution 2021-194.

AT-164 CM 1390 American Rescue Grants
Fund 61390 - Transfers In Transfers In from Fund 0100 Rev $ - 200,000 $ $ 200,000 A budget adjustment is necessary to establish the transfer out from the General Fund to the ARPA EIFD project budget for the revenue that will be ultimately be reimbursed from ARPA funds to support the development of the Enhanced Infrastructure Financing District (EIFD) Program. This funding is coming from the amounts received from the American Rescue Plan Act of 2021 Funds. The City of Modesto received $45.9 million in total allocated ARPA funds. This project was approved as part of the City's ARPA Spending Plan via Council Resolution 2021-194.

AT-165 CM 1390 American Rescue Grants
Fund
101406 - CED - ARPA 2021
EIFD Program Discretionary Expenses Exp $ - 200,000 $ $ 200,000 A budget adjustment is necessary to increase the revenue budget for the Direct Charge account that is being used as on offset for the ARPA funds that are being used to reimburse the transfer out from the General Fund that is funding the EIFD Project expenditure budget. This funding is coming from the amounts received from the American Rescue Plan Act of 2021 Funds. The City of Modesto received $45.9 million in total allocated ARPA funds. This project will track costs related to the development of the EIFD program and will be drawn against the Public Safety Payroll task as the costs are part of the ineligible expenditure category. This project was approved as part of the City's ARPA Spending Plan via Council Resolution 2021-194.

Total Changes for Fund 1390 $ - $ 600,000 $ 600,000
AT-119 BM 3130 Parks Fund 101389 - Enslen Park
Improvements Transfer In from Fund 0100 Rev $ - 24,000 $ $ 24,000 AT-119 BM 3130 Parks Fund 101389 - Enslen Park
Improvements Business Expenses Exp $ - 24,000 $ $ 24,000 A budget adjustment is necessary to reduce the Recreation Operations budget in the amount of $24,000 for Repair and Maintenance Services - Real Property and reallocate the budget to newly created Project 101389. In addition, a transfer needs to be established to move the budget from the operating budget to the project. The A budget adjustment is necessary to recognize some of the miscellaneous revenue within Project 100880 - Fund Development/Special Projects and allocate it to the Spirit of Giving and Leisure Bucks tasks. In addition, this adjustment is balancing the Movie Night tasks with funds at Stanislaus Community Foundation. The revenue was received to the project related to these activities, but was not recognized. This adjustment recognizes the revenue and increases the specific tasks for tracking. #1..
- 15 -
Department Director/Budget Manager/City Manager Approved Budget Adjustments EXHIBIT B For FY2021/22
AT #
Appro
ved by
CM,
BM or
DD Fund Fund Name Cost Ctr/Project Name Account Name
Rev/E
xp/TI/
TO
Accou
nt Current Budget
Increase
(Decrease)
Revised
Budget Description
AT-147 BM 3130 Parks Fund 101380 - Park Security
Camera Miscellaneous Revenue Rev $ - 17,000 $ $ 17,000
AT-147 BM 3130 Parks Fund 101380 - Park Security
Camera
Repair & Maintenance Services -
Real Property Exp $ - 17,000 $ $ 17,000
Total Changes for Fund 3130 $ - $ 82,000 $ 82,000
AT-136 BM 3140 Capital Grants - CIP Projects 101337 - BMF Parts Storage Room Upgrade
Intergov- Federal- Transit
Administration Rev $ 1,337,463 (16,976) $ $ 1,320,487
AT-136 BM 3140 Capital Grants - CIP Projects 101337 - BMF Parts Storage Room Upgrade Contingency - CIP Exp $ 104,164 (43,178) $ $ 60,986 AT-136 BM 3140 Capital Grants - CIP Projects 101337 - BMF Parts Storage Room Upgrade Construction Admin Exp $ 183,218 45,000 $ $ 228,218 AT-136 BM 3140 Capital Grants - CIP Projects 101337 - BMF Parts Storage Room Upgrade Construction Exp $ 1,320,842 (18,798) $ $ 1,302,044 AT-137 CM 3140 Capital Grants - CIP Projects 101348 - Amtrak Station Repairs and Rehab Intergov- State - LTF Rev $ 50,000 25,829 $ $ 75,829 AT-137 CM 3140 Capital Grants - CIP Projects 101348 - Amtrak Station Repairs and Rehab Construction Admin Exp $ 2,500 (2,500) $ $ - AT-137 CM 3140 Capital Grants - CIP Projects 101348 - Amtrak Station Repairs and Rehab Construction Exp $ 11,304 (11,304) $ $ - AT-137 CM 3140 Capital Grants - CIP Projects 101348 - Amtrak Station Repairs and Rehab Contingency - CIP Exp $ 23,402 (23,402) $ $ - AT-137 CM 3140 Capital Grants - CIP Projects 101348 - Amtrak Station Repairs and Rehab EDA Exp $ 12,794 (12,794) $ $ -
AT-137 CM 3140 Capital Grants - CIP Projects 101348 - Amtrak Station Repairs and Rehab AUC-CA-Construction Admin Exp $ - 16,755 $ $ 16,755 AT-137 CM 3140 Capital Grants - CIP Projects 101348 - Amtrak Station Repairs and Rehab AUC-CON-Construction Exp $ - 11,527 $ $ 11,527 AT-137 CM 3140 Capital Grants - CIP Projects 101348 - Amtrak Station Repairs and Rehab AUC-CTGY-Contingency - CIP Exp $ - 44,547 $ $ 44,547 AT-137 CM 3140 Capital Grants - CIP Projects 101348 - Amtrak Station Repairs and Rehab AUC-EDA-Eng./Design/Admin Exp $ - 3,000 $ $ 3,000 AT-139 BM 3140 Capital Grants - CIP Projects 101353 - BMF Tire Carousel Intergov-Federal-Federal Transit Administration Rev $ 44,755 (272) $ $ 44,483
AT-139 BM 3140 Capital Grants - CIP Projects 101353 - BMF Tire Carousel Intergov- State - LTF - Current Year Rev $ - $ 1 $ 1
AT-139 BM 3140 Capital Grants - CIP Projects 101353 - BMF Tire Carousel EA-Tools and Equip Supplies >$5,000 Exp $ 44,755 (271) $ $ 44,484
AT-140 BM 3140 Capital Grants - CIP Projects 101340 - PW- TC Video Surveillance System
Intergov - State - Prop 1B -
Capital Related Rev $ 116,946 (188) $ $ 116,758
AT-140 BM 3140 Capital Grants - CIP Projects 101340 - PW- TC Video Surveillance System
Appr Unit C - Video Equipment <
$5000 Exp $ 116,946 (188) $ $ 116,758
AT-149 BM 3140 Capital Grants - CIP Projects 101337-BMF Parts Storage Room Upgrade Contingency Exo $ 60,986 (44,981) $ $ 16,005 AT-149 BM 3140 Capital Grants - CIP Projects 101337-BMF Parts Storage Room Upgrade Construction Administration Exp $ 228,218 44,981 $ $ 273,199 Total Changes for Fund 3140 $ 3,658,293 $ 16,788 $ 3,675,081 AT-151 BM 3160 Capital Grants - Streets CIP
Projects
101063 - Pelandale
Interchange - Phase 2 EDA-CFF-Eng./Design/Admin Exp $ 204,849 (129,849) $ $ 75,000 AT-151 BM 3160 Capital Grants - Streets CIP
Projects
101063 - Pelandale
Interchange - Phase 2
CC-LA-R/W Support-CFF-Right
of Way Exp $ - 30,000 $ $ 30,000
AT-151 BM 3160 Capital Grants - Streets CIP
Projects
101063 - Pelandale
Interchange - Phase 2
CC-UC-R/W Support-CFF-Utility
Relocation Exp $ - 7,000 $ $ 7,000
A budget adjustment is necessary to recognize cell tower revenue and establish the project expenditure budget. The project will be used to purchase security cameras and fund small projects at various locations.

The purpose of this adjustment is to redistribute funds between task lines in the project to cover expenses associated with a consultant agreement for construction management services
A budget adjustment is necessary to re-allocate funds from the EDA CFF task to the appropriate tasks as needed for completion of this project.

A budget adjustment is necessary to reallocate budget from CTGY and CON to CA, and reduce an overbudgeted FTA grant by $16,976. $18,797.55 in actuals are being moved from CON to CA and EDA due to them being improperly coded. After the adjustment has been processed, the budgeted CON amount will match the construction contract, actuals, and encumbrances in the project.

A budget adjustment is necessary to recognize $25,829 in LTF from project 101238 (Reestablished as current project 101348). The expense budgets will be rearranged to match how they were created in the original project once the Appr Unit C actuals are moved to the correct task lines by A/P.

A budget adjustment is necessary to reduce revenue and expense budgets for project closure. $1 in LTF is being budgeted to account for an $0.87 difference between the revenue and expenses.

A budget adjustment is necessary to reduce revenue and expense budgets for project closure.
#1..
- 16 -
Department Director/Budget Manager/City Manager Approved Budget Adjustments EXHIBIT B For FY2021/22
AT #
Appro
ved by
CM,
BM or
DD Fund Fund Name Cost Ctr/Project Name Account Name
Rev/E
xp/TI/
TO
Accou
nt Current Budget
Increase
(Decrease)
Revised
Budget Description
AT-151 BM 3160 Capital Grants - Streets CIP
Projects
101063 - Pelandale
Interchange - Phase 2
UC-R/W Support-CFF-Utility
Relocation Exp $ - 10,000 $ $ 10,000
AT-151 BM 3160 Capital Grants - Streets CIP
Projects
101063 - Pelandale
Interchange - Phase 2
LA-R/W Support-CFF-Right of
Way Exp $ - 82,849 $ $ 82,849
AT-152 BM 3160 Capital Grants - Streets CIP
Projects
101119 - SR 132 W.

Expressway - CON
CTGY-ProjectML - ContingencyCIP Exp $ 2,478,275 (89,227) $ $ 2,389,048 AT-152 BM 3160 Capital Grants - Streets CIP
Projects
101119 - SR 132 W.

Expressway - CON
CA-DokkenML - Construction
Administration Exp $ 1,667,480 89,227 $ $ 1,756,707
Total Changes for Fund 3160 $ 4,350,604 $ - $ 4,350,604 AT-129 BM 3246 Fairview Village #2 CED - Fairview Village #2 CS-CD-Time and Materials Fee Rev $ - 50,000 $ $ 50,000 AT-129 BM 3246 Fairview Village #2 CED - Fairview Village #2 Services - City Forces - Interfund Exp $ - 25,000 $ $ 25,000 AT-129 BM 3246 Fairview Village #2 CED - Fairview Village #2 Professional Services Exp $ - 20,000 $ $ 20,000 AT-129 BM 3246 Fairview Village #2 CED - Fairview Village #2 Legal Services Exp $ - 5,000 $ $ 5,000 Total Changes for Fund 3246 $ - $ 100,000 $ 100,000
AT-141 BM 4140 Water Fund Grant 101131 - GSP Modesto Sub Basin Svcs City Forces - Interfund Exp $ 230,000 (50,000) $ $ 180,000 AT-141 BM 4140 Water Fund Grant 101131 - GSP Modesto Sub Basin Professional Services Exp $ 2,651,225 50,000 $ $ 2,701,225 AT-157 BM 4140 Water Grants 101131 - GSP Modesto Sub
Basin
Appr Unit C - Svcs City Forces -
Interfund Exp $ 180,000 (25,000) $ $ 155,000
AT-157 BM 4140 Water Grants 101131 - GSP Modesto Sub
Basin
Appr Unit C - Professional
Services Exp $ 2,701,255 25,000 $ $ 2,726,255
Total Changes for Fund 4140 $ 5,762,480 $ - $ 5,762,480 AT-113 BM 4180 Water CIP Fund 101367 - Sylvan Water Main Upgrade Engineering/Design/Admin Exp $ - 25,000 $ $ 25,000 A budget adjustment in the amount of $25,000 is needed to establish the initial expense budget for the Sylvan Water Main upgrade project.

AT-127 BM 4180 Water CIP Fund 101078 - Del Rio
Replacement Well Contingency-CIP Exp $ 265,000 (75,000) $ $ 190,000 AT-127 BM 4180 Water CIP Fund 101078 - Del Rio
Replacement Well Eng./Design/Admin Exp $ 700,000 75,000 $ $ 775,000 AT-128 BM 4180 Water CIP Fund 100953 - La Loma El Vista to Riverside Contingency-CIP Exp $ 330,000 (60,000) $ $ 270,000 AT-128 BM 4180 Water CIP Fund 100953 - La Loma El Vista to Riverside Eng./Design/Admin Exp $ 263,000 60,000 $ $ 323,000 AT-156 BM 4180 Water Fund CIP Projects 101154 - Sutter S&R Water Mains Construction Exp $ 740,000 (75,000) $ $ 665,000
AT-156 BM 4180 Water Fund CIP Projects 101154 - Sutter S&R Water Mains Eng./Design/Admin Exp $ 170,000 75,000 $ $ 245,000 AT-158 BM 4180 Water Fund CIP Projects 100804 - Paradise Water Main Construction Exp $ 2,100,000 (100,000) $ $ 2,000,000 AT-158 BM 4180 Water Fund CIP Projects 100804 - Paradise Water Main Eng./Design/Admin Exp $ 211,000 100,000 $ $ 311,000 Total Changes for Fund 4180 $ 4,779,000 $ 25,000 $ 4,804,000 AT-118 BM 4210 Sewer Operations Fund 100535 - Sonoma Trunk Ext Lift St. Construction Exp $ 1,315,000 (50,000) $ $ 1,265,000 AT-118 BM 4210 Sewer Operations Fund 100535 - Sonoma Trunk Ext Lift St. Eng./Design/Admin Exp $ 415,198 50,000 $ $ 465,198 A budget adjustment is necessary to reallocate funds within tasks on the project. No additional funding is being requested.

A budget adjustment is necessary to move budget from the CTGY-PROJECTML task to the CA-DOKKENML task to account for the fifth amendment to Dokken Engineering. The funding source is not charging as it is staying within the SR 132 Regional Measure L funds.

A budget adjustment is necessary to reallocate funds within tasks on the project. No additional funding is being requested.

A budget adjustment in the amount of $75,000 is needed in the Water CIP Fund, Del Rio Replacement Well project, to move budget from Contingency to Engineering/Design/Administration to cover additional costs related to the design state of this project.

A budget adjustment in the amount of 60,000 is needed in the Water CIP Fund, La Loma El Vista to Riverside project, to move budget from Contingency to Engineering/Design/Administration to cover additional costs related to the design state of this project.

A budget adjustment in the amount of $50,000 is needed to recognize revenue and appropriate expense budget related to the formation of the Fairview Village #2 CFD.

A budget adjustment is necessary to re-distribute funds between tasks within the project. There is sufficient funding in construction to move to the Eng./Design/Admin task.

A budget adjustment in the amount of $50,000 is needed to move budget between Services City Forces - Interfund to Professional Services to cover contract costs. #1..
- 17 -
Department Director/Budget Manager/City Manager Approved Budget Adjustments EXHIBIT B For FY2021/22
AT #
Appro
ved by
CM,
BM or
DD Fund Fund Name Cost Ctr/Project Name Account Name
Rev/E
xp/TI/
TO
Accou
nt Current Budget
Increase
(Decrease)
Revised
Budget Description
AT-154 BM 4210 Sewer Operations Fund 101381 - River Trunk Repair at 7th
Appr. Unit C - Construction
Administration Exp $ 25,000 (24,000) $ $ 1,000
AT-154 BM 4210 Sewer Operations Fund 101381 - River Trunk Repair at 7th Appr. Unit C - Construction Exp $ 558,717 58,000 $ $ 616,717 AT-154 BM 4210 Sewer Operations Fund 101381 - River Trunk Repair at 7th
Appr. Unit C -
Eng./Design/Admin Exp $ 25,000 (24,000) $ $ 1,000
Total Changes for Fund 4210 $ 2,338,915 $ 10,000 $ 2,348,915 AT-153 CM 4212 Wastewater PCE Mitigation
Fund
100668 - WW PCE
Mitigation Site 1 Appr. Unit C Exp $ 1,670,632 119,582 $ $ 1,790,214 A budget adjustment is necessary to cover expenses associated with professional services being provided by Tetra Tech approved by the City Attorney's Office in a letter dated August 11, 2021.

Total Changes for Fund 4212 $ 1,670,632 $ 119,582 $ 1,790,214 AT-155 BM 4330 County Aircraft Tax Fund 101055 - Airport Layout Update AIP 41 Transfer Out to Fund 4320 TO $ - 1,246 $ $ 1,246 A budget adjustment is necessary to re-establish the transfer out from the County Aircraft Tax Fund to Project 101055 - Airport Layout Update AIP 41. The transfer out is the remaining amount budgeted for the project, however, the transfer out lapsed at the end of the prior fiscal year and needs to be reestablished.

Total Changes for Fund 4330 $ - $ 1,246 $ 1,246
AT-148 BM 4510 Bus Fixed Route Fund 101238 Amtrak Station Repairs/Rehab AUC-CA-Construction Admin Exp $ 48,981 (1,048) $ $ 47,933 AT-148 BM 4510 Bus Fixed Route Fund 101238 Amtrak Station Repairs/Rehab AUC-CON-Construction Exp $ 434,166 (222) $ $ 433,944 AT-148 BM 4510 Bus Fixed Route Fund 101238 Amtrak Station Repairs/Rehab AUC-EDA-Eng./Design/Admin Exp $ 50,599 (280) $ $ 50,319 Total Changes for Fund 4510 $ 533,746 $ (1,550) $ 532,196 AT-114 BM 4549 Bus Fixed Route Fleet
Replacement Fund
53237 - PW-Fleet
Replacement Fund Bus
Services
Interfund Charges - Equipment
Pool Replacement Rev $ 12,446 (12,446) $ $ -
A budget adjustment is necessary to move the revenue related to equipment for StanRTA Maintenance from Fund 4549 to Fund 5409. Fund 4549 is no longer being used as Transit has moved to the StanRTA JPA. The adjustment will account for the replacement revenue anticipated to be received for cost center 53243 - City Services for StanRTA. Cost Center 53218 was created to track all revenue and expenses related to equipment tied to StanRTA.

AT-131 BM 4549 Bus Fixed Route Fleet
Replacement Fund Transfer Out Fund 4549 Transfer Out to Fund 5409 TO $ - 138,903 $ $ 138,903 A budget adjustment is necessary to establish the establish the transfer of $138,903 from Fund 4549 to Fund 5409. The fund 4549 was used for vehicles tied to the Transit Maintenance cost center. Those vehicles have now been moved to 5409 as the employees are housed in Fund 5400. The budget adjustment falls within the Budget Manager authority under bullet point #8 as this adjustment is moving from one fleet replacement sub-fund to the Fleet Replacement Management fund. Activity related to fleet replacement funds are done through the management fund. The replacement for these vehicles needs to move to the fund where they are now housed. All cash and fair market value in Fund 4549 is being moved to Fund 5409 so that the fund can be closed.

Total Changes for Fund 4549 $ 12,446 $ 126,457 $ 138,903 AT-146 BM 4600 Golf Fund 101294 - Dryden Clubhouse
Renovation Miscellaneous Revenue Rev $ 700,000 (700,000) $ $ - AT-146 BM 4600 Golf Fund 101294 - Dryden Clubhouse
Renovation Legal Settlements Rev $ - 700,000 $ $ 700,000 Total Changes for Fund 4600 $ 700,000 $ - $ 700,000
AT-126 DD 4895 Waste to Energy Dist Fund PW - Waste-to-Energy Administration Professional Services Exp $ - 21,747 $ $ 21,747 A budget adjustment of $21,747 is necessary to fund an agreement with R3 Consulting for compliance with state law. There are sufficient fund reserves for the increase in expense budget.

Total Changes for Fund 4895 $ - $ 21,747 $ 21,747
A budget adjustment is necessary to move revenue from the miscellaneous revenue account to the legal settlements account within project 101294. In discussions with Accounting, it was determined that the revenue should be placed in account 47021 instead of account 47005. All revenue is remaining in the project and this is simply A budget adjustment is needed to reduce the expense budget for project closure A budget adjustment is necessary to increase the project budget to cover Emergency Repair expenses on the project. The project will be closed once all payments are released.
#1..
- 18 -
Department Director/Budget Manager/City Manager Approved Budget Adjustments EXHIBIT B For FY2021/22
AT #
Appro
ved by
CM,
BM or
DD Fund Fund Name Cost Ctr/Project Name Account Name
Rev/E
xp/TI/
TO
Accou
nt Current Budget
Increase
(Decrease)
Revised
Budget Description
AT-134 CM 5230 Information Technology Fund 101220 - Hyland & DocuSign Transfer In from Various Funds TI $ 197,197 $ 197,197 - $ A budget adjustment is necessary to re-establish the transfer outs from various funds to Project 101220. This transfer out should not lapse per the Operating Budget Policy (Page 4 item number 4. under Inter-fund transfers and loans). In addition, Fund 4510 transfer in remaining budget is being reduced and re-allocated to all funds. The reason being is that Fund 4510 is no longer active in FY 21-22 with the JPA formation.

The total remaining transfer to the project is $42,117.19. All other funds will be charged for their portion of the expenses. This will be the final transfer for Project 101220 and once completed the project will be closed.

AT-167 DD 5230 Information Technology Fund 17410 - IT Administration Budget Only - Salary Adjustment - Decrease Exp $ - (25,000) $ $ (25,000)
AT-167 DD 5230 Information Technology Fund 17410 - IT Administration Budget Only - Benefit Adjustment - Decrease Exp $ - (5,000) $ $ (5,000)
AT-167 DD 5230 Information Technology Fund 17410 - IT Administration Professional Services Exp $ 3,160 30,000 $ $ 33,160 Total Changes for Fund 5230 $ 200,357 $ - $ 200,357
AT-132 BM 5310 Insurance Administration Fund Transfer Out Fund 5310 Transfer Out to Fund 5319 TO $ - $ 53 $ 53 A budget adjustment is necessary to establish the establish the transfer of $53 from Fund 5319 to Fund 5310. The fund 5319 is an old Fleet Replacement sub fund for Insurance Administration. The fund has not been used since 2018. All cash and fair market value in Fund 5319 is being moved to Fund 5310 so that the fund can be closed.

Total Changes for Fund 5310 $ - $ 53 $ 53
AT-132 BM 5319 Insurance Administration
Replacement Fund Transfer In Fund 5319 Transfer In from Fund 5310 TI $ - $ 53 $ 53 A budget adjustment is necessary to establish the establish the transfer of $53 from Fund 5319 to Fund 5310. The fund 5319 is an old Fleet Replacement sub fund for Insurance Administration. The fund has not been used since 2018. All cash and fair market value in Fund 5319 is being moved to Fund 5310 so that the fund can be closed.

Total Changes for Fund 5319 $ - $ 53 $ 53
AT-120 BM 5400 Fleet Management Fund 101365 - 416 N Jefferson and 121 Elm St Land Acquisition Exp $ 570,000 (5,000) $ $ 565,000 AT-120 BM 5400 Fleet Management Fund 101365 - 416 N Jefferson and 121 Elm St Eng./Design/Admin Exp $ - 5,000 $ $ 5,000 AT-150 BM 5400 Fleet Management Fund 100451 - Fleet Maintenance Facility Contingency Exp $ 325,114 (128,089) $ $ 197,025 AT-150 BM 5400 Fleet Management Fund 100451 - Fleet Maintenance Facility Construction Administration Exp $ 573,515 128,089 $ $ 701,604 AT-166 DD 5400 Fleet Management Fund 53255 - Fleet Vehicle and Equipment Maintenance
Budget Only - Salary Adjustment
- Decrease Exp $ - (150,000) $ $ (150,000)
AT-166 DD 5400 Fleet Management Fund 53255 - Fleet Vehicle and Equipment Maintenance
Budget Only - Benefit
Adjustment - Decrease Exp $ - (125,000) $ $ (125,000)
AT-166 DD 5400 Fleet Management Fund 53255 - Fleet Vehicle and Equipment Maintenance Oils Lubricants Expenses Exp $ 1,772,761 275,000 $ $ 2,047,761 Total Changes for Fund 5400 $ 3,241,390 $ - $ 3,241,390 AT-114 BM 5409 Fleet Management Fleet
Replacement Fund
53218 - PW-Fleet
Equipment Replacement -
StanRTA Maintenance
Interfund Charges - Equipment
Pool Replacement Rev $ - 12,446 $ $ 12,446
A budget adjustment is necessary to move the revenue related to equipment for StanRTA Maintenance from Fund 4549 to Fund 5409. Fund 4549 is no longer being used as Transit has moved to the StanRTA JPA. The adjustment will account for the replacement revenue anticipated to be received for cost center 53243 - City Services for StanRTA. Cost Center 53218 was created to track all revenue and expenses related to equipment tied to StanRTA.

A budget adjustment is necessary to move projected salary savings for vacant positions in Cost Center 53255 to the Oils Lubricants expense account as the invoices related to the account are coming in higher for the fiscal year.

A budget adjustment is necessary to move projected salary savings for the vacant CIO position to Professional Services to account for the invoices related to recruitment of the position.

A budget adjustment is necessary to redistribute funds between tasks in the project to cover expenses associated with a consultant agreement for construction management services.

A budget adjustment is necessary to reallocate funds from the Land Acquisition task to the Eng./Design/Admin task within project 101365. There are invoices related to legal costs that need to be paid and those invoices should not be paid under the land acquisition task per the asset guidelines.
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Department Director/Budget Manager/City Manager Approved Budget Adjustments EXHIBIT B For FY2021/22
AT #
Appro
ved by
CM,
BM or
DD Fund Fund Name Cost Ctr/Project Name Account Name
Rev/E
xp/TI/
TO
Accou
nt Current Budget
Increase
(Decrease)
Revised
Budget Description
AT-130 BM 5409 Fleet Management
Replacement Fund Transfer In Fund 5409 Transfer In from Fund 6599 TI $ - 21,852 $ $ 21,852 A budget adjustment is necessary to establish the establish the transfer of $21,852 from Fund 6599 to Fund 5409. The fund 6599 was used for one vehicle that was tied to the 10th Street JPA. All motor pool vehicles are housed in Fund 5409. The replacement for the vehicle needs to move to the fund where it is now housed. All cash and fair market value in Fund 6599 is being moved to Fund 5409 so that the fund can be closed.

AT-131 BM 5409 Fleet Management
Replacement Fund Transfer In Fund 5409 Transfer In from Fund 4549 TI $ - 138,903 $ $ 138,903 A budget adjustment is necessary to establish the establish the transfer of $138,903 from Fund 4549 to Fund 5409. The fund 4549 was used for vehicles tied to the Transit Maintenance cost center. Those vehicles have now been moved to 5409 as the employees are housed in Fund 5400. The budget adjustment falls within the Budget Manager authority under bullet point #8 as this adjustment is moving from one fleet replacement sub-fund to the Fleet Replacement Management fund. Activity related to fleet replacement funds are done through the management fund. The replacement for these vehicles needs to move to the fund where they are now housed. All cash and fair market value in Fund 4549 is being moved to Fund 5409 so that the fund can be closed.

Total Changes for Fund 5409 $ - $ 173,201 $ 173,201
AT-130 BM 6599 JPA-10th Street Fleet
Replacement Fund Transfer Out Fund 6599 Transfer Out to Fund 5409 TO $ - 21,852 $ $ 21,852 A budget adjustment is necessary to establish the establish the transfer of $21,852 from Fund 6599 to Fund 5409. The fund 6599 was used for one vehicle that was tied to the 10th Street JPA. All motor pool vehicles are housed in Fund 5409. The replacement for the vehicle needs to move to the fund where it is now housed. All cash and fair market value in Fund 6599 is being moved to Fund 5409 so that the fund can be closed.

Total Changes for Fund 6599 $ - $ 21,852 $ 21,852
AT-124 BM 6710 JPA - TRRP Special Revenue
Fund - CIP 6710
100599 TRRP Gateway
Phase 2
Intergov-Federal-Land and
Water Conservation Rev $ 451,060 (415,065) $ $ 35,995
AT-124 BM 6710 JPA - TRRP Special Revenue
Fund - CIP 6710
100599 TRRP Gateway
Phase 2
Intergov-State-Land and Water
Conservation Rev $ - 415,065 $ $ 415,065
AT-124 BM 6710 JPA - TRRP Special Revenue
Fund - CIP 6710
100599 TRRP Gateway
Phase 2 Construction Exp $ 2,069,336 (972) $ $ 2,068,364 AT-124 BM 6710 JPA - TRRP Special Revenue
Fund - CIP 6710
100599 TRRP Gateway
Phase 2 Contingency-CIP Exp $ 322,176 (268) $ $ 321,908 AT-124 BM 6710 JPA - TRRP Special Revenue
Fund - CIP 6710
100599 TRRP Gateway
Phase 2 Eng./Design/Admin Exp $ 626,869 (563) $ $ 626,306 AT-124 BM 6710 JPA - TRRP Special Revenue
Fund - CIP 6710
100599 TRRP Gateway
Phase 2 Construction Administration Exp $ 189,774 2,251 $ $ 192,025 Total Changes for Fund 6710 $ 3,659,215 $ 448 $ 3,659,663 AT-134 CM Various Various Transfer Out from Various
Funds
Transfer Out to Fund 5320
(Project 101220) TO $ - 42,117 $ $ 42,117
A budget adjustment is necessary to re-establish the transfer outs from various funds to Project 101220. This transfer out should not lapse per the Operating Budget Policy (Page 4 item number 4. under Inter-fund transfers and loans). In addition, Fund 4510 transfer in remaining budget is being reduced and re-allocated to all funds. The reason being is that Fund 4510 is no longer active in FY 21-22 with the JPA formation.

Total Changes for Fund Various $ - $ 42,117 $ 42,117
A budget adjustment is necessary to move the budgeted revenue from Account 42050 to Account 42165 as the actual revenue posted in account 42165 within the TRRP Gateway Phase 2 project. Additionally, the expense budget is being cleaned up to match actuals. There is $1,803 available in the CON, CTGY-CIP, and EDA tasks to move. There is also a need for an additional $448 in the project expense budget which will come from the 6710 fund balance. There are sufficient funds in the fund balance for the increase of $448.
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CITY OF MODESTO

COMMITTEE AGENDA REPORT
DATE OF MEETING:

May 23, 2022
Date: April 13, 2022
TO: Finance Committee
David Wright, Chair
Rosa Escutia-Braaton, Vice-Chair
Alternate Member
THROUGH: Joseph P. Lopez, City Manager
FROM: DeAnna Christensen, Director of Finance
SUBJECT: January and February 2022 Grant Application and Awards CONTACT: Maria Garnica, Accounting Manager, [email protected] 209-577-5249
DESCRIPTION:

Consider accepting an informational report on the January and February 2022 grant applications and awards and forwarding to Council for approval. (Funding Source: Not Applicable)
STRATEGIC PLAN ELEMENT:

This item supports the City of Modesto 2020-2025 Strategic Plan focus of Governance and Service Delivery under Goal H: Achieve Financial Sustainability.

BACKGROUND:

The Finance Department coordinated with California Consulting to update the Administrative Directive 7.2, “Grant Management.” The revised directive was updated on July 1, 2021 to streamline the grant management process and to establish better controls on local match requirements, including potential future costs which could be required as part of a grant agreement. Additionally, the Finance Department coordinated several training sessions to highlight key changes to the new directive.

This directive has eliminated the requirement to go to Council for the application and acceptance of grant awards if the amount of the grant is less than $1,000,000 and does not require any local match funding. The Director of Finance is authorized to approve grant applications and awards under $25,000 with no local funding requirements. The City Manager has the authority for approving grant applications and awards between $25,000 and under $1,000,000 with no local match funding requirements. Due to the need for quick turnaround on grant application and award acceptance required by the granting agencies, this directive allows #2..
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Finance Committee, May 23, 2022
January and February 2022 Grant Application and Awards

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for City departments to apply for more grants within the grant application periods and provide quick response to award acceptance deadlines.

The Finance Department will inform Council of all grant activity by preparing a bi-monthly informational report on both grant applications and awards. Finance Department has established internal grant application forms to manage the types of grants being applied for and to ensure local match requirements will be managed within our current budget.

City departments continue to actively pursue new grant applications as part of notifications received from federal, state, and local agencies they have subscribed to, such as Department of Housing, Department of Transportation, State Water Resources Control Board, Department of Justice and professional government associations. City departments have staff assigned to monitor these grant application notices to determine if the City meets the required qualifications to apply for the grant.

DISCUSSION:

During the months of January and February 2022, City Council approved the below grant application recommended by City staff based on opportunities to receive federal, state and/or local grant funds for the City with required local match or which exceeded $1,000,000 with no local match.

Community and Economic Development Department:
(Grant Application $7,591,200 – Local Match $0) – HomeKey 2.0 Project Application for 1208 9th Street, funds from this grant are intended for the prevention of homelessness by rapid rehousing individuals through the provision of coordinated, compassionate, high quality services. Center for Human Services (CHS) identified a commercial building located at 1208 9th Street to convert into permanent supportive housing for youth. This project will be designed to serve transitional aged youth ages 18-25 and will be used for the acquisition and commercial conversion of a building that will result in 9 studios and 5 one-bedroom apartments.
(Grant Application $161,956 – Local Match $0) Regional Early Action Plan grant funds are intended fund Housing Element updates and any other eligible housing-related planning activities. The City will be using these funds to fund project 100838- Modesto General Plan Update.
(Grant Application $3,504,000 – Local Match $0) HomeKey 2.0 Project Application, James Street funds are intended to help local communities rapidly acquire hotels, motels, commercial buildings and other creative properties in order to rapidly house people experiencing homelessness during COVID-19 pandemic. The City of Modesto in partnership with local entities will acquire and rehabilitate a variety of housing types including but not limited to hotels, motels hostels, single family homes, multifamily apartments adult residential facilities, manufactured housing, and/or to convert commercial properties and other existing buildings to permanent or interim housing for the target population.

Modesto Police Department:
(Grant Application $12,000,000 – Local Match $6,000,000 In-Kind contributions) California Violence Intervention and Prevention (CalVIP) grant, funds from this grant are #2..
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Finance Committee, May 23, 2022
January and February 2022 Grant Application and Awards

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intended to improve public health and safety by supporting effective violence reduction initiatives in communities that are disproportionately impacted by violence, particularly group member involved homicides, shootings, and aggravated assaults. Funds from this grant will be used to support, expand and replicate evidence-based violence reduction initiatives that shall be primarily focused on providing violence intervention services to the small segment of the population that is identified as having the highest risk of perpetrating or being victimized by violence in the near future.

Public Works Department:
(Grant Application $1,000,000 – Local Match $0) Clean California Local Grant funds will be used to fund the development of a city-owned vacant lot at 1850 Ruse Avenue to a walking path with amenities for the neighborhood such as the installation of urban greening, exercise equipment and four (4) 12 feet tower lights with directors which will be installed extending along both ends (east to west) of the path. Additionally, grant funds would also be used to establish a bulky item pickup program for multifamily units, aimed at eliminating the issue of illegal dumping in the community.

During the months of January and February 2022 the Director of Finance and City Manager approved the below grant application recommended by City staff based on opportunities to receive local grant funds for the City with no required local match.

Public Works Department:
(Grant Application $288,641 – Local Match $0) CalRecycle SB1383 Local Assistance Grant Programs, this grant funding will be used with the implementation of Senate Bill (SB) 1383 as it relates to the monitoring, record keeping and procurement requirements set forth by CalRecycle.

FISCAL IMPACT:

No fiscal impact will result from the acceptance of this informational report on January and February 2022 grant application and awards. A monthly summary by grant application and awards is below:

Grant Applications: $24,545,797
Grant Applications Local Match, In-Kind contributions $6,000,000 Approved by:

DeAnna Christensen, Director of Finance
Joseph P. Lopez, City Manager
Attachments:

1. January and February 2022 Grant Applications and Awards #2..
- 23 -
Grant Application
Grant Title Month Grant Awarding Agency City Department Name/Division Grant
Application
Amount
Grant Application
Local Match
Amount
Local Match
Source
Clean California Local Grant JAN-22 California Department of Transportation Public Works $ 1,000,000 $ - N/A HomeKey 2.0 - 1208 9th Street JAN-22 State of California Community & Economic Development Department $ 7,591,200 $ - N/A Regional Early Action Planning Grant JAN-22 State of California Department of Housing and Community Development Community & Economic Development Department $ 161,956 $ - N/A California Violence Intervention and Prevention Program (CalVIP) FEB-22 Board of State and Community Corrections Modesto Police Department $ 12,000,000 $ 6,000,000 In-kind CalRecycle SB1383 Local Assistance Grant Programs FEB-22 California Department of Resources, Recycling and Recovery Public Works $ 288,641 $ - N/A HomeKey 2.0 - James Street FEB-22 State of California Community & Economic Development Department $ 3,504,000 $ - N/A Total $ 24,545,797 $ 6,000,000
#2..
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CITY OF MODESTO

COMMITTEE AGENDA REPORT
DATE OF MEETING:

May 23, 2022
Date: April 26, 2022
TO: Finance Committee
David Wright, Chair
Rosa Escutia-Braaton, Vice-Chair
Alternate Member
THROUGH: Joseph P. Lopez, City Manager
FROM: DeAnna Christensen, Director of Finance
Bill Sandhu, Public Works Director
SUBJECT: Advanced Approval of Annual Fleet Replacements and New Additions List CONTACT: Cynthia Kline, Purchasing Manager, [email protected], 571-5175 DESCRIPTION:

Consider accepting a report on upcoming vehicle replacements and new additions planned for bidding. (Funding Source: Various Funds)
STRATEGIC PLAN ELEMENT:

These items support the City of Modesto 2020-2025 Strategic Plan Focus of Governance and Service Delivery under goal H: Achieve Financial Sustainability.

BACKGROUND:

Annually, City vehicles and equipment are individually evaluated based on their age, condition, mileage and maintenance costs. Following this process, an Annual Fleet Replacements and New Additions List is submitted to Council and is approved as part of a new fiscal year’s Fleet Replacement Budget. This list does not include emergency replacements for vehicles that have been involved in accidents and are unable to be repaired or when repair costs exceed the value of the vehicle. Once a City vehicle is replaced and put into service, funds for its replacement are charged out as monthly, recurring charges until the end of the unit’s service life. These funds are specifically designated for the replacement of City vehicles and equipment.

There are currently 170 vehicles on the Annual Fleet Replacements and New Additions List spanning five fiscal years, 2017-2018 through 2021-2022. This is due to the purchasing freeze and staff extending the useful life of many of the vehicles resulting in delayed replacement.

DISCUSSION:

Once the City Manager authorizes the replacement of a vehicle, the bid process is initiated.

These bids are received by the Purchasing and Fleet Divisions which will ensure all specifications have been met. Purchasing will then send an “Intent to Award” letter to vendors notifying who will be awarded the bid, (based on providing the lowest responsive and #3..
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Finance Committee, May 23, 2022
Advanced Approval of Annual Fleet Replacements and New Additions List

Page 2 of 3 ends

responsible bid) pending Council approval, which can take up to 3-5 months depending on agenda deadlines.

Once approved by Council, the purchase order is emailed to the awarded vendor, authorizing the order and the vehicle is placed into production. We are currently experiencing lead time delays of 6 months to a year before the vehicle is available to be delivered.

In addition to typical process delays, the COVID-19 pandemic has further impacted the purchase of vehicles for the City of Modesto, due to the lack of semiconductor computer chips, increased steel surcharges and limited production from manufacturers. This has resulted in ongoing price increases and current year chassis limitations.

Approving the Annual Fleet Replacements and New Additions List via Council Committee in advance will significantly decrease the timeline of providing a purchase order to the awarded vendor after the bid event pending Council approval and will decrease the possibility of price increases and delays in production.

Public Works, Finance – Purchasing Division and the City Manager’s Office, will continue to review the Annual Fleet Replacements and New Additions List on an ongoing basis and Purchasing will only bid vehicles which have been authorized by the City Manager.

FISCAL IMPACT:

As part of the annual budget, the Annual Fleet Replacements and New Additions List for that Fiscal Year is adopted and continues to be reviewed. The estimated total for Fiscal Year 2017- 2018 through 2021-2022 were part of those adopted fleet lists. The estimated total for Fiscal Year 2021-22 is from the current adopted budget for fleet replacement. Once the Purchasing Division completes the bids and evaluated for responsiveness in coordination with the Public Works Fleet Division, staff will present these items directly to Council for approval.

Fiscal Year
# of Replacements
and New Additions Estimated
Total
17/18 10 $526,000
18/19 5 $145,000
19/20 24 $1,626,000
20/21 11 $469,000
21/22 32 $2,206,550
TOTAL 82 $4,972,550
Next steps: Upon award of bids, staff will present these items directly to Council for approval. #3..
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Finance Committee, May 23, 2022
Advanced Approval of Annual Fleet Replacements and New Additions List

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Approved by:

DeAnna Christensen, Director of Finance
Bill Sandhu, Public Works Director
Joseph P. Lopez, City Manager
Attachments:

1. Fleet Replacement and New Additions List FY 18-22
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Fiscal Year 17-18 through 21-22 - Fleet replacement and New Additions List Fiscal Year Estimated Budget
Cost
Replacement or New
Addition Description of Unit Department Use
FY 17-18
$ 46,000.00 Replacement TRK 1 TON STAKE SIDE DUMP CC PW-Park Ops Svc FY 17-18
$ 46,000.00 Replacement TRK 1 TON STAKE SIDE DUMP CC PW-Park Ops Svc FY 17-18
$ 46,000.00 Replacement TRK 1 TON STAKE SIDE DUMP CC PW-Park Ops Svc FY 17-18
$ 46,000.00 Replacement TRK 1 TON STAKE SIDE DUMP CC PW-Park Ops Svc FY 17-18
$ 46,000.00 Replacement TRK 1 TON STAKE SIDE DUMP CC PW-Park Ops Svc FY 17-18
$ 46,000.00 Replacement TRK 1 TON STAKE SIDE DUMP CC PW-Park Ops Svc FY 17-18
$ 46,000.00 Replacement TRK 1 TON STAKE SIDE DUMP CC PW-Park Ops Svc FY 17-18
$ 45,000.00 Replacement TRK 1 TON REG CAB UTILITY PW-Park Ops Svc FY 17-18 $ 39,000.00 Replacement TRK 3/4 TON REG CAB WITH UTILITY UTL - Water System Mtnc.

FY 17-18 $ 120,000.00 Replacement TRK 33.0 W/DUMP UTL - Water System Mtnc.

FY 18-19 $ 35,000.00 Replacement TRK 3/4 TON FULL SIZE CREW CAB UTL - Water Construction FY 18-19 $ 45,000.00 Replacement TRK 3/4 TON SUPER SIZE CAB W/UTILITY UTL - Water Service Meters
FY 18-19 $ 45,000.00 Replacement TRK 3/4 TON W/UTILITY UTL - Water Service Meters FY 18-19 $ 17,500.00 New Addition SMALL BOAT WITH MOTOR UTL - Stormwater Comp.

Page 1 of 7 ends

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Fiscal Year 17-18 through 21-22 - Fleet replacement and New Additions List Fiscal Year Estimated Budget
Cost
Replacement or New
Addition Description of Unit Department Use
FY 18-19 $ 2,500.00 New Addition TRAILER FOR SMALL BOAT UTL - Stormwater Comp.

FY 19-20 $ 85,000.00 Replacement TRK 1 TON ON HD W/VALVE TURNER & VACUUM UTL - Water Quality
FY 19-20 $ 21,000.00 Replacement VAN 1/2 TON MIDSIZE 7 PASS WINDOW PW - Fleet Motorpool
FY 19-20 $ 21,000.00 Replacement VAN 1/2 TON MIDSIZE 7 PASS WINDOW PW - Community Forestry
FY 19-20 $ 28,000.00 Replacement TRK 1/2 TON PU EXT CAB SHOT BED CED - Building Permits FY 19-20 $ 26,000.00 Replacement TRK 1/2 TON PU EXT CAB SHOT BED PW - Curbs Gutters FY 19-20 $ 26,000.00 Replacement TRK 1/2 TON PU CREW CAB SHORT BED UTL - Water wells
FY 19-20 $ 30,000.00 Replacement TRK 3/4 TON EXT CAB LONG BED UTL - Water Construction FY 19-20 $ 48,000.00 Replacement TRK 3/4 TON EXT CAB W/SPRAY RIG PW - Streets Maint.

FY 19-20 $ 47,000.00 Replacement VAN 1 TON PRISONER TRAN MPD - Field Ops FY 19-20 $ 32,000.00 Replacement VAN 1 TON W/ COMPARTMENTS UTL - Wastewater FY 19-20 $ 46,000.00 Replacement VAN 1 TON W/ COMPARTMENTS PW - Electrical Division FY 19-20 $ 50,000.00 Replacement TRK 11.0 W/ UTILITY BODY UTL - Water Treatment

Page 2 of 7 ends

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Fiscal Year 17-18 through 21-22 - Fleet replacement and New Additions List Fiscal Year Estimated Budget
Cost
Replacement or New
Addition Description of Unit Department Use
FY 19-20 $ 46,000.00 Replacement TRK 11.0 W/COMPRESSOR PW - Fleet Services FY 19-20 $ 100,000.00 Replacement TRK 30.0 2 AXLE WATER UTL - Water Construction FY 19-20 $ 100,000.00 Replacement TRK 30.0 2 AXLE WATER UTL - Water Construction FY 19-20 $ 145,000.00 Replacement TRK 52.0 14 YD DUMP UTL - Water Construction FY 19-20 $ 145,000.00 Replacement TRK 52.0 14 YD DUMP UTL - Water Construction FY 19-20 $ 145,000.00 Replacement TRK 52.0 14 YD DUMP PW - Streets Maint.

FY 19-20 $ 145,000.00 Replacement TRK 52.0 14 YD DUMP UTL - Wastewater Collections FY 19-20 $ 145,000.00 Replacement TRK 52.0 14 YD DUMP UTL - Wastewater Collections FY 19-20 $ 140,000.00 Replacement TRK 57.2 3 AXLE TRACTOR UTL - Wastewater FY 19-20 $ 7,500.00 Replacement GRINDER - CONCRETE PW - Streets Maint.

FY 19-20 $ 7,500.00 Replacement GRINDER - CONCRETE PUSH TRUCK PW - Streets Maint.

FY 19-20 $ 40,000.00 New Addition TRK, 1 TON PU CREW CAB SHORT BED MFD - Fire Department
FY 20-21 $40,000.00 Replacement SPRAYER SELF PROPELLED PRN - Parks Operations

Page 3 of 7 ends

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Fiscal Year 17-18 through 21-22 - Fleet replacement and New Additions List Fiscal Year Estimated Budget
Cost
Replacement or New
Addition Description of Unit Department Use
FY 20-21 $ 19,000.00 Replacement SEDAN MID SIZE UTL - Water Administration FY 20-21 $ 36,000.00 Replacement TRK 3/4 TON W/ UTILITY UTL - Construction Admin.

FY 20-21 $ 42,000.00 Replacement TRK 3/4 TON W/LIFT GATE PW - Streets Maintenance FY 20-21 $ 11,000.00 Replacement CONCRETE SAW PW - Curbs Gutters FY 20-21 $ 40,000.00 Replacement SPRAYER SELF PROPELLED Parks Serv & Maint.

FY 20-21 $ 25,000.00 Replacement BALLFIELD HYDRO RAKE Parks Serv & Maint.

FY 20-21 $ 75,000.00 Replacement COMPACTOR TRENCH ROLLER UTL - Water Construction FY 20-21 $ 125,000.00 Replacement SWEEPER PARKING LOT - MASCO PW - Parking Maintenance FY 20-21 $ 35,000.00 Replacement TRAILER BACKHOE W/AIR UTL - Wastewater FY 20-21 $ 21,000.00 New Addition TRAILER, SIGN BOARD UTL - Stormwater Com.

FY 21-22
$ 30,000.00 Replacement MOTORCYCLE TRAFFIC MPD - Traffic Safety FY 21-22
$ 30,000.00 Replacement MOTORCYCLE TRAFFIC MPD - Traffic Safety FY 21-22
$ 30,000.00 Replacement MOTORCYCLE TRAFFIC MPD - Traffic Safety

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#3..
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Fiscal Year 17-18 through 21-22 - Fleet replacement and New Additions List Fiscal Year Estimated Budget
Cost
Replacement or New
Addition Description of Unit Department Use
FY 21-22
$ 20,000.00 Replacement SEDAN SMALL/MEDIUM MPD - Police Field Ops.

FY 21-22
$ 20,000.00 Replacement SEDAN SMALL/MEDIUM MPD - Police Field Ops.

FY 21-22
$ 30,000.00 Replacement SUV FULL SIZE MPD - Investigations FY 21-22
$ 35,000.00 Replacement TRK 1/2 TON PU C/C MID SIZE PW - Fleet Motorpool FY 21-22
$ 35,000.00 Replacement TRK 1/2 TON PU EXT CAB PW - Building Services FY 21-22
$ 35,000.00 Replacement TRK 1/2 TON PU PW - Compost Operations FY 21-22
$ 60,000.00 Replacement TRK 3/4 TON W/UTILITY UTL - Wastewater Collection FY 21-22
$ 105,000.00 Replacement TRK 1 TON W/ VALVE TURNER AND
VACUUM UTL - Water Construciton
FY 21-22
$ 150,000.00 Replacement TRK 14.5 CUBE BODY W/CCTV UTL - Wastewater Collection FY 21-22
$ 110,000.00 Replacement TRK 22.0 W/DUMP PW - Community Forestry

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#3..
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Fiscal Year 17-18 through 21-22 - Fleet replacement and New Additions List Fiscal Year Estimated Budget
Cost
Replacement or New
Addition Description of Unit Department Use
FY 21-22
$ 110,000.00 Replacement TRK 22.0 W/DUMP PW - Community Forestry FY 21-22
$ 255,000.00 Replacement TRK 33.0 CRANE 14 TON UTL - Water Construciton FY 21-22
$ 38,000.00 Replacement FORKLIFT 4000 LB ELECTRIC FIN - Central Stores FY 21-22
$ 35,000.00 Replacement FORKLIFT 5000 LB LPG UTL - Water Wells Treat FY 21-22
$ 35,000.00 Replacement FORKLIFT 5000 LB LPG UTL - Wastewater Treat FY 21-22
$ 35,000.00 Replacement FORKLIFT 5000 LBS LPG
PRN - Cultural Services Adm
FY 21-22
$ 125,000.00 Replacement FORKLIFT VARIABLE REACH UTL - Water Construciton FY 21-22
$ 125,000.00 Replacement FORKLIFT VARIABLE REACH UTL - Tertiary Treatment FY 21-22
$ 72,000.00 Replacement EXCAVATOR - COMPACT UTL - Water Construciton FY 21-22
$ 150,000.00 Replacement COMPACTOR 9 WHL PW - Streets Maintenance FY 21-22
$ 185,000.00 Replacement ROLLER 7 TON VIBRATORY PW - Streets Maintenance FY 21-22
$ 15,000.00 Replacement TRAILER ARROWBOARD UTL - Wastewater Collection FY 21-22
$ 109,050.00 New Addition TRUCK, DUMP, 5-6 YARD UTL - Sewer Operations

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#3..
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Fiscal Year 17-18 through 21-22 - Fleet replacement and New Additions List Fiscal Year Estimated Budget
Cost
Replacement or New
Addition Description of Unit Department Use
FY 21-22
$ 40,000.00 New Addition SUV, STAFF VEHICLE MFD - Modesto Fire FY 21-22
$ 17,500.00 New Addition TRAILER, DROP DECK PW - Traffic Striping FY 21-22
$ 75,000.00 New Addition EXCAVATOR, MINI WITH
ATTACHMENTS PW - Electrical Division
FY 21-22
$ 40,000.00 New Addition TRK 1/2 TON PU FIN - Stores
FY 21-22
$ 35,000.00 New Addition FORKLIFT 4000 LB ELECTRIC FIN - Stores TOTAL $ 4,972,550.00

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CITY OF MODESTO

COMMITTEE AGENDA REPORT
DATE OF MEETING:

May 23, 2022
Date: April 8, 2022
TO: Finance Committee
David Wright, Chair
Rosa Escutia-Braaton, Vice-Chair
Alternate Member
THROUGH: Joseph P. Lopez, City Manager
FROM: DeAnna Christensen, Director of Finance
SUBJECT: Circle Clamps, Gaskets, Pipe Couplings, Tapping Sleeves, & Sewer Materials CONTACT: Cynthia Kline, Purchasing Manager, [email protected], 209-577-5412 DESCRIPTION:

Consider approving a First Amendment with Ferguson Waterworks for the Purchase of Circle Clamps, Gaskets, Pipe Couplings, Tapping Sleeves and Sewer Materials for a revised estimated annual amount of $340,000 to $575,000 and a total revised amount not to exceed from $1,700,000 to $2,405,000 over five (5) years, and authorizing the Director of Finance, or her designee, the ability to add parts based on the department’s needs, ensuring the total cost does not exceed the authorized amount, and forwarding to Council for approval. (Funding Source: Water Fund)
STRATEGIC PLAN ELEMENT:

This item supports the City of Modesto 2020-2025 Strategic Plan focus of Governance and Service Delivery under Goal H: Achieve Financial Sustainability.

BACKGROUND:

The Finance Department, Central Stores Division inventories circle clamps, gaskets, pipe couplings and tapping sleeves for the Utilities Department, Water Division, for use in the setup and repair of water main lines and installation of residential water services and meters.

Competitively bidding and inventorying these products benefits the City in many ways including the following:
 Obtaining best pricing through economies of scale
 Products readily available in one location
 Staff time reduction in processing one-time bids throughout the year #4..
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Finance Committee, May 23, 2022
Circle Clamps, Gaskets, Pipe Couplings, Tapping Sleeves, & Sewer Materials

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On July 14, 2020 by Resolution 2020-306, Council approved a 1-year purchase agreement, with (4) four 1-year extension options with Ferguson Waterworks for the purchase of circle clamps, gaskets, pipe couplings, tapping sleeves and sewer materials for an estimated annual amount of $340,000 and a total not to exceed $1,700,000 over five years.

DISCUSSION:

Over this past year, City staff has received multiple price increases from vendors due to market volatility. Supply chain issues resulting from COVID-19, and weather-related manufacturing shutdowns have created an unstable market, which has yet to show signs of stabilizing. These price increases have been substantiated by the Producer Price Index (PPI)1.

Due to this market volatility, manufacturers are no longer holding annual pricing. The current pricing structure for polyvinyl chloride (PVC) parts which is a main component of this agreement are priced at the time of order and only held for approximately 48 hours.

The PVC market price has increased exponentially over the past several years, and continues to rise. Two of the largest PVC producer manufacturers declared a force majeure event due to weather, on August 14, 2021 & August 31, 2021 and were not lifted until late 2021. Since January 2021 to present, pricing has increased 200%.

Manufacturers are currently offering quotes for ductile and stainless-steel parts that are valid for approximately 30 to 90 days. Materials continue to remain in short supply, and are still experiencing market volatility. Since January 2021, pricing has increased approximately 20% and 78%, respectively, for ductile and stainless-steel parts.

Further compounding market volatility are fuel increases in the western region of the United States. The cost of fuel has increased almost 90% since January 2021. Additional information regarding the Western Region (California) fuel index can be located on the U.S. Energy Information Administration website.2
Staff continues to monitor supply chain trends on a regular basis, and validates that pricing provided by vendors falls within fair market value. Approving this amendment will ensure that the city can continue to secure the purchase of parts and supplies required to provide safe drinking water. Additionally, by establishing annual extension this will ensure City staff continue to monitor the market and determine if we should solicit a new bid to obtain lower pricing for these goods.

FISCAL IMPACTS:

Current agreement No. 185001 has a total annual estimated amount of $340,000. For years one and two, a total of $651,008 has been expended against the agreement. During the first year, approximately 30% of the funds were utilized for pipe, as opposed to current spend for pipe which now accounts for 71% of funds spent. Staff is requesting an increase to the total spending limit of $1,700,000, for a new total amount not to exceed $2,405,000 over five years.

Funds are budgeted in the Water Fund and Wastewater Fund. 1 https://data.bls.gov/PDQWeb/pc
2 https://www.eia.gov/dnav/pet/pet_pri_gnd_dcus_sca_w.htm #4..
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Finance Committee, May 23, 2022
Circle Clamps, Gaskets, Pipe Couplings, Tapping Sleeves, & Sewer Materials

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FUND ACCOUNT
NUMBER

REVISED
ANNUAL
AMOUNT
Water $517,000
4100-45020-53150
4100-45040-53150
4180-100357,
100576, 100577
Wastewater 4210-44211-53150 $58,000
ANNUAL TOTAL NOT TO EXCEED $575,000
FIVE (5) YEAR TOTAL NOT TO EXCEED $2,405,000
Approved by: _____________________________________________ DeAnna Christensen, Director of Finance
_____________________________________________
Joseph P. Lopez, City Manager
Attachments:

1. Amendment to Purchase Agreement 185001 – Ferguson Waterworks

2. Annual Agreement - Original
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1 FIRST AMENDMENT TO AGREEMENT

FOR CIRCLE CLAMPS, GASKETS, PIPE COUPLINGS, TAPPING SLEEVES, &

SEWER MATERIALS WITH FERGUSON WATERWORKS
This FIRST AMENDMENT to the AGREEMENT, made and entered into in the City of Modesto, State of California, this _____ day of ______________, 2022, by and between the City of Modesto, a municipal corporation of the State of California, hereinafter called CITY, and FERGUSON WATERWORKS hereinafter collectively referred to as CONTRACTOR.

This FIRST AMENDMENT to the AGREEMENT is made with reference to the following recitals:

A. An AGREEMENT, hereinafter referred to as AGREEMENT was entered into by and between CITY and CONTRACTOR on the 14TH day of JULY, 2020 to provide circle clamps, gaskets, pipe couplings, tapping sleeves & sewer materials B. CITY and CONTRACTOR desire to amend the AGREEMENT by increasing the previously approved annual amount from $340,000 to $575,000 for circle clamps, gaskets, pipe couplings, tapping sleeves & sewer materials identified in the AGREEMENT.

C. CITY and CONTRACTOR now desire to memorialize the change to the terms of the AGREEMENT with this FIRST AMENDMENT.

NOW, THEREFORE, the parties hereto mutually agree to the following:

1. The second paragraph of the AGREEMENT shall be amended to include the following:
“Total amount not to exceed $2,405,000 over five years

2. Except as modified and amended by this FIRST AMENDMENT to the AGREEMENT, all other provisions of the Agreement shall remain unchanged and in full force and effect.

IN WITNESS WHEREOF, the CITY OF MODESTO, a Municipal Corporation, has authorized the execution of this First Amendment to the Agreement by its City Manager and attested #4..
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2 by its City Clerk under authority of Resolution No.__________, adopted by the Council of the City of Modesto on the ____ day of _____________, 2022, and FERGUSON WATERWORKS has caused this First Amendment to the Agreement to be duly executed. #4..
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CITY OF MODESTO

COMMITTEE AGENDA REPORT
DATE OF MEETING:

May 23, 2022
Date: April 1, 2022
TO: Finance Committee
David Wright, Chair
Rosa Escutia-Braaton, Vice-Chair
Alternate Member
THROUGH: Joseph P. Lopez, City Manager
FROM: DeAnna Christensen, Director of Finance
SUBJECT: First Amendment for Online Auction Services
CONTACT: Cynthia Kline, Purchasing Manager, [email protected], 209-577-5412 DESCRIPTION:

Consider approving the First Amendment increasing the Agreement amount with the Public Group aka Public Surplus for the furnishing of online auction services by $12,000 annually from $18,000 to a revised annual estimated amount of $30,000 and for a revised total amount not to exceed $114,000 over five years and forwarding to Council for approval. (Funding Source:

Various Funds)
STRATEGIC PLAN ELEMENT:

This item supports the City of Modesto 2020-2025 Strategic Plan focus of Governance and Service Delivery under Goal H: Achieve Financial Sustainability.

BACKGROUND:

Under Administrative Directive 7.6 – Surplus of City Property Policy, the Finance Department in coordination with all City departments track, administers and records the surplus of City property. When surplus property is defined (excluding Real Property), Finance will coordinate if the property can be transferred to other City departments and then determine if the property can be sold using an internet public auction site.

The Accounting Division of the Finance Department has been using The Public Group’s online application, Public Surplus for auctioning the City’s obsolete, unused or surplus property items, which typically consist of: (1) property and scrap accumulated by the City; and (2) surplus City vehicles and equipment. Items not sold online are discarded through an agreement with an ewaste vendor. #5..
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Finance Committee, May 23, 2022
First Amendment for Online Auction Services

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On March 12, 2019 under Resolution 2019-117, Council approved an agreement with The Public Group by utilizing the competitive bid process with National Intergovernmental Purchasing Alliance (National IPA), City of Tucson, for an online auction service for a two-year agreement with three one-year extension options, for an estimated annual cost not to exceed $18,000 and a total amount not to exceed $90,000 over five years.

DISCUSSION:

With the increase in volume of the surplus of City vehicles, the Public Works Fleet Division is in need to surplus City vehicles that have defined as non-operational for field use. As the Fleet Division has been purchasing new vehicle replacements or additions, it is anticipated that the volume will increase the demand to place more vehicles for sale through the online auction services, which will require additional service costs under this agreement. We are also taking into consideration that the market for vehicles and equipment are currently much higher than normal sale prices.

The fee for the online auction service originally was captured as a surcharge fee of 5%, and now under the third year of the agreement, the surcharge fee has increased to 9.5%. This fee is captured as part of the overall bidding price and paid for by the winning bidder.

FISCAL IMPACT:

Revenue generated from the sales is distributed into General Fund or various Fleet Replacement funds. Such revenue and associated fees will vary each fiscal year, depending on items listed and sold. The table below represents a summary of the overall sales and fees processed for the last three years under the agreement.

Fiscal Year Auction Sales Service Fee
19-20 $ 387,748 $ 19,388
20-21 $ 161,004 $ 15,295
21-22 (thru 3/28/22) $ 160,168 $ 15,216
Total $ 708,920 $ 49,899
Approved by:

DeAnna Christensen, Director of Finance
Joseph P. Lopez, City Manager
Attachments:

1. First Amendment – Public Surplus

2. Original Agreement – Public Surplus
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1 FIRST AMENDMENT TO AGREEMENT
This First Amendment (“First Amendment”) is made with reference to the “Agreement” entered into between the CITY OF MODESTO, a municipal corporation of the State of California (hereinafter the “City”) and PUBLIC GROUP AKA “PUBLIC SURPLUS” (hereinafter the “Contractor”) entered into by the parties on the 12th day of March, 2019 (hereinafter referred to as “Original Agreement”). The City and Contractor shall be collectively referred to as the “Parties.”
This First Amendment to the Original Agreement is made with regard to the following recitals:

WHEREAS, the Modesto City Council adopted Resolution No. 2019-117 authorizing the award of proposal and contract for the furnishing of Online Auction Services to Contractor; and
WHEREAS, the Original Agreement, Section 1, ‘SCOPE OF WORK’ provides under part e, that Contractor agrees to furnish the services, for an estimated annual cost not to exceed $18,000 and a total amount not to exceed $90,000 over the five years; and WHEREAS, the parties now desire to increase the estimated annual amount of the Original Agreement to not to exceed $30,000 and to increase the total amount to not to exceed $114,000 over the five years.

NOW, THEREFORE, in consideration of the mutual promises, covenants, and stipulations contained herein and the mutual promises, covenants, and stipulations contained in the Original Agreement, the parties agree as follows:

1. The parties agree that each of the recitals set out above are factually true and correct.
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2 2. Section 1e, under “SCOPE OF WORK” shall be deleted in its entirety and the parties agree to and hereby do substitute the following in its place:
“CONTRACTOR shall furnish the services defined for the
contracted rate, for an estimated annual cost not to exceed $30,000 and a total amount not to exceed $114,000; the surcharge fee for services of

9.5% shall be paid by the buyer at no cost to the City.

3. Except as modified herein, the provisions of the Original Agreement, and all exhibits attached thereto, are expressly reaffirmed and remain in full force and effect.
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3 IN WITNESS WHEREOF, the CITY OF MODESTO, a municipal corporation. has authorized the execution of this First Amendment to Agreement for furnishing the furnishing of Online Auction Services, in duplicate, by its City Manager and attestation by its City Clerk, under authority of Resolution No. ______on the _____ day of _____________, 2022, and Contractor has caused this First Amendment be executed in duplicate. #5..
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Updated 2/5/19
Public Surplus Scope of Work Agreement
Scope of Work Statement:

This Scope of Work Statement explains in general terms the services offered to City of Modesto by The Public Group, LLC (“Public Surplus,” “We,” “Our,” or “Us”) through Our online auction and surplus management system Registration:

Public Surplus will assist City of Modesto (“Agency”) to register with and set up an account on Public Surplus. Registration of an account does not obligate Agency to use the account. Use of Agency’s account will be at Agency’s discretion. Agency may terminate use of its account at any time.

Training/Support:

Public Surplus will assist and train as many employees of Agency as is necessary to utilize Our system for this Sale. Training will be done online and on dates and times convenient to the Agency. Public Surplus will also offer user support for Agency Monday-Friday 7 AM – 4 PM PT. Agency will have access to an account manager by cell phone after hours if needed to resolve any unforeseen training or support issues.

Auction Management:

Agency will have total control over their auction process. Agency will be responsible for pictures and descriptions of auction items and for creating the auction on Public Surplus’ site. This process is simple and usually takes only a few minutes per auction to create and list on our site. Agency will be responsible for answering buyer’s questions and basic auction management. Agency will be able to upload onto Our site its own terms and conditions of sale. Buyers must agree to Agency’s terms and conditions using their legally binding digital signature before they can bid on Agency’s auctions.

AND
Auction Tech Services:

Public Surplus will provide agency with a company auction technician specialists who will come to your site to take pictures and write descriptions of auction items for creating auction on Public Surplus' site once a month. Public Surplus will also contact buyers and collect payment on behalf of the City if desired. Agency will be provided the contact information of our Auction Tech to create appointments at will.
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Updated 2/5/19
Payment/Fees:

Agency will receive payment from buyers for items sold on Public Surplus. Public Surplus will charge a [5%] auction listing fee to Agency, which can be passed on to buyers in the form of a Buyer’s Premium. Agency may determine how they will receive payment and what payment methods will be accepted. Public Surplus can calculate and include in the final bid price sales tax and/or a Buyer’s Premium if Agency so chooses. We do not charge late fees for payment and find that most of our clients pay within sixty (60) days. Agency can pay fees to Public Surplus by check, electronic check, or credit card
Auction Follow Up:

Public Surplus will notify the winning bidder by email that they need to contact Agency to arrange for pickup (and payment, if applicable) of the auction item.

Buyers agree to these conditions of pickup and payment upon registration with Us. As noted above, Agency will be able to upload onto our site additional terms and conditions of sale, such as how long each buyer has to make payment and pickup an auction item. Buyers must agree to Agency’s terms and conditions using their legally binding digital signature before they can bid on Agency’s auctions.

Customization and Added Services:

Public Surplus realizes that no two agencies are the same. The Agency may have need for enhancements and additions to our standard system to realize the full effectiveness of online auctions. We at Public Surplus are committed to working with Agency if these changes are needed. Some of these services are customized reporting tools, integration to existing software, and customized branding. We bring years of experience and our desire to see each of our clients succeed with this new and exciting technology.

Enhanced Auctions Services (Marketing and Sell Strategies):

Public Surplus is willing to help the City of Modesto with various marketing and sales strategies for all vehicles and heavy equipment and items of value over $5000. For support with all other items, the agency's Support Rep can be a resource to assist. Our marketing team is tasked with contacting bidders and sometimes selling agencies who have bid on similar items in the past. Their goal is to attempt to bring competition to the auctions in the hopes that it will increase auction totals.

System Accessibility/Reliability:

The Public Surplus system is accessible 24 hours a day/7 days a week for buyers and sellers. When we do take down the system for maintenance it is done late at night so as not to interrupt service. Our servers are located in a secure environment with multiple redundant connections and equipment. #5..
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CITY OF MODESTO

COMMITTEE AGENDA REPORT
DATE OF MEETING:

May 23, 2022
Date: May 2, 2022
TO: Finance Committee
David Wright, Chair
Rosa Escutia-Braaton, Vice-Chair
Alternate Member
THROUGH: Joseph P. Lopez, City Manager
FROM: Bill Sandhu, Director of Public Works
SUBJECT: Reject Bids for RFB No. 2122-23 for Building Intrusion Alarm Services CONTACT: Patrick Crowley, Facility Manager/Building Administration, [email protected], 209-402-6812
DESCRIPTION:

Consider rejecting all bids received for Request for Bid No. 2122-23 for Building Intrusion Alarm Services, and authorizing staff to re-evaluate and re-issue at a future date and forwarding to Council for approval. (Funding Source: Various Fund)
STRATEGIC PLAN ELEMENT:

This action supports the 2020-2025 City of Modesto Strategic Plan Area of Focus: Service Delivery Goals and Strategies; “build community trust in City government through responsive, transparent and efficient service delivery”; Goal H: “achieve long-term financial sustainability.” BACKGROUND:

The City of Modesto, Public Works Department, Building Services Division is responsible for maintaining facilities within the City of Modesto which includes the intrusion alarm systems within those facilities. There has not been a city-wide agreement for intrusion alarm system services which includes the detection of unauthorized entry, video/image coverage and thirdparty central office monitoring of these systems. On November 24, 2021, the Purchasing Division issued Request for Bids (RFB) No. 2122-23 for the Building Intrusion Alarm Services and posted the RFB on the City’s website and formally advertised as required by law. On December 28, 2021, bids were formally opened by the City Clerk’s office, where four companies chose to download the RFB documents, and submitted bids to the City. #6..
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Finance Committee, May 23, 2022
Reject Bids for RFB No. 2122-23 for Building Intrusion Alarm Services

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DISCUSSION:

After reviewing the bids received, it was determined that staff needed to amend the original Scope of Services to ensure a more competitive process and eliminate ambiguity in the original scope. This determination was based on the significant price variances between vendors ($2,105 - $49,904). In addition, further amendments may be needed to the Pricing Schedule and Bidding Process.

In accordance with Modesto Municipal Code Sec. 8-3.203, Formal Bid Procedures, the Council shall have the authority to accept or reject any or all bids. The rejection of all bids for the RFB No. 2122-23 for Building Intrusion Alarm Services conforms to Modesto Municipal Code 8-

3.203, subsection (e).

FISCAL IMPACT:

If Council approves the rejection of all proposals, there will be nominal additional costs of staff time to rebid the project. Funds for Building Intrusion Alarm Services have been budgeted in various funds and will be available when the revised Scope of Work has been completed.

Approved by:

Bill Sandhu, Director of Public Works
Joseph P. Lopez, City Manager
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CITY OF MODESTO

COMMITTEE AGENDA REPORT
DATE OF MEETING:

May 23, 2022
Date: May 4, 2022
TO: Finance Committee
David Wright, Chair
Rose Escutia-Braaton, Vice Chair
Alternate Member
THROUGH: Joseph P. Lopez, City Manager
FROM: William Wong, Director of Utilities
SUBJECT: Second Amendment to the Site Lease Agreement with New Cingular Wireless PCS, LLC for the Cell Tower at the Utilities Water Tank Site CONTACT: Jesse Franco, Engineering Division Manager, [email protected], (209) 571-5175
DESCRIPTION:

Consider approving a Second Amendment to the Site Lease Agreement with New Cingular Wireless PCS, LLC for Cell Tower Site at the Utilities Water Tank Site for an additional five (5) year term, with up to four (4) additional five (5) year terms and forward to Council for approval. (Funding Source: Water Fund)
STRATEGIC PLAN ELEMENT:

The recommended action supports the 2020-2025 City of Modesto Strategic Plan Initiatives, Goal D: Provide safe, efficient, and reliable infrastructure through proactive community investment, maintenance, and sustainability efforts.

BACKGROUND:

The City of Modesto has partnered with various cellular service providers in the past by leasing space and having cellular towers installed on its property. These partnerships have been a benefit to the residents of the City of Modesto by improving cellular service coverage throughout Modesto and also providing annual revenue to City of Modesto that has been utilized to maintain City facilities.
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Committee May 23, 2022
Second Amendment to the Site Lease Agreement with New Cingular Wireless PCS, LLC for Cell Tower Site at the Utilities Water Tank Site

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DISCUSSION:

New Cingular Wireless PCS, LLC entered into a Site Lease Agreement with the City, dated August 27, 2002, for Cell Tower leasing at the Utilities Tank Site located at 920 D Street, Modesto, CA 95354.

On September 28, 2010, by Resolution 2010-418, Council approved the First Amendment to the Site Lease Agreement.

New Cingular Wireless PCS, LLC has requested continued leasing of the Cell Tower through a Second Amendment to the Lease Agreement. The term of this Second Amendment shall be five (5) years with up to four (4) additional five (5) year terms, upon mutual agreement.

FISCAL IMPACT:

Commencing on September 1, 2022, the current Rent payable under the Second Amendment shall be One Thousand Eight Hundred and No/100 Dollars ($1,800.00) per month. New Cingular Wireless PCS, LLC will pay the City of Modesto a 3% rate increase per year, every year of lease term duration.

Revenue received from the lease will be deposited into the Water Fund.

Approved by:

William Wong, Director of Utilities
Joseph P. Lopez, City Manager
Attachments:

1. Second Amendment to Site Lease Agreement

2. Memorandum of Lease Second Amendment
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Category 2 Amendment Form
Market: San Francisco / Sacr / Reno
Cell Site Number: CVL01322
Cell Site Name: DT Modesto
Fixed Asset Number: 10090368

SECOND AMENDMENT TO SITE LEASE AGREEMENT
THIS SECOND AMENDMENT TO SITE LEASE AGREEMENT (“Second
Amendment”) dated as of the later date below (the “Effective Date”) is by and between City of Modesto, a California municipal corporation, having a mailing address at 1010 10th Street, Utilities Dept., Suite 4600, Modesto, CA 95354 (“Landlord”) and New Cingular Wireless PCS, LLC, a Delaware limited liability company, having a mailing address at 1025 Lenox Park Blvd.

NE, 3rd Floor, Atlanta, GA 30319 (“Tenant”).

WHEREAS, Landlord and Tenant (or its affiliate or predecessor in interest) entered into a Site Lease Agreement dated August 27, 2002, as amended by First Amendment to Site Lease Agreement dated September 28, 2010 (“First Amendment”), whereby Landlord leased to Tenant certain Premises, therein described, that are a portion of the Property located at 920 D Street, Modesto, CA 95354 (collectively, the “Agreement”); and
WHEREAS, the term of the Agreement will expire on August 31, 2022, and the parties mutually desire to renew the Agreement, memorialize such renewal period and modify the Agreement in certain other respects, all on the terms and conditions contained herein; and WHEREAS, Landlord and Tenant desire to amend the Agreement to extend the term of the Agreement; and
WHEREAS, Landlord and Tenant desire to adjust the Rent in conjunction with the modifications to the Agreement contained herein; and
WHEREAS, Landlord and Tenant desire to amend the Agreement to clarify the scope of Tenant's permitted use of the Premises; and
WHEREAS, Landlord and Tenant, desire to amend the Agreement to modify the notice section thereof; and
WHEREAS, Landlord and Tenant, in their mutual interest, wish to amend the Agreement as set forth below accordingly.

NOW THEREFORE, in consideration of the foregoing and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, Landlord and Tenant agree as follows:
 Term. The term of the Agreement shall be amended to provide that the Agreement has a new initial term of five (5) years (“New Initial Term”), commencing on September 1, 2022, #7..
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Category 2 Amendment Form
(“New Term Commencement Date”). As of such New Term Commencement Date, all remaining extension terms in the Agreement except as set forth herein shall be void and of no further force and consequence. The Agreement will be automatically renewed for up to four (4) additional five (5) year terms (each an “Extension Term”) upon the same terms and conditions of the Agreement, as amended herein, without further action by Tenant, unless Tenant notifies Landlord in writing of Tenant’s intention not to renew the Agreement at least sixty (60) days prior to the expiration of the New Initial Term or the then current Extension Term. Hereafter, the defined term “Term” shall include the New Initial Term and any applicable Extension Term.

Landlord agrees and acknowledges that except that as such permitted use or other rights may be amended herein, Tenant may continue to use and exercise its rights under the Agreement as permitted prior to the New Initial Term.
 Reserved.
 Modification of Rent. Commencing on September 1, 2022, the current Rent payable under the Agreement shall be One Thousand Eight Hundred and No/100 Dollars ($1,800.00) per month, and shall continue during the Term, subject to adjustment, if any, as provided below. In the event of any overpayment of Rent prior to or after the Effective Date, Tenant shall have the right to deduct from any future Rent payments an amount equal to the overpayment amount. It shall be the responsibility of the Tenant to ensure Rent payments, including any Rent escalations provided herein, are paid in full.
 Future Rent Increase / Extension Term Increase. Commencing on September 1, 2027 and at the beginning of each subsequent Extension Term thereafter, the Rent shall increase by three percent (3%) per year, every year of Agreement Term duration. Such Rent escalations shall replace and be in lieu of any Rent escalations scheduled to occur pursuant to the Agreement or First Amendment.
 Permitted Use. Tenant, its personnel, invitees, contractors, agents, subtenants, or its authorized sublessees, or assigns may use the Premises, at no additional cost or expense, for the transmission and reception of any and all communications signals and to modify, supplement, replace, upgrade, expand, including but not limited to the number and type(s) of antennas, or refurbish the equipment and/or improvements thereon or relocate the same within the Premises at any time during the term of the Agreement for any reason, or in order to be in compliance with any current or future federal, state or local mandated application, including but not limited to emergency 911 communication services, or for any other reason. Landlord shall reasonably cooperate in obtaining governmental and other use permits or approvals necessary or desirable for the foregoing permitted use. If Landlord does not comply with the terms of this Section, in addition to any other rights it may have at law, Tenant may terminate the Agreement and shall have no further liability to Landlord. The Tenant must inform the Landlord before any said use is initiated.

Landlord reserves the right to request additional information, including but not limited to engineering designs or calculations to confirm existing infrastructure will not be compromised by proposed modifications or improvements. Landlord reserves the right to deny said modifications or improvements if they will negatively impact or compromise the structural integrity of existing infrastructure or impede existing Landlord operations. Nothing in this Agreement shall be #7..
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Category 2 Amendment Form
interpreted as restricting or otherwise limiting the Landlord’s regulatory authority, including land use authority, or otherwise binding the Landlord to issue government approvals.  Removal/Restoration. In addition to the terms set forth in the Agreement, Landlord agrees that the Communications Facility and any related equipment brought to the Premises by Tenant, its agents, contractors, predecessors in interest or subtenants, shall be and remain Tenant’s personal property or the personal property of its subtenant(s), as the case may be. Landlord waives any and all rights it may have, including any rights it may have in its capacity as Landlord under the Agreement to assert any liens, encumbrances or adverse claims, statutory or otherwise, related to or in connection with the Communications Facility or any portion thereof. Tenant, in its sole discretion, may remove the Communications Facility or any portion of the Communications Facility at any time during the Term of the Agreement, without notice to Landlord and without Landlord’s consent. Tenant will repair any damage to the Property resulting from Tenant’s removal activities and not normal wear and tear. Notwithstanding any terms to the contrary, Tenant will not be responsible for the replacement of any trees, shrubs or other vegetation, nor will Tenant be required to remove from the Premises or the Property any foundations or underground utilities. Tenant, may, in its sole discretion, transfer any improvements or alterations to the Premises to Landlord at any time during the Term of the Agreement without notice to the Landlord and without the Landlord’s consent.
 Acknowledgement. Landlord acknowledges that: 1) this Second Amendment is entered into of the Landlord’s free will and volition; 2) Landlord has read and understands this Second Amendment and the underlying Agreement and, prior to execution of this Second Amendment, was free to consult with counsel of its choosing regarding Landlord’s decision to enter into this Second Amendment and to have counsel review the terms and conditions of this Second Amendment; 3) Landlord has been advised and is informed that should Landlord not enter into this Second Amendment, the underlying Agreement between Landlord and Tenant, including any termination or non-renewal provision therein, would remain in full force and effect.  Notices. Section 15 of the Agreement is hereby deleted in its entirety and replaced with the following:

NOTICES. All notices, requests, demands and communications hereunder will be given by first class certified or registered mail, return receipt requested, or by a nationally recognized overnight courier, postage prepaid, to be effective when properly sent and received, refused or returned undelivered. Notices will be addressed to the parties as follows.

If to Landlord:

City of Modesto
1010 10th Street
Utilities Dept., Suite 4600
Modesto, CA 95354
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Category 2 Amendment Form
If to Tenant:

New Cingular Wireless PCS, LLC
Attn: TAG – LA
Re: Cell Site #: CVL01322
Cell Site Name: DT Modesto (CA)
Fixed Asset #: 10090368
1025 Lenox Park Blvd. NE
3rd Floor
Atlanta, GA 30319
With a copy to:

New Cingular Wireless PCS, LLC
Attn: Legal Department
Re: Cell Site #: CVL01322
Cell Site Name: DT Modesto (CA)
Fixed Asset #: 10090368
208 S. Akard Street
Dallas, Texas, 75202-4206
The copy sent to the Legal Department is an administrative step which alone does not constitute legal notice. Either party hereto may change the place for the giving of notice to it by thirty (30) days prior written notice to the other as provided herein.  Sale of the Property.
Landlord shall not be prohibited from the selling, leasing or use of any of the Property or the surrounding property except as provided below.
If Landlord, at any time during the Term of the Agreement, decides to rezone or sell, subdivide or otherwise transfer all or any part of the Premises, or all or any part of the Property or surrounding property, to a purchaser other than Tenant, Landlord shall promptly notify Tenant in writing, and such rezoning, sale, subdivision or transfer shall be subject to the Agreement and Tenant’s rights hereunder. In the event of a change in ownership, transfer or sale of the Property, within ten (10) days of such transfer, Landlord or its successor shall send the documents listed below in this subsection (b) to Tenant. Until Tenant receives all such documents, Tenant shall not be responsible for any failure to make payments under the Agreement and reserves the right to hold payments due under the Agreement.
i. Old deed to the Property
ii. New deed to the Property
iii. Bill of Sale or Transfer
iv. Copy of current Tax Bill
v. New IRS Form W-9
vi. Completed and Signed AT&T Payment Direction Form
vii. Full contact information for new Landlord including phone number(s) #7..
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Category 2 Amendment Form
Landlord agrees not to sell, lease or use any areas of the Property or surrounding property for the installation, operation or maintenance of other wireless communications facilities if such installation, operation or maintenance would interfere with Tenant’s permitted use or communications equipment as determined by radio propagation tests performed by Tenant in its sole discretion. Landlord or Landlord’s prospective purchaser shall reimburse Tenant for any costs and expenses of such testing. If the radio frequency propagation tests demonstrate levels of interference unacceptable to Tenant, Landlord shall be prohibited from selling, leasing or using any areas of the Property or the surrounding property for purposes of any installation, operation or maintenance of any other wireless communications facility or equipment. The provisions of this Section shall in no way limit or impair the obligations of Landlord under the Agreement, including interference and access obligations.

 Charges. All charges payable under the Agreement such as utilities and taxes shall be billed by Landlord within one (1) year from the end of the calendar year in which the charges were incurred; any charges beyond such period shall not be billed by Landlord, and shall not be payable by Tenant. The foregoing shall not apply to monthly Rent which is due and payable without a requirement that it be billed by Landlord. The provisions of this subsection shall survive the termination or expiration of the Agreement.
 Other Terms and Conditions Remain. In the event of any inconsistencies between the Agreement and this Second Amendment, the terms of this Second Amendment shall control.

Except as expressly set forth in this Second Amendment, the Agreement otherwise is unmodified and remains in full force and effect. Each reference in the Agreement to itself shall be deemed also to refer to this Second Amendment.
 Capitalized Terms. All capitalized terms used but not defined herein shall have the same meanings as defined in the Agreement.
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Category 2 Amendment Form
IN WITNESS WHEREOF, the parties have caused this Second Amendment to be effective as of the last date written below.

LANDLORD:

City of Modesto,
a California municipal corporation
TENANT:

New Cingular Wireless PCS, LLC,
a Delaware limited liability company
By: AT&T Mobility Corporation
Its: Manager
By: ___________________________ By: ___________________________ Print Name: Print Name:

Its: Its:

Date: Date:
[ACKNOWLEDGMENTS APPEAR ON THE NEXT PAGE]
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Category 2 Amendment Form

LANDLORD ACKNOWLEDGMENT
State of California

County of ______________________ )
On __________________________ before me,
__________________________________________________________ (insert name and title of the officer)
personally appeared
_______________________________________________________________________________, who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.

I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.

WITNESS my hand and official seal.

Signature __________________________________ (Seal)
A notary public or other officer completing this
certificate verifies only the identity of the individual who signed the document to which this certificate is
attached, and not the truthfulness, accuracy, or
validity of that document.
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Category 2 Amendment Form

TENANT ACKNOWLEDGMENT
State of California

I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.

WITNESS my hand and official seal.

AT&T Mobility
Attn: Lease Administration
1025 Lenox Park Blvd NE
3rd Floor
Atlanta, GA 30319
APN: 106-046-001-000
_____________________________________________________________________________________ (Space Above This Line For Recorder’s Use Only)
Re: Cell Site #: CVL01322
Cell Site Name: DT Modesto (CA)
Fixed Asset Number: 10090368
State: CA
County: Stanislaus

MEMORANDUM OF SECOND AMENDMENT TO SITE LEASE AGREEMENT
This Memorandum of Second Amendment to Site Lease Agreement is entered into on this ____ day of ________________, 2022, by and between City of Modesto, a California municipal corporation, having a mailing address at 1010 10th Street, Utilities Dept., Suite 4600, Modesto, CA 95354 (hereinafter referred to as “Landlord”) and New Cingular Wireless PCS, LLC, a Delaware limited liability company, having a mailing address of 1025 Lenox Park Blvd. NE, 3rd Floor, Atlanta, GA 30319 (hereinafter referred to as "Tenant").

1. Landlord and Tenant (or its predecessor in interest) entered into a certain Site Lease Agreement dated August 27, 2002, as amended by that certain First Amendment to Site Lease Agreement dated September 28, 2010, and as further amended by that certain Second Amendment to Site Lease Agreement dated ____________________________, 2022 (collectively, the “Agreement”) for the purpose of installing, operating and maintaining a communications facility and other improvements. A Memorandum of First Amendment to Site Lease Agreement reflecting the Agreement was recorded on August 19, 2014, as Document No. 2014-0054244-00, in the public records of Stanislaus County, State of California.

2. The parties have agreed that the Agreement has a new initial term of five (5) years (“New Initial Term”), commencing on September 1, 2022, subject to the provisions of the Agreement.

3. The parties have agreed, following the New Initial Term, to add four (4) successive periods of five (5) years each upon the same terms and conditions of the Agreement.

4. The portion of the land being leased to Tenant (the “Leased Premises”) is described in Exhibit 1 annexed hereto.

5. This Memorandum of Second Amendment to Site Lease Agreement is not intended to amend or modify, and shall not be deemed or construed as amending or modifying, any of the terms, conditions or provisions of the Agreement, all of which are hereby ratified and affirmed. In the event of a conflict between the provisions of this Memorandum of Second Amendment to Site Lease Agreement and the provisions of the Agreement, the provisions of the Agreement shall control. The Agreement shall be binding upon and inure to the benefit of the parties and their respective heirs, successors, and assigns, subject to the provisions of the Agreement.
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IN WITNESS WHEREOF, the parties have executed this Memorandum of Second Amendment to Site Lease Agreement as of the day and year first above written.

LANDLORD:

City of Modesto,
a California municipal corporation
By: ________________________________________
Print Name:

Its:

Date:

TENANT:

New Cingular Wireless PCS, LLC,
a Delaware limited liability company
By: AT&T Mobility Corporation
Its: Manager
By: _______________________________________
Print Name:

Its:

Date:
[ACKNOWLEDGMENTS APPEAR ON NEXT PAGE]
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LANDLORD ACKNOWLEDGMENT
State of California

County of ______________________ )
On ________________________________ before me, ____________________________________________________ (insert name and title of the officer)
personally appeared _______________________________________________________________________________, who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.

I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.

WITNESS my hand and official seal.

TENANT ACKNOWLEDGMENT
State of California

I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.

WITNESS my hand and official seal.

DESCRIPTION OF LEASED PREMISES

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to the Memorandum of Second Amendment to Site Lease Agreement dated ________________________, 2022, by and between City of Modesto, as Landlord, and New Cingular Wireless PCS, LLC, a Delaware limited liability company, as Tenant.

The Premises are a portion of the Property described and/or depicted as follows:

Property Legal Description:
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CITY OF MODESTO

COMMITTEE AGENDA REPORT
DATE OF MEETING:

May 23, 2022
Date: April 29, 2022
TO: Finance Committee
David Wright, Chair
Rosa Escutia-Braaton, Vice-Chair
Alternate Member
THROUGH: Joseph P. Lopez, City Manager
FROM: Bill Sandhu, Public Works Director
SUBJECT: Accept “SB 1383 Collection Program and Compliance Options” Developed by R3 Consulting Group, Inc.

CONTACT: Rosene Salmo, Integrated Waste Program Manager [email protected] (209) 577-5453
DESCRIPTION:

Consider accepting “SB 1383 Collection Program and Compliance Options” report, accepting the recommended waste collection method therein, and forwarding to Council for approval. (Funding Source: Solid Waste Fund, Compost Fund)
STRATEGIC PLAN ELEMENT:

The recommended action is consistent with the Council’s Strategic Plan Area- Quality of Life:
“Engage partners across the community to ensure the safety, resilience, and attractiveness of Modesto;” Goal D: “Provide safe, efficient, and reliable infrastructure through proactive community investment, maintenance, and sustainability efforts.” BACKGROUND:

In September 2016, Governor Brown signed the Short-Lived Climate Pollution Reduction Act Senate Bill (SB 1383)1 into law, establishing emission reduction targets statewide by reducing organic waste to landfill by 75% and recovering 20% of edible food waste for human consumption by 2025. SB 1383 outlines extremely ambitious targets and specific details for implementation, monitoring, and documentation. As of 2022, the Department of Resources Recycling and Recovery (CalRecycle) monitors implementation and compliance with the following areas of SB 1383:
 Identifying, educating, and monitoring edible food generators and edible food recovery programs
1 https://www.calrecycle.ca.gov/organics/slcp
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Finance Committee, May 23, 2022
Accept “SB 1383 Collection Program and Compliance Options” Developed by R3 Consulting Group, Inc.

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 Residential and commercial organic collection services  Processing, sorting, and recycling of organic waste
 Procurement of recycled paper content products by the City and vendors  Donation of material produced at the City’s Composting Facility in compliance with a citywide organic procurement target
 Inspections and enforcement related to organic collection and recycling  Public education and outreach
On June 22, 2021, by Resolution 2021-227, Council approved an agreement with R3 Consulting Group, Inc. to provide a gap analysis between the City’s solid waste program and SB 1383 mandates and recommendations for future action to ensure compliance.

DISCUSSION:

The City chose to coordinate with an independent consultant with expertise in implementing SB1383 requirements in lieu of developing a compliance plan internally, because SB 1383 mandates could lead to significant changes in waste collection, waste processing, administrative responsibilities, and cost of service. Including an independent consultant in this process ensures that the City receives an impartial recommendation for changes resulting from the State’s unfunded mandate that will impact Modesto’s residents and businesses.

R3 Consulting Group, Inc. has provided the attached report, “SB 1383 Collection Program and Compliance Options” detailing their analysis. The report includes the following collection options:

Option A: Two-container collection program, with a 96-gallon organic container that accepts yard, food, and paper waste, and a 96-gallon trash container that accepts other household trash. Commercial accounts would have the option of having a single bin that is sorted postcollection, or a designated organics bin, if they produce more than two yards of organic waste.

Note: two-container system requires a high diversion material recovering facility (MRF). The City does not have a MRF and the estimated cost to build a high diversion facility is between $50 million and $100 million.

Option B (preferred): Three-container collection program, with a 96-gallon organic container that accepts yard, food, and paper waste, a 96-gallon recycling container that accepts glass, some metals and plastics, and clean recyclable paper, and a 96-gallon trash container that accepts other household trash. The trash container would be serviced weekly, and the recycling and organic containers would be serviced bi-weekly. Commercial accounts that produce organic waste or recyclables would need another commercial bin or, in some cases where less waste is produced, would need a 96-gallon organic and/or recyclable container.

Note: the bi-weekly Organic container collection will occur on a one-year pilot program. Biweekly organics collection might cause the following issues: Odor, bugs problems, overfilled containers, and cross contamination issues.

Option C: Three-container collection program, with a 96-gallon organic container that accepts yard, food, and paper waste, a 96-gallon recycling container that accepts glass, some metals and plastics, and clean recyclable paper, and a 96-gallon trash container that accepts other household trash. The trash and organic containers would be serviced weekly, and the recycling container would be serviced bi-weekly. Commercial accounts that produce organic waste or #8..
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Finance Committee, May 23, 2022
Accept “SB 1383 Collection Program and Compliance Options” Developed by R3 Consulting Group, Inc.

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recyclables would need another commercial bin or, in some cases where less waste is produced, would need a 96-gallon organic or recyclable container.

Note: this option is preferred by both haulers.

Option D: Three-container collection program, with a 96-gallon organic container that accepts yard, food, and paper waste, a 96-gallon recycling container that accepts glass, some metals and plastics, and clean recyclable paper, and a 96-gallon trash container that accepts other household trash. All containers would be serviced weekly. Commercial accounts that produce organic waste or recyclables would need another commercial bin or, in some cases where less waste is produced, would need a 96-gallon organic or recyclable container.

SURVEY RESULTS:

City staff posted a Solid Waste and Collection Services Survey on the City’s website. The survey ran for three weeks (3/8/2022 to 3/29/2022). The Survey was sent directly via email to different associations within the cities, and it was posted on several social media outlets (Facebook, Instagram, Twitter, Next Door, and LinkedIn). The results of the survey are shown below:

Residents 843
Businesses 9
Multi Family 20
Total Responses 872
FISCAL IMPACT:

Accepting R3’s report and recommended waste collection method would coincide with a future rate increase for both residential and commercial garbage service. Originally, staff and R3 recommended option C (Bi-weekly Blue pickup). However, as a result of the survey feedback, 54% of residents favored Options B (Bi-weekly Green and Blue pickup). Therefore, staff recommends proceeding with Option B as a one-year pilot study for the bi-weekly green can collection. Proceeding with this option would necessitate a 36.85% increase in the residential rate.

This increase would fund the collection method change, as well as programs required by SB 1383 as detailed in the “SB 1383 Collection Program and Compliance Options,”. This includes:
education and outreach conducted, organic waste processing to remove contamination, #8..
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Finance Committee, May 23, 2022
Accept “SB 1383 Collection Program and Compliance Options” Developed by R3 Consulting Group, Inc.

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required improvements to the City’s Compost Facility, inspections and route reviews, enforcement programs for contamination or noncompliance, and food recovery programs.

Table below shows rates adjustment schedule for option B and C:

Option B (preferred):

Residential
Three-Container (BiWeekly Green and BiWeekly Blue)
Option C: Residential
Three-Container (BiWeekly Blue)
Current Rate $37.45 $37.45
Total Estimated Rate Increase $13.80 $16.79
Estimated July 1, 2022 Rate $45.85 $45.85
Rate Increase $ 8.40 $ 8.40
Estimated January 1, 2023 Rate $51.25 $54.24
Rate Increase $ 5.40 $ 8.39
Estimated Percentage Increase 36.85% 44.83%
Staff reviewed fiscal year (FY) 20/21 audited financial for both haulers. Based on the haulers data; the base rate will be increased by $3.60 for residential accounts, $1.39 for commercial accounts, and $8.05 for industrial accounts.

Additionally, the Haulers will receive a fuel rate adjustment of $0.33 for the residential accounts and $0.47 for the commercial accounts. To calculate the residential fuel component, a factor of

0.27 gallons of diesel fuel per residence per month was used, and for the commercial fuel component, a factor of 0.078 gallons of diesel fuel per cubic yard was used. For this rate review, the average diesel fuel prices from July 1, 2021 to March 30, 2022 were analyzed, and staff recommends a fuel adjustment for both residential and commercial maximum rates based on the prices of diesel fuel during that time period.

The tables below show how the rate adjustment will be distributed to the different programs:
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Finance Committee, May 23, 2022
Accept “SB 1383 Collection Program and Compliance Options” Developed by R3 Consulting Group, Inc.

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Table 1a: Residential Rate Adjustment for option B: 3-Container Program- Bi-weekly Organics and Recycling
Current Adjustment
07/01/22
Adjustment
01/01/23
Contractual Agreement
 Base Rate $ 31.13
 Base Rate Adjustment $ 3.60
 Fuel Rate Adjustment $ 0.33
SB 1383 Fees
 Compost Fee $ 1.70
 SB 1383 Collection Fee $ 5.40
 Organic Waste Pre-Processing $ 1.72
 City Implementation (Route Review,
Education and Outreach, Enforcement, etc.)
$ 1.05
No Additional Changes
 Recycling Fees $ 0.46
 Green Waste $ 5.01
 Carpenter Road $ 0.70
 Geer Road $ 0.15
Total Increase $ 8.40 $ 5.40
Total Residential Garbage Rate $ 37.45 $ 45.85 $ 51.25
Percent Increase 22.43% 14.42%
Table 1b: Commercial Rate Adjustment for option B: 3-Container Program- Bi-weekly Organics and Recycling
Current Adjustment
07/01/22
Adjustment
01/01/23
Contractual Agreement
 Base Rate $ 41.53
 Base Rate Adjustment $ 1.39
 Fuel Rate Adjustment $ 0.47
SB 1383 Fees
 Compost Fee $ 3.08
 Organic Waste Pre-Processing $ 3.11
 City Implementation (Route Review,
Education and Outreach, Enforcement, etc.)
$ 1.90
No Additional Changes
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Finance Committee, May 23, 2022
Accept “SB 1383 Collection Program and Compliance Options” Developed by R3 Consulting Group, Inc.

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 Recycling Fees $ 0.63
 Green Waste $10.18
 Litter Abatement $ 0.59
 Carpenter Road $ 0.95
 Geer Road $ 0.21
Total Proposed Increase $ 9.95 $0 *
Total Commercial Garbage Rate $ 54.09 $64.04 $64.04
Percent Increase 18.40% Varies *
*Commercial Customers who do not qualify for waivers will need to have either the organics and/or recycling cart service at an additional cost of $25.00 per cart per month.

Table 2a: Residential Rate Adjustment for option C: 3-Container Program- Bi-weekly Recycling Current Adjustment
07/01/22
Adjustment
01/01/23
Contractual Agreement
 Base Rate $ 31.13
 Base Rate Adjustment $ 3.60
 Fuel Rate Adjustment $ 0.33
SB 1383 Fees
 Compost Fee $ 1.70
 SB 1383 Collection Fee $ 8.39
 Organic Waste Pre-Processing $ 1.72
 City Implementation (Route Review,
Education and Outreach, Enforcement, etc.)
$ 1.05
No Additional Changes
 Recycling Fees $ 0.46
 Green Waste $ 5.01
 Carpenter Road $ 0.70
 Geer Road $ 0.15
Total Increase $ 8.40 $ 8.39
Total Residential Garbage Rate $ 37.45 $45.85 $54.24
Percent Increase 22.43% 22.40%
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Finance Committee, May 23, 2022
Accept “SB 1383 Collection Program and Compliance Options” Developed by R3 Consulting Group, Inc.

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Table 2b: Commercial Rate Adjustment for option B: 3-Container Program- Bi-weekly Recycling Current Adjustment
07/01/22
Adjustment
01/01/23
Contractual Agreement
 Base Rate $41.53
 Base Rate Adjustment $ 1.39
 Fuel Rate Adjustment $ 0.47
SB 1383 Fees
 Compost Fee $ 3.08
 Organic Waste Pre-Processing $ 3.11
 City Implementation (Route Review,
Education and Outreach, Enforcement, etc.)
$ 1.90
No Additional Changes
 Recycling Fees $ 0.63
 Green Waste $10.18
 Litter Abatement $ 0.59
 Carpenter Road $ 0.95
 Geer Road $ 0.21
Total Proposed Increase $ 9.95 $0 *
Total Commercial Garbage Rate $54.09 $64.04 $64.04
Percent Increase 18.40% Varies *
*Commercial Customers who do not qualify for waivers will need to have either the organics and/or recycling cart service at an additional cost of $25.00 per cart per month. #8..
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Finance Committee, May 23, 2022
Accept “SB 1383 Collection Program and Compliance Options” Developed by R3 Consulting Group, Inc.

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Industrial Drop Box/Roll-Off Compactors Maximum Rate Recommendation The maximum rates for industrial drop boxes and roll-off compactors are set for the pick-up charge and daily rental rate only. The actual disposal charge is negotiated directly between the garbage company and the customer. These services are open to competition between the two authorized collection companies in the City. The current maximum rate per pick-up is $431.19.

Based on the cost structure of the lowest cost hauler utilizing the FY 20/21 audited financial statements and the rate analysis conducted by staff, a $8.05 increase in the base rate per pickup is recommended. The new rate would be $439.24 per pick-up, to be effective July 1, 2022.

The new rate structure is listed in the table below.

Approved by:

Bill Sandhu, Public Works Director
Joseph P. Lopez, City Manager
Attachments:

1. R3 Final Draft report

2. R3 Letter Final Draft Cost Estimates
Base Rate $383.21
Recycling Fee $ 19.71
Carpenter Rd Landfill Fee $ 29.77
Geer Rd Landfill Fee $ 6.55
Total Maximum Rate $439.24
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April 29, 2022
Mr. Bill Sandhu, Public Works Director
City of Modesto
1010 10th Street, Modesto, CA 95354
submitted via email: [email protected]
SUBJECT: Final Draft SB 1383 Collection Program Cost Estimates Dear Mr. Sandhu,
R3 Consulting Group Inc. (R3) is engaged by the City of Modesto (City) to provide analysis regarding the City’s compliance with SB 1383, included the estimated costs for implementing a three-container organic waste collection program.

At the direction of the City’s Council Finance Committee, R3, City staff, and representatives from the City’s two haulers – Gilton Solid Waste (GSW) and Bertolotti – met on April 15, 21 and 27 to discuss, refine and agree on estimated costs to be used for the purposes of setting solid waste rates to implement required programs to comply with SB 1383. In conjunction with those meetings, GSW and Bertolotti provided clarified costs estimates which R3 analyzed. The results of the analysis, which was shared and discussed with City staff and the haulers, is presented below.

Residential Cost Estimates
Table 1: Estimated New Monthly Costs per Residential Customer Updated Option B:

Bi-Weekly Collection
of Green and Blue
Updated Option C:

Weekly Collection of
Green and Bi-Weekly
Collection of Blue
Collection Program Costs $5.40 $8.39
Organic Waste Pre-Processing Costs $1.72 $1.72
Compost Facility Upgrades $1.70 $1.70
SB 1383 Implementation Costs $1.05 $1.05
Total New Costs $9.87 $12.85
Estimates for collection program costs and organic waste pre-processing costs both increased in comparison to prior estimates, which was a result of the haulers providing updates and clarifications to prior estimates. Additionally, prior estimates for hauler SB 1383 programs and services have been combined with City SB 1383 implementation costs due to clarification that City staff will be conducting SB 1383 contamination monitoring activities. R3, City staff and the #8..
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Clarification on SB 1383 Two-Container Collection Program Cost Estimates Mr. Bill Sandhu
April 29, 2022

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1512 Eureka Road, Suite 220, Roseville, CA 95661 | p 916.782.7821 | f 916.782.7824 | www.r3cgi.com haulers concur with the accuracy and adequacy of these estimates for the purposes of setting residential customer rates.

For rates effective July 1, 2022, the organic waste pre-processing, compost facility upgrades, and SB 1383 implementation cost items (totaling $4.47 per month) could be applied to begin funding those activities. This would be in addition other rate adjustments that the City may make (e.g., base rate adjustment and fuel rate adjustment). The collection program cost ($5.40 per month for Option B or $8.39 per month for Option C) would become effective January 1, 2023 (or another date selected by the City in accordance with the start date for the new collection program.

Commercial Cost Estimates
Green Container Collection via Large “Detachable Containers” Commercial customers can already subscribe to green organics container collection service at the “detachable container” rates set by the City. Those rates will need to be adjusted to include costs for organic waste pre-processing, compost facility upgrades, and SB 1383 implementation. R3 calculated these costs for a 1 cubic yard container (shown in Table 2). The amounts shown in Table 2 were derived based on the residential 96-gallon monthly costs from Table 1 and proportionately scaled given the larger 1 cubic yard volume (174 dry gallons).

Table 2: Estimated New Monthly Costs per Commercial Cubic Yard Organic Waste Pre-Processing Costs $3.11
Compost Facility Upgrades $3.08
SB 1383 Implementation Costs $1.90
For example, the residential 96-gallon compost facility upgrade monthly cost of $1.70 per month, divided by 96-gallons, times 174 gallons per cubic yard, yields a commercial “detachable container” cost of $3.08 per month. The costs for organic waste pre-processing and SB 1383 implementation costs were also proportionately scaled in this same way. The costs shown in Table 2 would be effective July 1, 2022 and would be in addition other rate adjustments (e.g., base rate adjustment and fuel rate adjustment) that the City may make. The costs shown in Table 2 are the same for both Options B and C because they are not affected by collection option. These costs have been reviewed by the City and the haulers.

Blue and Green Container Collection via 96-Gallon Carts The City and haulers have discussed other green and blue container collection options, and have agreed that organic waste generating customers (those not eligible for a “de minimus” waiver from the City) that cannot accommodate or do not need the larger commercial green “detachable containers” for organic waste will be provided 96-gallon green container collection service at a cost of $12.50 per month for Option B (bi-weekly green container collection) or $25.00 per month for Option C (weekly green container collection). #8..
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Clarification on SB 1383 Two-Container Collection Program Cost Estimates Mr. Bill Sandhu
April 29, 2022

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1512 Eureka Road, Suite 220, Roseville, CA 95661 | p 916.782.7821 | f 916.782.7824 | www.r3cgi.com Likewise, commercial customers that generate blue container organic waste and/or recyclables (and are not eligible for waivers) will be provided 96-gallon blue containers at a cost of $12.50 per month. R3 has reviewed the cost estimate for the proposed green and blue 96-gallon container commercial collection service provided by the haulers and finds the proposed cost to be reasonable and consistent with industry standards. The minimum total additional costs for a commercial customer subscribed to 2 cubic yards of weekly garbage service are shown in Table

3. Costs shown are prior to other rate adjustments (e.g., base rate adjustment and fuel rate adjustment) that the City may make.

Table 3: Estimated New Monthly Costs for Commercial Customer Subscribed to 2 Cubic Yards of Garbage
Updated Option B:

Bi-Weekly Collection
of Green and Blue
Updated Option C:

Weekly Collection of
Green and Bi-Weekly
Collection of Blue
Organic Waste Pre-Processing (2x 1 cy costs) $6.22 $6.22 Compost Facility Upgrades (2x 1 cy costs) $6.16 $6.16
SB 1383 Implementation (2x 1 cy costs) $3.81 $3.81
96-gallon Blue Recycling Container $12.50 $12.50
96-gallon Green Organics Container $12.50 $25.00
Total New Costs $41.19 $53.69
It should be noted that commercial customers that are subscribed to more than 2 cubic yards of weekly garbage service may be able to reduce their garbage service needs with the addition of new green and blue container collection services, thus reducing the overall increase in monthly costs. Additionally, commercial customers that do not generate organic waste and/or do not have space to accommodate additional containers are eligible for City-issued waivers from SB 1383’s requirements, and thus would not need to pay for additional blue or green container service.

Sincerely,
Garth Schultz | Principal
R3 Consulting Group, Inc.
510.292.0853 | [email protected]
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CITY OF MODESTO

COMMITTEE AGENDA REPORT
DATE OF MEETING:

May 23, 2022
Date: April 25,2022
TO: Finance Committee
David Wright, Chair
Rosa Escutia-Braaton, Vice-Chair
Alternate Member
THROUGH: Joseph P. Lopez, City Manager
FROM: Christina Alger, Director of Human Resources
SUBJECT: Award of Agreement for Workers’ Compensation Claims Management CONTACT: Joe Rodriguez, Risk Manager, [email protected], 209-577-5446 DESCRIPTION:

Consider approving the Award of Proposal and Agreement for Workers’ Compensation Claims Management Services to Athens Administrators, Inc., Concord, California, for a two-year Agreement with three, one-year extension options, for an estimated annual amount of $480,430 and a total amount not to exceed $2,511,820 over five years; and forwarding to Council for approval. (Funding Source: Workers’ Compensation Fund)
STRATEGIC PLAN ELEMENT:

This item supports the 2020-2025 Strategic Plan’s Governance and Service Delivery Goals & Strategies – Achieve Financial Sustainability by applying private and public sector best practice financial strategies relative to workers’ compensation claims.

BACKGROUND:

Since 1979, the City of Modesto has been permissibly self-insured for workers’ compensation claim liabilities under a self-insurance certificate issued by the State of California’s Office of Self-Insured Plans. The City’s Workers’ Compensation Fund operates on a budget of around $7,000,000 annually, covering the cost of claims administration, medical, legal, and indemnity payments, as well as excess insurance. The City purchases excess insurance for workers’ compensation liabilities through Public Risk Innovation, Solutions, & Management (PRISM) with a self-insured retention of $750,000. All claim costs below that threshold are the responsibility of the City.

In 2009, the City conducted a request for proposals (RFP) to determine whether it would be more effective to continue self-administering claims, which was not the norm for public entities, or to switch to the more common third-party administrator (TPA) model. Following the RFP, in #9..
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2010, the Risk Management Division made the recommendation to switch to a TPA model due to the high caseloads of the City’s internal claims examiners, lack of compliance with State reporting requirements, and the potential cost savings of more effective claims management.

The City has been administered by a TPA since then and has seen significant improvements in key program metrics including the overall number of open claims. The City’s Workers’ Compensation Program is currently administered by Innovative Claims Solutions, Inc., of San Ramon, California.

On July 12, 2016, by Resolution No. 2016-296, Council approved the award of proposal and contract for the furnishing of workers’ compensation TPA services to Innovative Claims Solutions for a term of two years, with three optional one-year extension options. On August 10, 2021, by Resolution No. 2021-321, Council approved an extension of that agreement through September 1, 2022 to allow staff time to complete a Request for Proposals (RFP) to renew or replace the existing agreement without a significant service disruption.

The current Agreement No 105138 is set to expire August 31, 2022.

DISCUSSION:

With the current agreement approaching the end of its term, the City Manager authorized the Purchasing Manager to issue a formal Request for Proposals (RFP) for the furnishing of workers’ compensation claims management services.

On November 16, 2021, the Purchasing Division issued RFP 2021-44, Workers’ Compensation Claims Management Program, on Planet Bids via the City’s website under two commodity codes1. Prospective proposers were notified online and via email of the bid opportunity. Twenty companies chose to download the RFP document.

On December 28, 2021, proposals were formally opened by the City Clerk and broadcast via Microsoft Teams Livestream2. Six companies chose to respond, none of which were local companies. All six (6) companies provided responsive and responsible proposals.

An evaluation committee comprised of three (3) City staff members evaluated and graded the proposals.

Based on being ranked highest in total evaluation criteria, the evaluation committee recommends the award of proposal and agreement for the furnishing of workers’ compensation claims management program, to Athens Administrators, Inc., Concord, CA.

Athens Administrators has been providing claims services to public entities in California for over 45 years, and their proposal and presentation demonstrated that they would be the best-suited company to administer the City’s workers’ compensation claims. As a mid-size California TPA, Athens applies their core values of Commitment to Service, Commitment to Results, Honesty and Integrity, and a Caring Family Culture to the day-to-day administration of the $2.5 billion in claims liabilities they handle for their clients. Their philosophy is building strong, long-term partnerships that provide the highest levels of claims administration services for their clients. 1 95300 – Insurance and Insurance Services, (All Types), 95861 – Insurance and Risk Management Services. 2 Staff implemented a virtual bid opening in an effort to slow the spread of COVID-19. #9..
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On the technical side, the City was looking for a TPA that would be able to maximize communication with injured workers to reinforce the sense that they are being taken care of and that their medical treatment matters. Athens demonstrated resources that would help the City achieve that, including a web portal and a mobile app for injured workers to view information and status of their claims. Athens also uses automated text message notifications as a way to reinforce, but not replace, person-to-person contact with injured workers.

Another important aspect of the TPA’s role in the claims process is managing third-party claims services including nurse case management, bill review, utilization review, and more.

Collectively, these services are known as managed care services. Athens features its own Managed Care Unit with in-house staff able to coordinate or directly provide those services.

Services that are currently outsourced, such as telephonic injury reporting, will be brought under the Athens Managed Care Unit, giving the City better oversight and control over the level of service provided. Because these services are in-house, they are also directly connected to Athens Claims Management Information System, which allows for near real-time updates to individual claim files. We estimate that the transition to Athens’ in-house managed care services could save the City up to $130,000 per year on claim payments.

The current job market for claims examiners in California is as tough as in any other industry.

TPAs across the state are struggling to recruit and retain examiners with the claims knowledge, skills, and abilities to meet the needs of their clients. Athens Administrators sets themselves apart in the field by investing in their employees’ welfare, making them a “Best Place to Work” in the San Francisco Bay Area 13 times since 2005. Athens’ claims examiners in turn take care of their clients, resulting in a 98% client retention rate over the last five years.

Modesto Municipal Code Section 8-3.203 generally requires all purchases, which meet or exceed $50,000 for material, equipment or contractual services to be formally bid. The award of proposal and contract for workers’ compensation claims management services to Athens Administrators, Inc., Anaheim, CA, conforms to the Modesto Municipal Code because the City complied with the formal bid procedures and Athens Administrators, Inc was the most responsive and responsible proposer.

FISCAL IMPACT:

Funds for these services are already budgeted in the Workers’ Compensation Fund for FY21/22. It is estimated that all costs of the agreement for the full term will be absorbed by the Workers’ Compensation Fund, specifically accounting string 5320-17320-53300. Expenses for these services for the last five years are provided below.

Year Amount Spent
FY16/17 $324,715.06
FY17/18 $553,280.46
FY18/19 $570,863.36
FY19/20 $583,560.34
FY20/21 $595,522.00
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Approved by:

Christina Alger, Director of Human Resources
Joseph P. Lopez, City Manager
Attachments:

1. Athens Administrators Inc., Agreement

2. RFP 2021-44 Workers Compensation Claims Management Services

3. Financial Interest Disclosure

4. Athens Bid Submittal

5. Scoring Abstract for RFP No. 2021-44
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STANDARD CONSULTANT SERVICES AGREEMENT NO. 223388
FOR WORKERS’ COMPENSATION CLAIMS MANAGEMENT PROGRAM
ATHENS ADMINISTRATORS, INC.

THIS AGREEMENT, made and entered into in the City of Modesto, State of California, this day of 2022 (“Effective Date”), by and between the CITY OF MODESTO, a municipal corporation of the State of California, hereinafter referred to as "City", and Athens Insurance Services Inc. (DBA Athens Administrators), a California S Corporation, hereinafter referred to as "Consultant."
This Agreement is made with regard to the following recitals:

A. The City has determined that a Workers’ Compensation Claims Management Program is needed to process claims for the City.

B. Consultant represents that it is qualified, willing and able to provide the services to prepare said document(s).

NOW, THEREFORE, in consideration of this agreement, and the mutual promises, covenants, and stipulations hereinafter contained, the parties agree as follows:

1. SCOPE OF SERVICES.

Consultant shall undertake and complete the preparation of the scope of work as set forth and described in the RFP 2021-44 documents attached hereto and referred to as Exhibit "A" or "project". The Consultant shall perform the services as described in Exhibit "A" in a manner compatible with the standards of its profession, and shall produce a fully complete project that is acceptable to City.

2. TERM OF AGREEMENT.

This agreement is effective for a term date of September 1, 2022 to August 31, 2024, with the option to extend on an annual basis for up to three (3) additional years and will continue in effect until City's acceptance of and payment for all services authorized by City #9..
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and performed by Consultant, unless terminated earlier in accordance with the provisions of the termination clause in this agreement.

3. COMPENSATION.

Consultant agrees to accept an estimated annual amount of $480,430 during each agreement term, and not to exceed a combined amount of two million five hundred eleven thousand eight hundred twenty and 00/100 DOLLARS ($2,511,820.00) as full remuneration for performing all services and furnishing all staffing and materials called for in Exhibit "A" and for performance by Consultant of all of its duties and obligations under this agreement excluding managed care services provided by Consultant.

The Compensation shall be paid pursuant in the manner and at the rates set forth below:

All work to be performed under this agreement shall be billed at the rates set forth in Exhibit “B” attached hereto, Consultant shall submit monthly invoices to City which include detailed tasks, hours worked, and billable rates for all work completed, and detailed receipts for any out-of-pocket, reimbursable costs paid by Consultant in connection with work performed on this project.

4. OBLIGATIONS OF CONSULTANT.

Throughout the term of this agreement, Consultant shall possess, or secure all licenses, permits, qualifications and approvals legally required to conduct business.

Consultant warrants that it has all of the necessary professional capabilities and experience, as well as all tools, instrumentalities, facilities and other resources necessary to provide the City with the services contemplated by this agreement. Consultant further warrants that it will follow the best current, generally accepted and professional practices to make findings, render opinions, prepare factual presentations, and provide professional advice and recommendations regarding this project.
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5. PERFORMANCE BY KEY EMPLOYEE.

Consultant has represented to City that James Jenkins, President will be the person primarily responsible for the performance of the services referred to in this agreement.

City has entered into this agreement in reliance on that representation by Consultant.

6. OWNERSHIP OF DOCUMENTS/TITLE TO DATA.

Ownership of Documents
All reports, drawings, designs, graphics, working papers and other incidental work or materials furnished hereunder shall become and remain the property of the City, and may be used by City as it may require without any additional cost to City. No reports shall be used by the Consultant for purposes other than this agreement without the express prior written consent of City.

Title to Data
If, as a part of the agreement, Consultant is required to produce data such as, but not limited to, drawings, plans, specifications, calculations, models, flow diagrams, visual aids and other related materials, the originals of all such data generated under this agreement will be delivered to City upon the completion or termination of services under the agreement.

All materials, documents, data or information obtained from the City data files or any City medium furnished to Consultant in the performance of this agreement will at all times remain the property of the City. Such data or information may not be used or copied for direct or indirect use by Consultant after termination of this agreement without written consent of the City.

7. NEWS AND INFORMATION RELEASE.

Consultant agrees that it will not issue any news releases in connection with either the award of this agreement, or any subsequent amendment of or efforts under this #9..
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agreement, without first obtaining review and approval of said news releases from City through the City Manager.

8. INTEREST OF CONTRACTOR.

Consultant warrants that it presently has no interest and shall not acquire any interest, direct or indirect, which would conflict in any manner or degree with the performance of services required to be performed under this agreement. Consultant warrants that, in performance of this agreement, Consultant shall not employ any person having any such interest. Consultant agrees to file a Statement of Economic Interests with the City Clerk at the start and end of this agreement if so required at the option of City.

9. AMENDMENTS.

Both parties to this agreement understand that it may become desirable or necessary during the execution of this agreement, for City or Consultant to modify the scope of services provided for under this agreement. Any material extension or change in the scope of work shall be discussed with City and the change and cost shall be memorialized in a written amendment to the original agreement prior to the performance of the additional work.

Until a change order is so executed, City will not be responsible to pay any charges Consultant may incur in performing such additional services, and Consultant shall not be required to perform any such additional services.

10. INDEPENDENT CONTRACTOR.

All acts of Consultant, its agents, officers, and employees and all others acting on behalf of Consultant relating to the performance of this agreement, shall be performed as independent contractors and not as agents, officers, or employees of City. Consultant, by virtue of this agreement, has no authority to bind or incur any obligation on behalf of City.

Consultant has no authority or responsibility to exercise any rights or power vested in the City. #9..
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No agent, officer, or employee of the City is to be considered an employee of Consultant. It is understood by both Consultant and City that this agreement shall not under any circumstances be construed or considered to create an employer-employee relationship or a joint venture.

Consultant, its agents, officers and employees are and, at all times during the terms of this agreement, shall represent and conduct themselves as independent contractors and not as employees of City.

Consultant shall determine the method, details and means of performing the work and services to be provided by Consultant under this agreement. Consultant shall be responsible to City only for the requirements and results specified in this agreement, and, except as expressly provided in this agreement, shall not be subjected to City's control with respect to the physical action or activities of the Consultant in fulfillment of this agreement. Consultant has control over the manner and means of performing the services under this agreement. Consultant is permitted to provide services to others during the same period service is provided to City under this agreement. If necessary, Consultant has the responsibility for employing other persons or firms to assist Consultant in fulfilling the terms and obligations under this agreement.

If in the performance of this agreement any third persons are employed by Consultant, such persons shall be entirely and exclusively under the direction, supervision, and control of Consultant. All terms of employment including hours, wages, working conditions, discipline, hiring, and discharging or any other term of employment or requirement of law shall be determined by the Consultant.

It is understood and agreed that as an independent contractor and not an employee of City neither the Consultant or Consultant's assigned personnel shall have any entitlement as a City employee, right to act on behalf of the City in any capacity whatsoever as an agent, or to bind the City to any obligation whatsoever. #9..
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It is further understood and agreed that Consultant must issue W-2 forms or other forms as required by law for income and employment tax purposes for all of Consultant's personnel.

As an independent contractor, Consultant hereby indemnifies and holds City harmless from any and all claims that may be made against City based upon any contention by any third-party that an employer-employee relationship exists by reason of this agreement.

11. ASSIGNMENT.

Neither this agreement nor any portion thereof shall be subcontracted or assigned without the express prior written consent of the City in each and every instance.

12. PATENT/COPYRIGHT MATERIALS.

Unless otherwise expressly provided in the agreement, Consultant shall be solely responsible for obtaining the right to use any patented or copyrighted materials in the performance of this agreement. Consultant shall furnish a warranty of such right to use to City at the request of City.

13. NOTICES.

Any and all notices permitted or required to be given hereunder shall be deemed duly given and effective (a) upon actual delivery, if delivery is by hand; or (b) five (5) days after delivery into the United States mail if delivery is by postage paid registered or certified (return receipt requested) mail. Each such notice shall be sent to the parties at the address respectively indicated below or to any other address as the respective parties may designate from time to time.

FOR Consultant: Name: Athens Administrators, Inc.

Address: P.O. Box 696
Concord, CA 94522
Attention: James Jenkins, President
Phone: (925) 826-1100
Email: [email protected]
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FOR CITY: Name: City of Modesto
Address: P.O. Box 642
Modesto, CA 95354
Attention: Christina Alger
Phone: (209) 571-5126
Email: [email protected]

14. INSURANCE REQUIREMENTS.

The Consultant shall provide at its own expense and maintain at all times the following insurance with insurance companies licensed in the State of California and shall provide evidence of such insurance to the City as may be required by the Risk Manager of the City. The policies or certificates thereof shall provide that, thirty (30) days prior to cancellation or material change in the policy, notices of same shall be given to the Risk Manager of the City via PINS Advantage Insurance Program, for all of the following stated insurance policies. (a) General Liability insurance with a minimum limit of liability per occurrence of $1,000,000 for bodily injury and property damage. This insurance shall indicate on the certificate of insurance the following coverages and indicate the policy aggregate limit applying to: premises and operations; broad form contractual; independent consultants and subconsultants; products and completed operations; and/or professional liability. (b) Automobile Liability insurance with a minimum limit of liability per occurrence of $1,000,000 for bodily injury and property damage. This insurance shall cover any automobile for bodily injury and property damage.
(c) Worker's Compensation - in compliance with the statutes of the State of California, plus employer's liability with a minimum limit of liability of $1,000,000. (d) Professional Liability (Errors and Omissions) Insurance with a minimum limit of $1,000,000 per claim, $2,000,000 policy aggregate. If coverage is on a claim made basis it shall be maintained for at least three (3) years following completion of the work. #9..
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If at any time any of said policies shall be unsatisfactory to the City, as to form or substance, or if a company issuing such policy shall be unsatisfactory to the City, the Consultant shall promptly obtain a new policy, submit the same to the Risk Management via PINS for approval and submit a certificate thereof as hereinabove provided. Upon failure of the Consultant to furnish, deliver or maintain such insurance and certificates as above provided, this Agreement, at the election of the City, may be forthwith declared suspended or terminated.

Failure of the Consultant to obtain and/or maintain any required insurance shall not relieve the Consultant from any liability under this agreement, nor shall the insurance requirements be construed to conflict with or otherwise limit the obligations of the Consultant concerning indemnification. The City, its agents, officers, employees, and volunteers shall be named as an additional insured on all insurance policies required herein, except Workers' Compensation and Professional Liability. Consultant shall provide City with separate endorsements evidencing proof of the City’s additional insured status as to both the general liability and automobile liability insurance policies. The Workers' Compensation insurer shall agree to waive all rights of subrogation against the City, its agents, officers, employees, and volunteers for losses arising from work performed by Consultant for the City. In addition, Consultant shall provide City with a Workers Compensation subrogation waiver by way of a separate endorsement. The Consultant's insurance policy(es) shall include a provision that the coverage is primary as respects the City; shall include no special limitations to coverage provided to additional insured; and, shall be placed with insurer(s) with acceptable Best's rating of A: VII or with approval of the Risk Manager. The Consultant must deliver certificates evidencing existence of the insurance listed above to the City prior to the time the agreement is signed.

All endorsements referenced above must include the applicable policy number.

15. TERMINATION OF AGREEMENT.
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Termination by Either Party
Either party, with ninety (90) days notice can terminate this agreement with prior written notice to the designated contacts listed in this agreement.

Termination by City for Default of Consultant
Should Consultant default in the performance of this agreement or materially breach any of its provisions, at its option, City may terminate this agreement by giving written notification to Consultant. The termination date shall be the effective date of the notice.

For the purposes of this section, material breach of this agreement shall include, but not be limited to, any of the following: failure to perform required services or duties, willful destruction of City's property by Consultant, dishonesty or theft.

Termination by City for Convenience
The City may also terminate the Consultant's performance under the agreement, either in whole or in part, at its own discretion, or when conditions encountered during the work make it impossible or impracticable to proceed, or when the City is prevented from proceeding with the agreement by act of God, by law, or by official action of a public authority, or upon a determination by the City that such termination is in the best interest and convenience of the City, or whenever the City is prohibited from completing the work for any reason. The City shall provide no less than ten (10) calendar days written notice of its intent to terminate the agreement for convenience, and shall endeavor to provide the Consultant with consultation with the City prior to termination.

Termination by City for Lack of Budgeted Funds
The City may terminate this agreement effective July 1 of any given year upon the City's determination to not appropriate sufficient funds for this agreement for the ensuing fiscal year. In such event City shall give Consultant not less than 30 days written notice of termination.

Termination by City for Change of Consultant's Tax Status #9..
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If City determines that Consultant does not meet the requirements of federal and state tax laws for independent contractor status, City may terminate this agreement by giving written notice to Consultant. The termination date shall be the effective date of the notice.

Post-Termination Procedures
If this agreement is terminated pursuant to this Section, Consultant shall:

1. Cease its work as directed in the notice of termination as of the termination date and see to it that its employees, sub-consultants and agents are notified of such termination and act as specified in the notice of termination;

2. Terminate all orders and sub-consultants except as necessary to complete any portion of the work that is not terminated;

3. If directed in writing by the City to do so, assign all right, title and interest in sub-contracts and materials in progress to City, in which case the City will have the right at its discretion to settle, or pay any or all claims arising out of the termination of such sub-consultants, but in no event shall recovery by any Consultant or sub-consultant include lost profits for portions of the work not completed or undertaken, including materials not delivered;

4. Deliver or otherwise make available to the City all data, drawings, specifications, reports, estimates, summaries and such other information and material as may have been accumulated by the Consultant in performing the work whether completed or in process;

5. Settle outstanding liabilities and claims, subject to the approval of #9..
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City and Consultant;

6. Complete performance of such part of the work as has not been terminated;

7. Take such other actions as may be necessary, or as may be directed by the City for the protection and preservation of the work and/or property related to the work;

8. If City so requests, and at City's cost, Consultant shall provide sufficient oral or written status reports to make City reasonably aware of the status of Consultant's work on the project.

9. The Consultant understands and agrees that City may, in City's sole discretion, refuse to pay Consultant for that portion of Consultant's services which were performed by Consultant on the project prior to the termination date and which remain
unacceptable and/or not useful to City as of the termination date.

City will pay Consultant an amount based on the percentage of satisfactory work completed in accordance with the notice of termination that will be agreed to by the City and the Consultant. If the agreement is terminated pursuant to the subparagraph entitled Termination by City for Default of Consultant, Consultant understands and agrees that City may, in City's sole discretion, refuse to pay Consultant for that portion of Consultant's services which were performed by Consultant on the project prior to the termination date and which remain unacceptable and/or not useful to City as of the termination date. The final payment to the Consultant after termination for convenience shall be limited to amounts due and owing under the agreement at time of termination, including the following:
a. The cost of settling and paying valid claims arising out of the termination of the work such as sub-consultant agreements or #9..
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contracts for materials;
b. The agreement price allocable to the portion of the work properly performed or goods supplied to the work site by the Consultant as of the date of termination, as determined in accordance with the notice of termination, reduced by any sums previously paid to the Consultant.

17. INDEMNITY.

Consultant's obligation to defend, indemnify, and hold the City, its agents, officers, and employees harmless under the provisions of this paragraph is not limited to or restricted by any requirement in this agreement for Consultant to procure and maintain a policy of insurance.

18. DISPUTE RESOLUTION.

All claims, controversies, or disputes arising out of, or relating to the formation of this agreement, or the breach, termination execution, enforcement, interpretation, or validity of this agreement, including the determination of the scope or applicability of this agreement provision shall be determined by binding arbitration in Modesto, California by one arbitrator, except as otherwise specified in this agreement. The American Arbitration Association shall administer the arbitration under its Arbitration Rules then in effect, subject o the #9..
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modifications of those rules contained in this paragraph. This agreement to arbitrate shall be specifically enforceable under the prevailing law of any court having jurisdiction, and the award rendered by the arbitrator may be entered in any court having jurisdiction. The appropriate venue for any arbitration or court proceeding relating to or arising out of this provision shall be in Stanislaus County, California.

This paragraph is not intended to and does not waive the claim filing requirements found in California Government Code section 900 et seq. In the event that a timely and legally sufficient, arbitrable claim is filed by Consultant with City, and the claim is rejected in whole or in part by City, this paragraph shall result in the conclusive, final, and binding resolution of all the issues presented in the claim by Consultant so long as any issues presented by the claim are arbitrable. Claims rejected by City or by operation of law, shall be submitted by Consultant to arbitration pursuant to the Arbitration Rules of the American Arbitration Association within ninety (90) days after mailing of the written rejection by City to Consultant.

Otherwise, the claim or claims shall be deemed waived in their entirety.

The “fast track” rules of the American Arbitration Association shall apply to any claim or counterclaim less than ONE HUNDRED FIFTY THOUSAND AND 00/100 ($150,000.00) DOLLARS. In arbitration not proceeding under the “fast track” rules, the arbitrator shall have the power to order that depositions be taken and other discovery be made.

Both City and Consultant shall have the right, upon written notice to take no more than three (3) depositions of the other as a matter of right in an arbitration proceeding under the “fast track” rules.

Whether or not City and Consultant may be engaged in interstate commerce, any controversy or dispute mentioned above shall be determined by, and the parties shall be bound by, the substantive law of the State of California, and not the Federal Arbitration Act at 9 USC Section 1 et seq.
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The arbitrator may grant any remedy or relief deemed by the arbitrator just and equitable under the circumstances, whether or not such relief could be awarded in a court of law. The arbitrator shall be empowered to award monetary sanctions against a party for failure of cooperation in the arbitration. The arbitrator shall, in written award, allocate all the costs of the arbitration, including the fees of the arbitrator and the reasonable attorney fees of the prevailing party, against the party who did not prevail. The prevailing party shall be the party in whose favor the majority of the central issues in the case are resolved.

Notwithstanding anything in this provision to the contrary, the arbitrator shall have no power to award punitive damages or other damages not measured by the party’s actual damages (excluding litigation costs and fees) against any party. This limitation of the arbitrator’s powers under this agreement shall not operate as an exclusion of the issue of punitive damages from this agreement to arbitrate sufficient to vest jurisdiction in a court with respect to that issue.

Consultant shall include in all subcontracts a specification whereby the subconsultant consents to being joined in an arbitration between City and Consultant involving the work of the subconsultant to be joined. Consultant’s failure to do so shall be a breach of this agreement.

The parties waive any rights provided by Title 9.2 of the California Code of Civil Procedure, Section 1293. The arbitrator’s award shall be deemed final, conclusive and binding to the fullest extent allowed by California law.

19. ENTIRE AGREEMENT.

This agreement and its exhibits contain the entire understanding between Consultant and City. Additional or new terms contained in this agreement which vary from Consultant's proposal are controlling and are deemed accepted by Consultant by shipment of any article or other commencement of performance hereunder. All previous proposals, offers and #9..
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communications relative to this agreement, whether oral or written, are hereby superseded except to the extent that they have been incorporated into this agreement. No future waiver of or exception to any of the terms, conditions, and provisions of this agreement shall be considered valid unless specifically agreed to in writing by all the parties.

20. PARTIAL INVALIDITY.

If any provision in this agreement is held by a court of competent jurisdiction to be invalid, void, or unenforceable, the remaining provisions shall nevertheless continue in full force without being impaired or invalidated in any way.

21. WAIVER.

The waiver by any party to this agreement of a breach of any provision hereof shall be in writing and shall not operate or be construed as a waiver of any other or subsequent breach hereof unless specifically stated in writing.

22. AUDIT.

The City's duly authorized representative shall have access at all reasonable times to all reports, contract records, contract documents, contract files, and personnel necessary to audit and verify Consultant's charges to City under this agreement.

Consultant agrees to retain reports, records, documents, and files related to charges under this agreement for a period of four (4) years following the date of final payment for Consultant services. City's representative shall have the right to reproduce any of the aforesaid documents.

23. GOVERNING LAW.

This agreement shall be governed according to the laws of the State of California.
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24. HEADINGS NOT CONTROLLING.

Headings used in the agreement are for reference purposes only and shall not be considered in construing this agreement.

25. COMPLIANCE WITH LAWS.

Consultant shall insure compliance with all safety and hourly requirements for employees, in accordance with federal, state, and county safety and health regulations and laws. Consultant shall fully comply with all applicable federal, state, and local laws, ordinances, regulations and permits.

26. CITY BUSINESS LICENSE.

Consultant shall have a City of Modesto business license.

IN WITNESS WHEREOF, the City of Modesto, a municipal corporation, has authorized the execution of this agreement in duplicate by its City Manager and attestation by its City Clerk under authority of Resolution No. 2022- adopted by the Council of the City of Modesto on the day of ,2022, and Athens Insurance Services, Inc. (DBA Athens Administrators), has caused this Agreement to be duly executed in duplicate as of the Effective Date.
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1 REQUEST FOR PROPOSAL AND SPECIFICATIONS NO. 2021-44
FOR
WORKERS’ COMPENSATION CLAIMS MANAGEMENT PROGRAM
Non-Mandatory Pre-Proposal Conference
To be held on
Monday, November 30, 2021 at 9:00 A.M.

Location:

CITY OF MODESTO CONTACT: Carol Wattle, Buyer
E-MAIL ADDRESS: [email protected]
PHONE: (209) 577-5406
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2 CITY OF MODESTO
REQUEST FOR PROPOSAL AND SPECIFICATIONS NO. 2021-44

TABLE OF CONTENTS
Page
. Notice to Proposers.............................................................................................................3 . City Contacts.......................................................................................................................4 . Calendar of Events..............................................................................................................4 . Offer and Acceptance..........................................................................................................4 . Covid-19 Response .............................................................................................................5 . Submittal Checklist ............................................................................................................6 FORMS
. Proposal Acknowledgement (Signature Form)................................................................7 . Pricing Schedule (Signature Form) ............................................................................ 8-10 . References................................................................................................................... 11-12 . Exceptions, Clarifications, Amendments (if applicable)..................................................13 . Financial Interest Disclosure (Signature Form) ....................................................... 14-16 . Company History Statement ............................................................................................17 . Minimum Qualifications ..................................................................................................17 . Addenda Acknowledgement page (if applicable) ...........................................................18 . Proposal Evaluation Criteria.............................................................................................19 . Acronym and Term Glossary............................................................................................20 . Specific Requirements......................................................................................................21 . Programs ...........................................................................................................................22 . Third-party Administrator Questionnaire................................................................... 23-26

TECHNICAL SPECIFICATIONS AND REQUIREMENTS
. Statement of Work ............................................................................................................27 . Background ................................................................................................................. 27-28 . Specific Requirements................................................................................................ 28-38 . Performance Based Contract Provision Requirements .............................................. 38-39 . Insurance Requirements.............................................................................................. 39-40 . Pre-Proposal Conference ..................................................................................................40

GENERAL TERMS AND CONDITIONS
. Proposal Submittal............................................................................................................41 . Complete Proposal Document..........................................................................................42 . Compliance / Non-Compliance ........................................................................................42 . Pricing Format...................................................................................................................42 . Pricing Schedule................................................................................................................42 . Award of Proposal ............................................................................................................43 . Evaluation Process............................................................................................................43 . Term of Agreement...........................................................................................................43 . Payment Terms .................................................................................................................50 . Exhibit A – Self Insured Annual Reports................................................................... 51-54 . Exhibit B – PRISM..................................................................................................... 55-61 . Exhibit C – EWC Reporting....................................................................................... 62-63 . Sample Standard Consultant Agreement.................................................................... 64-78 #9..
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3 NOTICE TO PROPOSERS
NOTICE IS HEREBY GIVEN that the City of Modesto, County of Stanislaus, State of California, will receive at the City Clerk’s office, 1010 Tenth Street, Suite 6600, Modesto, CA 95354 sealed proposals for the furnishing of Workers’ Compensation Claims Management Program for the City of Modesto.

Proposals shall be submitted on the proposal sheet provided and shall be downloaded from the City’s Purchasing website at http://www.modestogov.com/257/Contracting-Bid-Opportunities; such proposals shall include all necessary specifications. It is highly recommended all proposal documents be downloaded from the City’s website.

Each proposal shall be sealed and filed with the City Clerk’s office, 1010 Tenth Street, Suite 6600, Modesto, CA 95354 prior to Tuesday, December 28, 2021 at 11:00 A.M., at which time proposals will be opened, read and recorded. All proposals shall be available for review following City Council award approval at the Purchasing Division, 1010 Tenth Street, 5th Floor, Suite 5300, Modesto, CA 95354.

Proposals will be received only at the address shown above, and prior to the time indicated. Any proposal received at or after said time and/or date, or at a place other than the stated address cannot be considered and will be returned to the proposer unopened.

All proposals, whether delivered by an employee of the proposer, U.S. Postal Service, courier or package delivery service must be received and time stamped at the stated address prior to the time designated. The City Clerk’s time stamp shall be considered the official timepiece for the purpose of establishing the actual receipt of proposals. The City of Modesto assumes no responsibility for delay in the delivery of the proposal.

On the outside of both the proposal envelope and courier envelope, the proposer shall indicate the following:

NAME AND ADDRESS OF PROPOSER
SPECIFICATION NUMBER 2021-44
WORKERS’ COMPENSATION CLAIMS MANAGEMENT PROGRAM
PROPOSAL OPENING DATE: DECEMBER 28, 2021 AT 11:00 A.M.

MAIL TO: CITY CLERK COURIER TO: CITY CLERK

CITY OF MODESTO CITY OF MODESTO
P.O. BOX 642 1010 10TH STREET, SUITE 6600
MODESTO, CA 95353 MODESTO, CA 95354
The City reserves the right to reject any or all proposals or to waive any informalities or minor irregularities in a proposal.

No proposer may withdraw his/her proposal for a period of one-hundred twenty (120) days after the date set for the opening thereof.

Note: Deliver or mail proposals to the referenced address, only as indicated in the Notice to Proposers.
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4 CITY CONTACTS
All questions regarding these specifications, terms, and conditions shall be submitted in writing to Carol Wattle, Buyer, via email at: [email protected] All contacts during the proposal process shall be through the Purchasing Division. Attempts by the proposer to contact department representatives may result in disqualification of the proposer from the proposal process.

CALENDAR OF EVENTS
Event Date
Proposal Issued November 16, 2021
Non-Mandatory Pre-Proposer Conference November 30, 2021 Written Questions Due December 7, 2021
Addendum Issued (if required) December 14, 2021
Response Due PRIOR 11:00 A.M. on Tuesday, December 28, 2021 Proposal Award Date Approximately, June, 2022
It is the responsibility of each proposer to be familiar with all of the specifications, terms and conditions and the site condition (if applicable). The proposer agrees and acknowledges all RFP specifications, terms, and conditions and indicates the ability to perform by submission of a proposal.

By the submission of a proposal, the proposer certifies that if awarded an agreement they will make no claim against the City based upon ignorance of conditions or misunderstanding of the specifications.

OFFER AND ACCEPTANCE:

Seller represents his/her acceptance to provide products and/or services as follows: City’s offer to purchase products and/or services is expressly conditioned upon Seller’s assent to the terms and conditions set forth in the City’s agreement documents, specifications, supporting data, and these articles. Seller agrees that Seller’s Order Acknowledgement terms and conditions received prior to, during, or after order placement by City are hereby rejected. City agreements signed by the City’s Purchasing Manager or designated agent and issued to Seller constitutes written notification to Seller of City’s rejection of any and all of Seller Order Acknowledgements, counter offers and change to the City’s terms and conditions.
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5 REQUEST FOR PROPOSAL AND SPECIFICATIONS NO. 2021-44
WORKERS’ COMPENSATION CLAIMS MANAGEMENT PROGRAM
COVID-19 RESPONSE
The City of Modesto is doing our part to slow the spread of COVID-19. The City of Modesto will be broadcasting bid openings electronically via Microsoft Teams at 11:00 a.m. PT on Tuesday, December 28, 2021. The City Clerk Record of Proposal document will be available on Planet Bids by the end of day, Tuesday, December 28, 2021. The public bid opening for RFP 2021-44 Workers’ Compensation Claims Management Services, will be available using the URL link, video system or via phone provided below. By submitting your proposal for the above-stated RFP you acknowledge, understand, and agree to this modified bid opening procedure.

URL - https://teams.microsoft.com/l/meetupjoin/19%3ameeting_NTI0YzBiMDMtNDQ0Yi00YjNlLWIwZjYtYzg4ZDVjMDdkM2Mz%40thread.v2/0?co ntext=%7b%22Tid%22%3a%22125ccacf-fc61-463c-9976-
189f876ff90b%22%2c%22Oid%22%3a%229715c333-c997-4dd7-8984-12cd4deaa705%22%7d Join Microsoft Teams Meeting
+1 469-998-7409 United States, Dallas
Conference ID: 961 656 049#
Should you have any questions regarding this, please do not hesitate to contact Carol Wattle, by email at [email protected] or telephone at (209)577-5406. #9..
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6 REQUEST FOR PROPOSAL AND SPECIFICATIONS NO. 2021-44
WORKERS’ COMPENSATION CLAIMS MANAGEMENT PROGRAM

SUBMITTAL CHECKLIST

PROPOSAL SUBMITTAL CHECKLIST
The proposer shall provide a complete proposal in a sealed envelope before 11:00 A.M. on the proposal opening date. Failure to provide all the required documents may cause the proposal to be considered non-responsive.

COMPLETE PROPOSAL Page No.
. Proposal Acknowledgement (Signature Form)................................................................7 . Pricing Schedule (Signature Form) .............................................................................. 7-9 . References................................................................................................................... 10-11 . Exceptions, Clarifications, Amendments (if applicable)..................................................12 . Financial Interest Disclosure Form (Signature Form).............................................. 13-15 . Company History Statement ............................................................................................16 . Minimum Qualifications ..................................................................................................16 . Addenda Acknowledgement Page (if applicable) ...........................................................17 . Specific Requirements .....................................................................................................20 . Programs ..........................................................................................................................21 . Third-party Questionnaire ......................................................................................... 21-25 #9..
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7 REQUEST FOR PROPOSAL AND SPECIFICATIONS NO. 2021-44
WORKERS’ COMPENSATION CLAIMS MANAGEMENT PROGRAM

PROPOSAL ACKNOWLEDGEMENT
The City is soliciting proposals from qualified proposers to furnish its requirements per the specifications, terms and conditions contained in the above referenced proposal number. This Proposal Acknowledgement must be completed, signed by a responsible officer or employee, dated and submitted with the proposal response.

Obligations assumed by such signature must be fulfilled.

1. Preparation of Proposals: (a) All prices and notations must be printed in ink or typewritten. No erasures permitted. Errors may be crossed out and corrections printed in ink or typewritten adjacent and must be initialed in ink by person signing the proposal. (b) Quote price as specified in proposal. No alterations or changes of any kind shall be permitted to the Proposal Form. Responses that do not comply shall be subject to rejection in total.

2. Failure to Submit Proposal: If you are not submitting a proposal but want to remain on the mailing list and receive future proposals, complete, sign and return this Proposal Acknowledgement and state the reason you are not pricing.

3. Taxes and Freight Charges: (a) Unless otherwise required and specified in the RFP, the prices quoted herein do not include Sales, Use or other taxes. (b) No charge for delivery, drayage, express, parcel post packing, cartage, insurance, license fees, permits, costs of bonds, or for any other purpose, except taxes legally payable by City, will be paid by the City unless expressly included and itemized in the proposal. (c) Amount paid for transportation of property to the City is exempt from Federal Transportation Tax. An exemption certificate is not required where the shipping paper shows the consignee as one (1) of the Agencies; as such papers may be accepted by the carrier as proof of the exempt character of the shipment. (d) Articles sold to the Agencies are exempt from certain Federal excise taxes. The Agencies will furnish an exemption certificate.

4. Award: (a) Unless otherwise specified by the proposer or the RFP gives notice of an all-or-none award, the City may accept any item or group of items of any proposal. (b) Proposals are subject to acceptance at any time within thirty (30) days of opening, unless otherwise specified in the RFP. (c) A valid, written purchase order mailed, or otherwise furnished, to the successful proposer within the time for acceptance specified results in a binding agreement without further action by either party. The agreement shall be interpreted, construed and given effect in all respects according to the laws of the State of California.

5. Patent Indemnity: Proposers who do business with the City shall hold the City, its officers, agents and employees, harmless from liability of any nature or kind, including cost and expenses, for infringement or use of any patent, copyright or other proprietary right, secret process, patented or un-patented invention, article or appliance furnished or used in connection with the contract or purchase order.

6. Samples: Samples of items, when required, shall be furnished free of expense to the City and if not destroyed by test may upon request (made when the sample is furnished), be returned at the proposer’s expense.

7. Rights and Remedies of Agencies for Default: (a) In the event any item furnished by the proposer in the performance of the agreement or purchase order should fail to conform to the specifications therefore or to the sample submitted by the proposer with its proposal, the City may reject the same, and it shall thereupon become the duty of the proposer to reclaim and remove the same forthwith, without expense to the City, and immediately to replace all such rejected items with others conforming to such specifications or samples; provided that should the proposer fail, neglect or refuse so to do the City shall thereupon have the right to purchase in the open market, in lieu thereof, a corresponding quantity of any such items and to deduct from any moneys due or that may there after come due to vendor the difference between the prices named in the agreement or purchase order and the actual cost thereof to the City.

In the event that the proposer fails to make prompt delivery as specified for any item, the same conditions as to the rights of the City to purchase in the open market and to reimbursement set forth above shall apply, except when delivery is delayed by fire, strike, freight embargo, or Act of God or the government. (b) Cost of inspection or deliveries or offers for delivery, which do not meet specifications, will be borne by the proposer. (c) The rights and remedies of the Agencies provided above shall not be exclusive and are in addition to any other rights and remedies provided by law or under the agreement.

8. Discounts: (a) Terms of less than ten (10) days for cash discount will be considered as net. (b) In connection with any discount offered, time will be computed from date of complete, satisfactory delivery of the supplies, equipment or services specified in the RFP, or from date correct invoices are received by the City at the billing address specified, if the latter date is later than the date of delivery. Payment is deemed to be made, for the purpose of earning the discount, on the date of mailing the City’s check.

9. California Government Code Section 4552: In submitting a proposal to a public purchasing body, the proposer offers and agrees that if the proposal is accepted, it will assign to the purchasing body all rights, title, and interest in and to all causes of action it may have under Section 4 of the Clayton Act (15 U.S.C. Sec. 15) or under the Cartwright Act (Chapter 2, commencing with Section 16700, of Part 2 of Division 7 of the Business and Professions Code), arising from purchases of goods, materials, or services by the proposer for sale to the purchasing body pursuant to the proposal. Such assignment shall be made and become effective at the time the purchasing body tender’s final payment to the proposer.

10. No Guarantee or Warranty: The City makes no guarantee or warranty as to the condition, completeness or safety of any material or equipment that may be traded in on this order.

11. Two “Inked” Signed Original Proposal Document Required: Failure to furnish at least one “inked” signed original proposal document may result in disqualification.

THE undersigned acknowledges receipt of the referenced RFP and/or Addenda and offers and agrees to furnish the articles and/or services specified on behalf of the proposer indicated below, in accordance with the specifications, terms and conditions of this RFP and Proposal Acknowledgement, for the pricing indicated on the Pricing Schedule.

Firm:

Address:

City/State/Zip:

Signature/Title/Date:
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8 REQUEST FOR PROPOSAL AND SPECIFICATIONS NO. 2021-44
WORKERS’ COMPENSATION CLAIMS MANAGEMENT PROGRAM

PRICING SCHEDULE
Proposers shall provide an annual flat fee cost for all services described in this RFP document. Proposals must be submitted on the Pricing Schedule provided. No alterations should be made to the pricing schedule. Any exceptions, amendments or adjustments should be noted on the “Exception, Clarification, Amendments” section on page 13.

FLAT FEE FOR ANNUAL SERVICES
Description Fee
Transition Cost (First year only) $__________________________________/YR Flat Annual Fee for Services – (First year,) $__________________________________/YR Flat Annual Fee for Services – (Second year) $__________________________________/YR Flat Annual Fee for Services – (Third year,) $__________________________________/YR Flat Annual Fee for Services – (Fourth year,) $__________________________________/YR Flat Annual Fee for Services – (Fifth year,) $__________________________________/YR TOTAL (Five-Year Program) $_____________________________________ Nurse Care Management Services
For occupational illness/injuries, managed care costs are paid from the involved claim files, and are not additionally billable to the client. The City of Modesto may, at its option, request managed care services to be provided for non-occupational illness/injuries. Please list the per hour costs for the listed services for both occupational and non-occupational cases.

Service Type Occupational Non-Occupational
Early Intervention / Telephone Case Management $________________/Hour $________________/Hour On-site Case Management (medical and vocational) $________________/Hour $________________/Hour Catastrophic Case Management $________________/Hour $________________/Hour Telephonic Case Management $________________/Hour $________________/Hour Company Name (Proposer):
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9 REQUEST FOR PROPOSAL AND SPECIFICATIONS NO. 2021-44
WORKERS’ COMPENSATION CLAIMS MANAGEMENT PROGRAM

PRICING SCHEDULE
Bill Review Services
All Bills, with the exception of pharmaceutical billings, are subject to Bill Review. The City of Modesto requests your firm to provide pricing based on a “hybrid” billing schedule. All reviewed bills in which charges in excess of the State Official Medical Fee Schedule were reduced to the State-authorized level shall be billed at a flat fee. All reviewed bills in which charges were reduced to below the state-authorized fee may also be subject to a share of the savings based on a percentage of the difference between the State-authorized fee and the adjusted amount paid below the state-authorized fee. Below, please provide your per-bill review rate (note that no charge can be imposed on bills that required no adjustment) and your proposed savings percentage.

Per-bill Cost $___________________________________/Each Percent of Savings Below Official Medical Fee Schedule ____________________________________% Utilization Review Services
List Service Type Occupational Non-Occupational
$______________/Hour $______________/Hour
$______________/Hour $______________/Hour
$______________/Hour $______________/Hour
$______________/Hour $______________/Hour
$______________/Hour $______________/Hour
$______________/Hour $______________/Hour
$______________/Hour $______________/Hour
Company Name (Proposer):
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10 REQUEST FOR PROPOSAL AND SPECIFICATIONS NO. 2021-44
WORKERS’ COMPENSATION CLAIMS MANAGEMENT PROGRAM

PRICING SCHEDULE
Does proposer accept the City’s Epay Payment Program? Please check one: Yes ____ No ____ Information regarding the program is provided in Section 2.25 Payment.

City Business/Delivery License No. __________ Expiration Date: __________ THE undersigned acknowledges receipt of the referenced RFP and/or Addenda and offers and agrees to furnish the articles and/or services specified on behalf of the proposer indicated below, in accordance with the specifications, terms and conditions of this RFP and Proposal Acknowledgement, for the pricing indicated on the Pricing Schedule.

Company Name (Proposer):

By (Person Submitting Proposal): (Print)
By (Person Submitting Proposal): (Signature)
Title of Person Submitting Proposal:

Business Address
(City/State/Zip):

E-Mail Address:

Telephone #:

Fax #:

Date:
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11 REQUEST FOR PROPOSAL AND SPECIFICATIONS NO. 2021-44
WORKERS’ COMPENSATION CLAIMS MANAGEMENT PROGRAM

REFERENCES
All proposers must provide a list of five (5) current or former clients in the area provided below, identifying prior experience with the same type of services requested by the City under Scope of Work. References shall have similar volume and requirements to those outlined in these specifications, terms and conditions.

Proposer’s failing to provide references shall be deemed unacceptable.

The City may contact some or all of the references provided in order to determine the Proposers’ performance record on services similar to that described in this proposal. The City reserves the right to contact references other than those provided in the response and to use the information gained from them in the award process.

Company Name:

Address:

City, State, Zip Code:

Contact Person:

Email Address:

Telephone Number:

Type of Business:

Date of Service:

Annual Contract Value $
Company Name:

Address:

City, State, Zip Code:

Contact Person:

Email Address:

Telephone Number:

Type of Business:

Date of Service:

Annual Contract Value $
Company Name:

Address:

City, State, Zip Code
Contact Person:

Email Address:

Telephone Number:

Type of Business:

Date of Service:

Annual Contract Value $
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12 REQUEST FOR PROPOSAL AND SPECIFICATIONS NO. 2021-44
WORKERS’ COMPENSATION CLAIMS MANAGEMENT PROGRAM

REFERENCES-CONTINUED
Company Name:

Address:

City, State, Zip Code
Contact Person:

Email Address:

Telephone Number:

Type of Business:

Date of Service:

Annual Contract Value $
Company Name:

Address:

City, State, Zip Code
Contact Person:

Email Address:

Telephone Number:

Type of Business:

Date of Service:

Annual Contract Value $
Company Name (Proposer):
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13 REQUEST FOR PROPOSAL AND SPECIFICATIONS NO. 2021-44
WORKERS’ COMPENSATION CLAIMS MANAGEMENT PROGRAM

EXCEPTIONS, CLARIFICATIONS, AMENDMENTS
Exceptions, Clarifications, Amendments
List requests for proposal clarifications and exceptions below, if any, sign and submit with your proposal response.

Item No. Reference To: Description
Page No. Paragraph No.

Company Name (Proposer):
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14 REQUEST FOR PROPOSAL AND SPECIFICATIONS NO. 2021-44
WORKERS’ COMPENSATION CLAIMS MANAGEMENT PROGRAM

FINANCIAL INTEREST DISCLOSURE

REQUIRED DISCLOSURE BEGINNING THE COUNCIL MEETING
OF JANUARY 7, 2003
The ordinance requiring financial interest disclosure by all parties having a direct or indirect interest of $2,000 or more (except for certain publicly traded companies) will be effective at the Council meeting of January 7, 2003. This means that any Council action on a contract, agreement or development right must be accompanied by a FINANCIAL INTEREST DISCLOSURE FORM listing by name all parties that have a material financial interest in the agreement, contract or development right.

PLEASE NOTE, any Council action that requires a FINANCIAL INTEREST DISCLOSURE cannot be considered by the City Council until the required reporting is made. That means that Agenda Items without the DISCLOSURE will be removed from the Council Agenda.

FinDisclosure12-19
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15 REQUEST FOR PROPOSAL AND SPECIFICATIONS NO. 2021-44

FINANCIAL INTEREST DISCLOSURE
All persons included within the meaning of either of the following tests have a material financial interest in an agreement, or application for development rights, submitted for approval or disapproval by the City Council, and shall be identified by the applicant, by name.

Tests of Materiality:

1. Whether it is foreseeable to a reasonable person that the value of their interest in property available for use by an applicant, or their interest in the applicant itself, may increase or decrease by an amount greater than $2,000.00 as a direct or indirect result of Council action on the applicant’s agreement or application for development rights.

2. Whether it is foreseeable to a reasonable person that the person’s gross income from the applicant may increase or decrease by a sum greater than $2,000.00 as a direct or indirect result of Council action on the agreement or application for development rights.

It is the legal obligation of all applicants for approval of an agreement or of an application for development rights to verify in writing, under penalty of perjury, that the identity of each person having a material financial interest in the agreement or application or development rights is true, correct and complete.

The applicant understands that this information is provided under penalty of perjury, and that intentionally supplying misinformation or deception may result in either invalidation of the agreement or application, or criminal prosecution for misdemeanor violation of the Modesto Municipal Code, or both. Negligent provision of misinformation shall be grounds for invalidation. In accordance with the Modesto Municipal Code, each applicant has a continuing obligation to maintain the truth, accuracy and completeness of the financial interest disclosure information provided below until after final consideration by the City Council of any matter arising out of or relating to the agreement or application.

By signing this document, I agree to the information contained within.

COMPANY NAME: ____________________________________________________ __________________________________
APPLICANT’S NAME (SIGNATURE):
__________________________________
APPLICANT’S NAME/TITLE (PRINT):
__________________________________
Applicable Names (if any, use page 16): DATE:
(See attached list)
Questions concerning the application of either test to particular facts should be resolved in advance of Council action by agreement with the department head recommending approval of its agreement/application.

DIRECTOR
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16 REQUEST FOR PROPOSAL AND SPECIFICATIONS NO. 2021-44

FINANCIAL INTEREST DISCLOSURE
COMPANY NAME: __________________________________________ NAMES
Signature / Print:

Signature / Print:

Signature / Print:
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17 REQUEST FOR PROPOSAL AND SPECIFICATIONS NO. 2021-44
WORKERS’ COMPENSATION CLAIMS MANAGEMENT PROGRAM

COMPANY HISTORY STATEMENT
Your company shall have been in business for a minimum of three (3) continuous years (immediately prior to the time of the RFP submittal date) providing the types of services requested in this RFP.

The company history statement shall be prepared on company letterhead and provided with the proposal submittal.

MINIMUM QUALIFICATIONS
Minimum Qualifications are mandatory for proposal consideration, and at a minimum shall include the following:

Financial Stability (Provided in a sealed separate envelope):

Proposers shall submit a copy of their company’s most recent professionally prepared Financial Statements (Income Statement and Balance Sheet). These statements, if un-audited, shall be accompanied by a cover letter that states the name and title of the preparer, the basis of the financial statement presentation (cash or accrual) and whether these statements have been prepared in accordance with Generally Accepted Accounting Principles for the most recent fiscal year end of the proposer. Audited financial statements shall be submitted in their entirety, including the auditor’s opinion and notes to the financial statements.

A separate document shall be provided and signed under penalty of perjury by the proposer’s financial officer or owner that explains the proposer’s inability to provide statements for a fiscal period that ended at least eight (8) months before the required date of submittal, if such inability exists.

One complete set of Financial Statements shall be submitted in a sealed separate envelope filed with the (original proposal document), marked with the following:

FINANCIAL STATEMENTS

NAME AND ADDRESS OF PROPOSER
SPECIFICATION NO. RFP 2021-44
WORKERS’ COMPENSATION CLAIMS MANAGEMENT PROGRAM
PROPOSAL OPENING DATE: TUESDAY, DECEMBER 28, 2021 AT 11:00 A.M. #9..
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18 REQUEST FOR PROPOSAL AND SPECIFICATIONS NO. 2021-44
WORKERS’ COMPENSATION CLAIMS MANAGEMENT PROGRAM

ADDENDA ACKNOWLEDGEMENT
The proposer shall check the RFP listing on the City’s Planet Bid website, periodically, and in any event, no later than the day prior to the proposal opening to obtain any addenda information. The changes identified in the addenda modify this request for proposal and specifications. The addenda now become a part of this request for proposal and specifications. Signing the Proposal on the signature portion thereof, the proposer is acknowledging that the proposer has confirmed that he or she has received all addenda issued for this request for proposal and specifications, and has included costs for such in the proposal submitted. Failure to list and acknowledge all addenda numbers may cause the proposal to be considered non-responsive. Do not attach any of the addenda to this sheet nor include them with the proposal.

This document is only required to be returned should addenda have been issued.

The Proposal is submitted with respect to the changes to the request for proposal and specifications included in addenda numbers:

LIST ALL ADDENDA NUMBERS: ____________________________________________________ Company Name (Proposer):
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19 REQUEST FOR PROPOSAL AND SPECIFICATIONS NO. 2021-44
WORKERS’ COMPENSATION CLAIMS MANAGEMENT PROGRAM

PROPOSAL EVALUATION CRITERIA
Most of the material needed to present a comprehensive proposal can be placed into one of the sections referenced below under Evaluation Criteria. Responses should be complete and detailed. However, if relevant information needs to be presented to further support the proposers’ case other appropriate sections may be added in the proposers’ submittal.

EVALUATION
All proposals submitted will be reviewed by a City of Modesto evaluation committee. At the completion of the proposal review, finalists may be asked to provide an in-depth presentation in Modesto. Whether or not a presentation shall be performed is wholly within the discretion of the evaluation committee. The committee will select the proposal which best fulfills the City’s requirements and represents the best value to the City of Modesto as determined by the evaluation committee. No single factor will determine the final award decision.

Overall responsiveness to the Request for Proposal is an important factor in the evaluation process.

EVALUATION CRITERIA

1. REFERENCES (MINIMUM OF 5):

2. SPECIFIC REQUIREMENTS:

3. PROGRAMS:

4. THIRD-PARTY ADMINISTRATOR QUESTIONNAIRE:

5. COST:

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20 REQUEST FOR PROPOSAL AND SPECIFICATIONS NO. 2021-44
WORKERS’ COMPENSATION CLAIMS MANAGEMENT PROGRAM

ACRONYM AND TERM GLOSSARY
ACOEM American College of Occupational and Environmental Medicine ADA Americans with Disabilities Act of 1990
ADA-FEHA Americans with Disabilities Act of 1990-California Fair Employment and Housing Act AME Agreed Medical Examiner
AOE/COE Arising Out of Employment/Course of Employment
Cal/OSHA California Occupational Safety & Health Administration Cal/PERS California Public Employee’s Retirement System PRISM California State Association of Counties Excess Insurance Authority DIR Department of Industrial Relations, State of California DOR Declaration of Readiness
EAMS Electronic Adjudication Management System
EDD Employment Development Department, State of California EFJA Essential Functions Job Analysis
E.L. Employer’s Liability
EPA United States Environmental Protection Agency
F.O.B Shall mean without charge for delivery to destination and placing on board a carrier at a specified point (Free on Board)
FY Fiscal Year (July 1 through June 30)
L.C. or LC Refers to California Labor Code
LC 4610 Refers to California Labor Code section 4610
MCMA Modesto Confidential and Management Association
MMI Maximum Medical Improvement
MPN Medical Provider Network
MSC Mandatory Settlement Conference
ODG Official Disability Guidelines
OMFS Official Medical Fee Schedule
OSHA Refers to California Occupational Safety and Health Administrations P & S Permanent and Stationary
PD Permanent Disability
PPN Preferred Provider Networks
PPO Preferred Provider Organization
QIW Qualified Injured Worker
QME Qualified Medical Examiner
QRR Qualified Rehabilitation Representative
RFP Request for Proposal
RSI Repetitive Stress Injuries
RTW Return-to-Work
SB899 Refers to Senate Bill 899, the most recent overhaul of the State of California workers’ compensation system passed on 4/19/04
SIP Self-Insurance Plans, California Department of Industrial Relations SIR Self-insured Retention
TPA Third-party Administrator
WC Workers’ Compensation
WCAB Workers’ Compensation Appeals Board
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21 REQUEST FOR PROPOSAL AND SPECIFICATIONS NO. 2021-44
WORKERS’ COMPENSATION CLAIMS MANAGEMENT PROGRAM

SPECIFIC REQUIREMENTS
Proposer shall provide detailed information on the following:

Contractor shall be licensed with the California Department of Industrial Relations, Self-Insurance Plans (SIP).

A copy of the license shall be provided to the City as part of the proposal response.

Proposer shall list their physical office location address, City and State, administering the City’s claims. If the successful proposer has multiple adjusting locations the City reserves the right to choose which office will adjust the City’s claims.

Because of the need to be fully aware of and compliant with the terms of SB899, Contractor shall have a minimum of five (5) years’ experience working with public agencies with public safety employees of combined size equal to the City. The experience shall be within the past eight (8) years. Please provide detailed history. #9..
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22 REQUEST FOR PROPOSAL AND SPECIFICATIONS NO. 2021-44
WORKERS’ COMPENSATION CLAIMS MANAGEMENT PROGRAM

PROGRAMS
Proposer shall provide a detailed overview of their firm’s processes on the following programs:

A. Claims Management
B. General Program Administration
C. General Claims Administration
D. Accounting Control
E. Medical Administration
F. Litigation Management
G. Investigation Management
H. Auditing
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23 REQUEST FOR PROPOSAL AND SPECIFICATIONS NO. 2021-44
WORKERS’ COMPENSATION CLAIMS MANAGEMENT PROGRAM

THIRD-PARTY ADMINISTRATOR QUESTIONNAIRE
This section of the RFP provides a series of questions which will give the City an overview of the claim’s administrator for the type and extent of services required.

Proposer shall repeat the question in their response and provide the answer immediately following.

A. About the Firm

1. Give a brief history of your firm since inception, including:
o A list of principals
o An organizational chart
o Size and location(s) of your firm, including numbers of employees at each location o A description of the types of services provided by your firm and the number of years provided, and
o The contact person(s) for this RFP process

2. Discuss any major changes in your firm’s structure or ownership over the past three (3) years.

Discuss anticipated changes in your firm’s structure or ownership in the next three (3) years.

3. Discuss your firm’s affiliation, if any, with a parent firm.

4. Discuss your firm’s affiliation with:
o Medical service providers
o Utilization review services
o Medical bill review services

5. Describe your firm’s mission and goals as related to corporate growth, customer service, quality assurance/quality control management and affirmative action standards.

6. Describe the number and types of clients your firm currently provides TPA services to, both corporately and locally. Please list all public agency clients with 1,000 or more employees and the number of years served. Provide contact name and phone number for each.

7. Provide information regarding any contracts which have been terminated within the past thirty-six (36) months with an explanation of the termination. Provide contact name and phone number for each.

8. Provide a history of PRISM audit results for the past five (5) years, if applicable, including an explanation of any negative findings.

9. Provide a history of State audit results for the past five (5) years including an explanation for any penalties that may have been assessed.

10. Submit a detailed implementation plan, including the expected timeline for each of the following:
a) Staff recruitment and training.
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24 b) Data conversion of the City’s existing electronic claim files. c) Transfer of existing hard copy files from current TPA. d) Distribution of all required notifications (vendors, claimants, WCAB, etc.). e) Providing printed forms.
f) Training and coordination of IT systems and operational procedures with City staff B. About Your Firm’s Management Information System(s) (MIS)

1. Describe the type of data processing hardware and software proposed for this contract. Discuss your firm’s experience in using the system, whether the system is owned and operated in-house or through an agreement with another provider, the general capabilities of this system, compatibility with other existing systems for continuity of data and transferring of historical data, and any projected upgrades or changes during the term of this contract.

2. List and describe the management information reports generated by your firm’s data processing system. Identify those reports which are standard and included in the service fee. Identify those reports which are optional and the cost for generating these reports. Include in each description the interval at which the reports are generated. Provide a one-page example of each of five (5) reports listed and explain how each will assist the City of Modesto in managing its program.

3. Describe the unique features of the management information reports provided by your firm which are not typically provided by other TPAs.

4. Discuss the methods used by your firm to segregate and track OSHA-recordable injuries, first aid injuries, medical-only injuries, time loss injuries, denials, aggravations and any other claim type designations.

5. Describe how your system differentiates Workers’ Compensation injuries and days lost from OSHA-recordable injuries and days lost. Provide an example of the OSHA 300 Log report provided by your firm. Discuss how this report is generated and reconciled against Workers’ Compensation data.

6. Describe your firm’s ability to provide the City of Modesto with a minimum of three (3) MIS user connections on existing personal computers allowing for full database access and standard/ad hoc report writing/generating.

7. Discuss the MIS technical support services provided by your firm. Include the location of MIS staff and how many clients are serviced from that location.

C. Claims Administration Services

1. Discuss the allocation of personnel your firm will use to staff a dedicated claims unit to adjust City of Modesto’s claims. Describe the title, function and minimum ongoing training/experience requirements for each position.

2. Please indicate which of the personnel you plan to use to staff this claims unit have attained certification to administer self-insured claims (SIP) Certification and when all staff members will be certified.
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25 2. Discuss your firm’s standard ratio for case closures as related to new claims. Explain how you utilize closure performance comparisons and the frequency that these comparisons are calculated. Explain other criteria used to determine the appropriateness of closing claims.

4. Please submit your firm’s Claims and Litigation Management Guidelines.

5. Explain how the claims adjuster will coordinate legal activities with counsel once a claim is assigned to defense counsel.

6. Discuss your interaction with clients in reporting on account management or claims related issues.

How frequently do you expect supervisors and/or adjusters to initiate contact with City of Modesto? What is your protocol regarding returning telephone and/or E-Mail messages?

7. Identify the firm’s criteria for designating a claim as a first aid, medical only or indemnity case.

8. Explain your firm’s current policies regarding the assignment of claims to each claims supervisor, claims examiner and claims assistant. Include a description of the number and types of claims assigned to each position.

9. Describe the criteria for re-indexing existing claims.

10. Describe the firm’s policies and practices in establishing and maintaining reserves for indemnity, medical care, expenses and future medical benefits.

11. Describe the firm’s policies and procedures to ensure timely review and appropriate payment of benefits and bills.

12. Describe how the firm will assist and facilitate Return-to-Work activity at the earliest possible opportunity.

13. Describe how the firm communicates temporary and permanent work restrictions in a timely manner.

14. Discuss your firm’s policy on payments of fines and penalties resulting from errors internal to your firm. Describe how your firm accounts for such payments and provide the total dollar amount of fines and penalties paid to State or Federal regulators in each of the preceding five fiscal years.

D. Summary

1. Describe in detail your firm’s data processing and staff experience with converting claim and financial records data from former TPAs to your proposed system. Provide the client’s company name, type of system converted from, contact name and phone number.

2. Describe your firm’s plan for provision of each of the following service elements. Include documentation of your firm’s philosophy, protocol and readiness to provide the following services:
• Utilization Review
• Preferred Provider Organization Network*
• Bill Review Services
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26 *Include the number of members in the PPO to be used and the number of specialties represented. In addition, provide the PPO member’s contract provision language which specifies the percentage below the California Official Medical Fee Schedule to which the PPO member has agreed.

3. List and describe the features that distinguish your firm from other third-party administrators. #9..
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27 REQUEST FOR PROPOSAL AND SPECIFICATIONS NO. 2021-44
WORKERS’ COMPENSATION CLAIMS MANAGEMENT PROGRAM

TECHNICAL SPECIFICATIONS AND REQUIREMENTS

1.1 STATEMENT OF WORK:

A. Intent:

The City of Modesto is seeking a qualified third-party administrator (TPA) to perform claims administration services as required by law and in accordance with City policy for its self-insured workers’ compensation program. The City’s program is currently administered by Innovative Claim Solutions.

The successful proposer shall work with ancillary service providers, and cooperate with them at no additional cost to the City.

B. Scope:

There are approximately fifteen-hundred (1500) full-time or part-time employees covered in the City workers’ compensation program. Of these approximately three-hundred forty (340) are safety employees in the Police and Fire Departments. Public Safety personnel are afforded salary continuation benefits under Labor Code §4850.

All full-time employees are members of California Public Employees’ Retirement System (CalPERS).

The City’s total payroll for the 2020/21 fiscal year is approximately $104,389,085. Currently the City maintains a self-insured retention amount (SIR) of $750,000 per incident and is a member of the Public Risk Innovation, Solutions, and Management (PRISM) insurance pool, a Joint Powers Authority which provides excess workers’ compensation coverage.

The TPA shall provide claims administration services for all existing claims.

As of Dec. 31, 2020, the City currently has two-hundred ninety-eight (298) open claims, which includes:
one-hundred thirty-one (131) Future Medical, one-hundred forty (140) Indemnity and twenty-seven (27) Medical Only. The City’s Self Insurance Plan Reports for the last four (4) years are included in (Exhibit A).

1.2 BACKGROUND:

The TPA shall coordinate all aspects of the workers’ compensation program in conjunction with the City’s Risk Management Division. This includes reporting of injuries; employee contact; providing lost time and salary information; training managers, supervisors, and employees on workers’ compensation procedures; and the administration of return to work programs (RTW), claim audits, payment of benefits, litigation management, and medical management.

The Contractor shall work with and fully cooperate with any ancillary vendor(s) selected by the City. In addition, the Contractor shall not charge the City or the ancillary vendor(s) for setting up and maintaining this relationship including, but not limited to, implementation fees, electronic data interface, or scanning fees.

The City currently uses Company Nurse for employees to report injuries telephonically and electronically submit claim information to the (TPA) to generate employer first reports of injury (5020). #9..
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28 Currently, the City does not have a medical provider network (MPN) nor a pharmacy program but may be interested in exploring both further.

1.3 SPECIFIC REQUIREMENTS:

The Contractor shall be licensed with the California Department of Industrial Relations, Self-Insurance Plans (SIP). A copy of the license shall be provided to the City as part of the proposal response.

The Contractor shall administer the City’s claims from an office located within a reasonable distance of City. If the successful proposer has multiple adjusting locations the City reserves the right to choose which office will adjust the City’s claims.

The Contractor shall perform all services required to supervise and administer a self-insured workers’ compensation program for the City and act as the City’s representative in matters relating to the City’s obligations under the workers’ compensation laws of the State of California.

In addition to the above, the Contractor shall perform claims administration services in accordance with City specific policies and industry standards. The claims administrative services required shall include, but are not limited to, the following:

A. City Program Requirements:

1. Subcontractor Approvals: The City reserves the right to require reassignment of subcontractors that are not performing in a manner satisfactory to the City.

2. Americans with Disabilities Act-California Fair Employment and Housing Act (ADA-FEHA) Program: Contractor shall provide appropriate disability information to the City to assist the City with departmental and Citywide (ADA-FEHA) accommodation efforts. Disability information including specific permanent restrictions and the City Essential Functions Job Analysis (EFJA) completed by Workers’ Compensation (WC) doctors shall be provided to contacts designated by the City.

3. Return-To-Work Program: Contractor shall obtain disability information and temporary restrictions from the primary treating physician and forward them to the City within 24 hours of the provider appointment. Documentation providing for temporary modified duty, including restrictions and duration shall be entered into the claims management system.

4. Cal/PERS Disability Retirement Services: Contractor shall cooperate with all inquiries made in relation to disability retirement applications for City employees. Such cooperation shall include, but is not limited to, responses to verbal and written inquiries by the City, and provision of documents and case notes as requested. Cooperation may include direct contact, and/or the exchange of information and documents between Risk Management and the assigned worker’s compensation defense attorney. Contractor shall respond to written inquiries regarding the existence and status of WC claims and provide copies of medical files within one (1) week of receipt of a request from Risk Management.
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29 5. Essential Functions Job Analysis (EFJA): Contractor shall obtain from Risk Management, the (EFJA) for the injured employee’s generic or specific job class and shall be responsible for sending the (EFJA) to the Qualified Medical Examiner (QME), Agreed Medical Examiner (AME), and/or the primary treating physician prior to the Permanent and Stationary (P&S) determination. Contractor shall obtain the completed form from the evaluator with the medicallegal reports. If one is not available, Contractor shall refer the request for an (EFJA) to an approved vendor within one (1) week.

6. Contractor shall provide Risk Management P&S Reports within two (2) days of Contractor’s receipt.

7. Contractor shall provide Risk Management Work Status Reports within twenty-four (24) hours of receipt.

8. Penalty Reimbursement: Contractor shall be responsible for all costs and penalties incurred as a result of its errors or delays in the administration of claims. This includes, but is not limited to, penalties as a result of failure to determine compensability or to pay claims timely, self-imposed penalties, and penalties imposed by the Workers’ Compensation Appeals Board (WCAB) or other regulatory agencies. Contractor shall reimburse the City, for any such penalties incurred, on a quarterly basis.

9. Payments through the City’s Trust Account: The City requires that certain payments made through the trust account be pre-approved by the Risk Manager or designee. This includes all payments to the Contractor for ancillary services. The Contractor shall cooperate with the City in developing a process so that the bills are paid in a timely manner.

10. Transitional Work Services: The (TPA) shall include these services in the overall agreement administration fee. The services expected under this program include but are not limited to:
• Review of all injuries for which temporary work restrictions are provided • Work with injured employees, physicians, therapists and departments to clarify restrictions, appropriateness of assigned tasks and scheduling of ongoing treatment/therapy while employee remains on transitional duty • Track duration of transitional work assignments within database system in order to meet OSHA/CAL-OSHA reporting requirements
B. Ancillary Services:

The City reserves the right to discuss modifications and additions to the agreed upon agreement services throughout the term of the agreement. Should additional services become desirable, the City of Modesto and the (TPA) shall negotiate the terms of such desired services as appropriate. If the (TPA) is unable to provide any of the below desired services in a manner acceptable to the City, the City of Modesto may identify an alternate service provider and obtain the services in a manner agreeable to all involved parties. The Contractor shall work with and fully cooperate with any managed care vendor(s) selected by the City if not provided for by (TPA).

1. Nurse Case Management Services: The (TPA) shall establish a clear protocol by which Nurse Case Management Services are triggered. Nurse Case Management costs shall be allocated to the involved claim files, not included as part of the agreement administration fee, and subject to the prevailing rates. In addition, the Contractor shall not charge the City or the managed care vendor(s) for setting up and maintaining this relationship including, but not limited to, implementation fees, electronic data interface, or scanning fees. The City has established #9..
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30 relationships with two (2) nurse case management providers and wishes to continue utilizing those services.

2. Telephonic/Electronic Claim Reporting: The City desires that authorized individuals have the capacity to electronically complete the Employer’s First Report of Injury (Form 5020) in conjunction with the current Company Nurse telephonic claims reporting service.

3. Preferred Provider Organization (PPO) Network: The (TPA) shall make available to the City participation in an established and extensive PPO network. This PPO must provide significant savings below the medical services fees contained within the State of California Official Medical Fees Schedule. The (TPA) shall provide information on its proposed PPO along with the benefits to the City if treatment is directed to members within the proposed PPO network. The City of Modesto reserves the right to reject use of the (TPA’s) PPO and/or require use of an alternate PPO/Preferred Service Provider.

4. Bill Review Services: The (TPA) shall provide bill review services for all invoices received unless otherwise specified by City. Fees associated with the Bill Review Service shall be on a per-bill basis. For bills submitted by PPO members, the (TPA) shall share a percentage of the savings below the California Official Medical Fee Schedule rates in addition to the per-bill charge. For Joint Ventures or for (TPA’s) without in-house or affiliated bill review services, this function must be contracted to a single bill review company.

5. Utilization Review Services: The (TPA) shall be responsible for evaluating situations that may require and/or benefit from referral to an approved UR provider. It is expected that the experienced examiner will make most first line UR decisions and defer to formal UR assessment when an appropriate medical expertise is needed or when required by the State. The (TPA) shall work with the City to develop utilization standards and guidelines to review treatment requests and outline all review fees to include physician reviews and any automatic per file referral fees.

For Joint Ventures or for (TPA’s) without in-house or affiliated UR services, this function must be contracted to a single UR vendor. The (TPA’s) medical director shall be Board certified as required by law. The (TPA) shall provide monthly reports.

C. Claims Management:

1. Information Technology: The City requires access to the Contractor’s claims management system. Contractor shall provide training in accessing information, creating reports. Contractor shall provide reports within twenty-four (24) hours of a request.

Regardless of the type of claims management system used, the Contractor shall provide City with online, full access for three (3) designated City representatives. The City representatives should have access to, but not be limited to, the following:
• Diary access,
• Status notes,
• Payments & reserves,
• Correspondence to attorneys & investigators,
• Appointment letters,
• Correspondence to physician,
• Correspondence to injured workers and their agency/departments, • Work status access.
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31 The Contractor shall comply with the requirements of the state Electronic Adjudication Management System (EAMS) at no additional charge to the City.

2. Meetings, Audits, Coding, and Training: Contractor shall be responsible for the following:
• Preparing and maintaining a City/Contractor policy and procedure manual, • Preparing status reports for and participating in monthly claims review, meetings with respective Agency/Department liaisons and City,
• Providing documentation for the bi-weekly bill and check register audits, • Participating in Risk Management meetings quarterly and as needed, • Using and updating, as needed, the City’s agency and department location, coding and occupational coding that correspond with City budget and job classifications, and • Utilizing appropriate pay codes for all transactions.

3. General Program Administration:
a. Contractor shall provide a claims team dedicated to the City of Modesto account and sufficient claims personnel so that no claims adjuster will be required to handle more than one-hundred forty (140) open indemnity claims at any one time. The claims count shall be reviewed on a quarterly basis. It is expected that the team will consist of two senior examiners.
b. Contractor shall have sufficient staff at all times to effectively handle the City’s workers’ compensation claims including back-up personnel when primary personnel are unavailable.

Insurance Code Section 11761 requires the Contractor to certify that their personnel meet minimum standards. Contractor will ensure that all claims personnel assigned to the City’s account shall meet the annual requirement for continuing education. In addition, the City requires that all personnel managing claims or contacting the public or employees must fluently speak and write English for the effective administration of this agreement. The City expects that claims staff will meet or exceed the experience and professional qualifications listed below and have successfully completed a background check. i. The Claims Manager, Claims Supervisor, and Claims Adjusters shall be state-certified, Self-Insurance Administrators as set forth in Title 8, California Code of Regulations, Section 15452.
ii. The Claims Supervisor shall have a minimum of five (5) years of workers’ compensation claims experience with a California public agency with public safety employees and at least two (2) years workers’ compensation claims supervisory experience. Supervisors shall not carry caseloads but may handle sensitive claims. iii. Senior Claims Adjusters shall be state-certified and experienced with the competency to handle medical, indemnity and litigated claims. The Senior Claims Adjuster shall have a minimum of five (5) years of workers’ compensation claims experience and a minimum of two (2) years’ experience with a California public agency with public safety employees.
iv. Claims Adjusters handling medical-only claims shall be state-certified with a minimum of three (3) years of workers’ compensation claims experience. #9..
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32 v. Throughout the term of this agreement, City shall have the right but not the obligation to participate in (TPA’s) hiring of personnel to service the City account; however, the City retains the right to reject or require the removal of any individual assigned to the City account without establishment of cause.
vi. Contractor shall conduct training in workers’ compensation law and procedures, claims system procedures, and orientation meetings for the City’s personnel involved in the workers’ compensation program, including supervisors and department liaisons. vii. Contractor shall provide the City with information on changes or proposed changes in legislation and rules and regulations affecting the City’s self-insured workers’ compensation program.
c. Contractor shall identify problem areas and recommended solutions on an on-going basis with City representatives. Contractor shall provide consultation services, as needed, to ensure the success of the program, including cost containment and reduction of losses. d. Contractor shall provide loss and injury reports for the City, as a whole, and for each Agency/Department quarterly and prepare annual stewardship reports, SIP, Cal/OSHA, and other reports as requested.
e. City reserves the right to renegotiate the annual fee in the event of a significant change (e.g. 20%) in the claims inventory or in the number of open claims.

4. General Claims Administration:
a. All correspondence is to be date-stamped and distributed to staff within one day of receipt. b. Claims shall be reviewed and setup within twenty-four (24) hours of receipt. The Contractor shall determine the compensability of claimed injuries and illnesses in accordance with the Labor Code by making a 3-point contact with the injured employee, supervisor, and physician within forty-eight (48) hours of receipt.
c. Contractor shall code claims as first-aid/incident only, medical only, or indemnity. d. Claims Adjusters and supervisors shall respond to phone calls and emails within one working day and to written inquiries within three (3) working days. e. Claims Adjusters will preface any written correspondence to claimants with a phone call to claimant explaining the reason for the correspondence.
f. A copy of the Employer’s First Report Form (5020), shall be forwarded to the Contractor within five (5) days of receipt. If requested, the Contractor shall send a copy of the (5020) to the City within forty-eight (48) hours.
g. Contractor shall review and timely process all claims for workers’ compensation benefits in accordance with the California Department of Industrial Relations (DIR) report and notification requirements.
h. Contractor shall request a report from the Index Bureau on all new indemnity claims.

Subsequent requests should be made every six to twelve months thereafter or earlier if required. #9..
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33 i. Contractor shall determine eligibility for and provide timely payments of medical and indemnity benefits and schedule QME examinations to determine the compensability of claims. Prior to the initial payment of temporary disability, a medical report must be received or the medical provider contacted to establish the nature and extent of injury, causal relation to the alleged incident, treatment plan and estimated return-to-work date. Contractor shall obtain medical reports and contact the medical provider, as needed, for verification of continuing indemnity payments.
j. Contractor shall make disability voucher payments in accordance with the City’s bi-weekly payroll schedule. In the event of continuing disability, the Contractor shall obtain medical documentation and contact the medical provider, as needed, for verification of continuing indemnity payments prior to issuing the temporary disability payment and document all activities in claim notes.
k. Contractor shall set up and maintain appropriate reserves based on ultimate claims cost and, according to SIP requirements, using a diary system for regular review of adequacy, but at least every forty-five (45) days. Contractor shall establish reserves within two (2) days of receipt of the new claims and re-evaluate them at each diary date. The basis for any changes shall be documented in the file. If there are no adjustments, the file should be documented to show that the review was conducted and that no changes are required. l. Contractor shall obtain and evaluate medical reports as to the amount of any residual permanent disability to be anticipated, causation for apportionment and subrogation potential. m. Contractor shall review, compute, and authorize timely payment for mileage and temporary and permanent disability benefits due to injured employees whether paid voluntarily or under Decisions, Orders, Findings & Awards of the WCAB, or Compromise & Release settlements.

Payments shall be paid in accordance with the terms of the settlements and awards, Labor Code, or PRISM Workers’ Compensation Administration Guidelines, whichever provides the timeliest payment to the injured worker.
n. Contractor shall assist in the preparation of litigated cases, negotiation of Stipulated Awards, Compromise & Release settlements, and subrogation actions. Contractor shall not assign attorneys without first obtaining approval by the Claims Supervisor and the City. The Contractor shall utilize City approved defense firms/attorneys. The Contractor shall send copies of all legal referral letters outlining issues to be handled, status of case, and supporting documents to the City.
o. Contractor shall evaluate and arrange for the investigation of questionable claims and the disability status of injured employees in order to adjust all claims, minimize disability, and assist in the trial or settlement of claims in a cost-effective manner. Outside investigation services shall be employed only when necessary and only with the Claims Supervisor’s authorization and the City’s approval. The Contractor shall utilize City approved investigators. The Contractor shall send copies of all investigation referral letters to the City outlining issues and desired outcomes.
p. Contractor shall timely report all claims to the excess insurance carrier when the reserves reach (50%) of the City’s Self-Insured Retention (SIR) or as required by the PRISM Excess Workers’ Compensation Claim Reporting and Reimbursement Procedures (see Exhibit B). Upon notice #9..
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34 from the City, Contractor shall post all checks received from PRISM to the appropriate claim file.
q. Contractor shall negotiate State Employment Development Department (EDD) and other liens and attend Mandatory Settlement Conferences (MSC) as required for proper case administration.

EDD payments shall be coordinated with the City’s Human Resources Department. r. Contractor shall code all claims with proper City 2-tier organization codes and City occupational titles.
s. Each open indemnity claim file shall include a plan for case activity and resolution. Such plan shall be reviewed regularly while the claim remains open and identified and dated by the person who established the plan. Open indemnity claims shall be reviewed at thirty (30) days unless there is a compelling reason, as determined by the Claims Supervisor, not to do so (e.g. future medical cases). All such reviews and summaries shall be documented in the claim notes. t. On all future medical award cases, Contractor shall ensure that awards are specific as to the body parts(s) and/or specific condition for which future care has been awarded. Coverage parameters outlined on the P&S report should be stated in file notes and referenced prior to authorization of future medical treatment.
u. Contractor shall complete the Public Self Insurers’ Annual Report and submit it to the City by September 1st of each year.
v. Contractor shall subrogate all claims where a third-party is the cause of the injury and copy the City on initial notice and final resolution. If legal counsel is required, Contractor shall notify the City of such action. The City shall approve all third-party recovery agreements. Reimbursement should be sent directly to the City. Contractor shall post recovery to the appropriate claim file upon notice from the City.
w. Contractor shall follow the settlement authority process in accordance with the City/PRISM settlement guidelines.
x. Contractor shall obtain and review all past medical records as part of the process for managing possible apportionment.
y. Contractor shall maintain complete claim files, including subpoenaed medical records, depositions, defense attorneys’ records, and surveillance and investigation reports. z. Contractor shall administer claims in accordance with the PRISM Claims Administration Guidelines see (Exhibit I) and PRISM Excess Workers’ Compensation Claim Reporting and Reimbursement Procedures see (Exhibit B).

5. Workers’ Compensation Revolving Account:

The City shall establish a revolving fund checking account in an amount to be determined by the parties and confirmed by written document to cover payments and reimbursements applicable to the selfinsured workers’ compensation program. Checks shall be protected with state-of-the-art security measures. The trust fund shall be established in the name of the Contractor as the agent of the City.

Deposits shall be made to the account as required to ensure that funds are available for payments of lawful and approved claim benefits, settlements and allocated expenses, including Labor Code Section #9..
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35 132a claims. “Allocated expense” shall include all WCAB costs, legal fees, copy and process service expenses, independent investigation expenses, expert witness fees, and other costs as approved by the City.

Contractor shall not draw on the fund for any purposes other than for the payment of lawful expenses.

Contractor shall provide the City with a bi-weekly check register in EXCEL format of all payments from the fund. The register shall include, but not be limited to, the date and check number, transaction purpose, name of claimant, claim number, name of adjuster, name of payee, and amount paid.

Appropriate supporting documentation shall be made available upon request from the City. In addition, the Contractor shall provide to the City a monthly check register in EXCEL format.

The City requires that certain payments be pre-approved. This includes any payments made to the Contractor for ancillary services. The Contractor shall assist the City in developing a pre-approval process so that bills are paid in a timely manner.

In addition, the Contractor shall reconcile the revolving fund checking account within three (3) working days of the receipt of the bank statement and provide the information to the City.

Contractor shall develop, implement, and maintain necessary security procedures to safeguard the checks and the funds from fraud.

If the Contractor uses its own bank, the City requires that the bank provide the following:
• Hard copy of the monthly bank statement and a soft copy of the cashed checks in an EXCEL format, and
• An electronic record of the cashed checks showing the front and the back of each check.

6. Medical Administration:
a. Contractor shall coordinate with the City to maintain a panel of medical practitioners for the initial treatment of injured employees including specialists to be used for long-term disabilities, for those requiring special treatment, or for second opinions. b. Contractor shall take a proactive role in handling initial medical control including contacting initial treatment providers within two (2) days of notice of claim. c. Contractor shall redirect care where the injured employee has not initially gone to a designated facility or pre-designated physician.
d. Contractor shall maintain contact with treating physicians to ensure employees receive proper medical treatment and are returned to full or modified employment at the earliest possible date. e. Contractor shall work with the managed care provider(s) to assure appropriateness of treatment and follow utilization review procedures, American College of Occupational and Environmental Medicine (ACOEM) guidelines, and Official Disability Guidelines (ODG). Contractor shall manage medical treatment for the $10,000 cap on all delayed claims. Contractor shall authorize medical case management and nurses per agreed upon criteria and monitor their use for necessity and reasonableness.
f. Contractor shall pay bills in accordance with the California Labor Code. Medical bills shall be reviewed by the Claims Adjuster for relation to injury before being transmitted to the bill review vendor. Prompt and appropriate notice to providers shall be sent regarding any medical charges #9..
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36 that are questionable and/or disputed. Uncontested medical bills shall be paid in accordance with the Labor Code. Contractor shall use appropriate pay code when processing bill payments.

Contractor shall ensure that a utilization review process in compliance with California Labor Code section 4610 (LC 4610) is in place and that Contractor shall ensure a cost-effective efficient bill review process is in place to help minimize medical treatment costs. g. Contractor shall provide complete claims administration and processing of all lifetime medical cases awarded or ordered by WCAB in accordance with current laws and utilization review. h. Contractor shall monitor temporary disability and restricted duty cases. Contractor shall contact the primary treating physician every thirty (30) days on claims where employees remain on temporary disability with the goal of returning employee to temporary modified work or to regular work as soon as possible.
i. Contractor shall monitor all claims where injured employees are on temporary modified work with a goal of returning them to full duty or maximum medical improvement (MMI) as soon as possible. These claims shall be monitored in compliance with City policy.

7. Litigation Management:
a. Contractor shall assist the City in creating a panel of defense firms/attorneys. Defense attorney referrals shall be approved by the Claims Supervisor and the City prior to assignment. b. Cases should be assigned to law firms using criteria specified by the City. Referral to defense counsel shall be authorized by the City.
c. Contractor shall monitor performance of and require all defense attorneys to provide a case summary along with recommendations for resolution and an action plan within 30 days of referral and provide justifications for settlement proposals 30 days before the MSC or trial. The Contractor shall copy the City on correspondence as specified by the City. d. Contractor shall obtain settlement authority from the City and provide such authority to defense counsel at least two (2) weeks prior to Mandatory Settlement Conference and trial dates. e. Contractor shall hold periodic meetings and file reviews on selected cases with Risk Management, department liaisons and defense attorney.

8. Investigation Management:
a. Contractor shall assist the City in creating a panel of investigators and assignment criteria.

Investigation referrals shall be approved by the Claims Supervisor and City. b. Cases should be assigned to investigators by the Contractor on an “as-needed” basis as specified by the City. All claims requiring referral to investigators shall be accompanied by a referral letter outlining the status of the case, issues to be handled. A copy of the referral shall be sent to the City.
c. SIU Investigation Management. Contractor shall develop and implement a process to refer potentially fraudulent claims to the City. If warranted, the Contractor shall prepare the case and refer it to the District Attorney’s Office SIU for prosecution. Contractor shall provide quarterly reports of these activities, including results of sub-rosa investigations. All potential fraudulent claims shall also be referred to the State Department of Insurance and copies be sent to the City. #9..
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37 d. Contractor shall monitor performance of and require all investigators to provide a final report within seven (7) days of receipt of assignment. The Contractor shall copy the City on correspondence as specified by the City.

9. Audit:

The City reserves the right to audit files for claims handling and payments. In addition, the City may require periodic claims audits and/or actuarial studies to be conducted by independent auditors or actuaries, at the City’s expense. Contractor shall cooperate fully with audits and/or actuarial studies at no additional expense to the City. Additionally, Contractor shall provide City personnel and/or representatives with work space and provide aid by locating files and invoices for these audits and studies.

10. Quality Assurance:

The Contractor shall provide the City with a description of its quality assurance program. The program shall include, but not be limited to, the following areas:
• Employee Qualification and Training
o Minimum education and/or work experience requirements for each position o On-going training as required by the state
o Staff meetings
o Performance evaluation
• Claims Handling
o An acceptable staff to supervisor ratio
o Random internal audits
o Regularly updated claims processing manual
o Phone monitoring
• Supervisor’s Qualification and Training
o Minimum education and/or work experience
o On-going training as required by the state
o Credentials and continuing education requirements

11. Reporting Services and Records Retention:

In addition to the information described in, Specific Requirements, Contractor shall provide the City with monthly, quarterly, and annual reports in the format and number requested by the City. Such reports shall include, but not be limited to, the following:
a. Annual “Self-Insurer’s Annual Report” to the California Department of Industrial Relations b. Annual tax statement, including Federal Form 1099 and State Form 599 as appropriate c. Annual Cal/OSHA Log 300 by Agency/Department and by Unit d. Report of claimants off work and claimants on modified duty e. Annual Stewardship Reports
f. Monthly Loss Runs
g. Bi-weekly voucher payment reports. Contractor shall make disability voucher payments in accordance with the City’s bi-weekly payroll schedule. All reports must be received by end of business on “payroll” Monday. Certain holidays may impact payroll processing and the City shall provide at least two (2) weeks’ notice to contractor should the voucher report need to be produced earlier to run payroll.
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38 Standard, Custom and Adhoc Reports shall be furnished at no additional cost. All requests for Custom and Adhoc Reports shall be authorized by the Risk Management Division. Reports identified by the City shall automatically be generated at the intervals specified during the negotiation process.

All claims files, records, and other documents and materials pertaining to the City’s claims shall be the property of the City. They shall be available for the City’s use at any time and shall be delivered to the City upon termination of the agreement.

1.4 PERFORMANCE BASED CONTRACT PROVISION REQUIREMENTS
CSAC Excess Insurance Authority shall conduct a biennial claims audit, which shall be used as one of the bases for evaluating performance, in addition to providing timely, and accurate claim data as requested.

The claims audit shall evaluate compliance with the PRISM Workers’ Compensation Claims Administration Guidelines (claim guidelines). The claims audit shall measure the percentage of compliance achieved in each of seven (7) selected audit categories. If the claims audit composite score is below 90%, penalties to the claim’s administration fees would apply as outlined below.

If the performance as identified by the audit is at a level significantly below the 90% composite score noted previously, such that the City schedules an interim audit with an independent auditor, the cost of said interim audit shall be the responsibility of TPA to reimburse the City upon submission of the paid invoice.

1.5 PENALTY CALCULATION:

TPA can be assessed a penalty of $1,000 or up to $7,000 for each of the audit categories listed below where the composite rating for a category is below 90%:

1.6 AUDIT CATEGORY:
• Medicare Reporting
• Three Point Contact
• Indexing
• Disability Management
• Reserving
• Reimbursement & Recovery
• Excess Reporting

1.7 AUDITOR CONTROLS:

In conducting the annual audit, the auditor shall limit the evaluation to areas directly under TPA’s control.

The audit shall be limited to activity performed by TPA since the previous audit. The sample size obtained for each audit category shall be at least thirty (30) files representing all City claims, or that audit category shall be disregarded. As respects the audit category of “Reserving”, the auditor shall consider file to be complying if reserve changes are properly considered and documented and the auditor’s reserve recommendation is within 5% of the indicated reserve. However, in the event of a dispute the independent auditor’s final opinion shall be the determining factor.

1.8 PAYMENT OF PENALTY:

The penalty shall apply to claims administration fees earned during the July 1st to June 30th contract year during which the audit is completed. The penalty shall be payable in equal monthly installments over the contract year immediately following the subject audit year. (For example, if the audit is completed during the 2012/13 contract year, the penalty shall be assessed during the 2013/14 contract year.) The penalty is separate from the annual administration fee. Should this contract be cancelled, or not renewed beyond the term of this #9..
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39 Agreement, the balance of the penalty shall be payable within thirty (30) days of the termination or nonrenewal.

1.9 CLAIM REPORTS:

The monthly claim reports and bi-weekly voucher reports are to be fully checked for quality prior to submitting to the City, and shall be provided timely. Monthly reports must be received before the 15th of the month and biweekly voucher reports shall be received by end of business on payroll Mondays. Certain holidays may impact payroll processing and the City shall provide at least two weeks’ notice to contractor should the voucher report need to be produced earlier to run payroll. Failure to provide accurate and timely reports shall result in a $100 penalty for the first report missed. Late or inaccurate reporting penalty shall be capped at $2,600 for each contract year, with the penalty being assessed at the end of that contract year.

If the City is required to re-request data due to errors identified due to adjuster or system error, or the reports are submitted after the indicated due date and time, the penalty provision shall apply.

1.10 INSURANCE:

The CONTRACTOR shall provide, at its own expense, and maintain at all times the following insurance with insurance companies licensed in the State of California and shall provide evidence of such insurance to the CITY as may be required by the City Clerk of the CITY. The policies or certificates thereof shall provide that, thirty (30) days prior to cancellation or material change in the policy, notices of same shall be given to the Risk Manager of the CITY via PINS Advantage Insurance Program, for all of the following stated insurance policies.

A. General Liability - insurance with a minimum limit of liability per occurrence of $1,000,000 for bodily injury and property damage. The insurance shall indicate on the certificate of insurance the following coverage and indicate the policy aggregate limit applying to: premises and operations; broad form contractual; independent contractors and subcontractors; products and completed operations; and/or professional liability.

B. Automobile Liability – insurance with a minimum limit of liability per occurrence of $1,000,000 for bodily injury and property damage. This insurance shall cover any automobile for bodily injury and property damage.

C. Workers' Compensation - in compliance with the statutes of the State of California, plus employer's liability with a minimum limit of liability of $1,000,000.

D. Professional Liability – insurance with a minimum limit of $1,000,000 per claim and $2,000,000 policy aggregate. If coverage is on a claim made basis it shall be maintained for at least three (3) years following completion of the work.

If at any time any of said policies shall be unsatisfactory to the CITY, as to form or substance or if a company issuing such policy shall be unsatisfactory to the CITY, the CONTRACTOR shall promptly obtain a new policy, submit the same to Risk Management via PINS for approval and submit a certificate thereof as hereinabove provided. Upon failure of the CONTRACTOR to furnish, deliver or maintain such insurance and certificates as above provided, this agreement, at the election of the CITY, may be forthwith declared suspended, or terminated. Failure of the CONTRACTOR to obtain and/or maintain any required insurance shall not relieve the CONTRACTOR from any liability under this agreement, nor shall the insurance requirements be construed to conflict with or otherwise limit the obligations of the CONTRACTOR concerning indemnification. The CITY, its agents, officers, employees, and volunteers shall be named as an additional insured on all insurance policies required herein, except Workers' Compensation. #9..
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40 The Workers' Compensation insurer shall agree to waive all rights of subrogation against the CITY, its agents, officers, employees, and volunteers for losses arising from work performed by CONTRACTOR for the CITY.

The CONTRACTOR's insurance policy(ies) shall include a provision that the coverage is primary as respects the CITY; shall include no special limitations to coverage provided to additional insured; and, shall be placed with insurer(s) with acceptable Best's rating of A: VII or with approval of the Risk Manager.

For any claims related to this project, the CONTRACTOR’s insurance coverage shall be primary insurance as respects the Entity, its officers, officials, employees, and volunteers. Any insurance or self-insurance maintained by the Entity, its officers, officials, employees, or volunteers shall be excess of the Contractor’s insurance and shall not contribute with it.

CONTRACTOR shall either require any subcontractor to procure and to maintain during the term of the subcontract all insurance in the amounts specified above, or shall insure the activities of subcontractors in the policy specified above. The limits of liability required may vary, depending on the type of permit or contract.

1.11 PRE-PROPOSAL CONFERENCE:

A pre-proposal conference is scheduled for Tuesday, November 30, 2021, beginning at 9:00 A.M. (PT), via Microsoft Teams. Please utilize the following information to join.

Microsoft Teams meeting
Join on your computer or mobile app
Click here to join the meeting
Or call in (audio only)
+1 469-998-7409,48176356# United States, Dallas
Phone Conference ID: 481 763 56#
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Persons attending the pre-proposal conference assume all risks of damage or loss to person and property and specifically release the City of Modesto from liability therefore. #9..
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41 REQUEST FOR PROPOSAL AND SPECIFICATIONS NO. 2021-44
WORKERS’ COMPENSATION CLAIMS MANAGEMENT PROGRAM

GENERAL TERMS AND CONDITIONS

2.1 PROPOSAL SUBMITTAL:

Proposers shall submit two (2) “inked” (preferably blue ink) signed original proposal document, plus one (1) copy of the signed original proposal document and one (1) electronic copy submitted via USB. The original proposal document shall be clearly marked. Photocopies do not constitute an original proposal document.

FAILURE TO FURNISH AT LEAST ONE “INKED” SIGNED ORIGINAL PROPOSAL DOCUMENT MAY RESULT IN DISQUALIFICATION.

It is the responsibility of the proposers to identify information in their proposal responses that they consider confidential under the California Public Records Act. To the extent that the City agrees with that designation, such information will be held in confidence whenever possible. All other information will be considered public.

All costs associated with the preparation of this proposal shall be borne by the proposer.

All exceptions taken to these specifications shall be specifically and clearly identified on the Exceptions, Clarifications, and Amendments Form. Failure to comply with this provision is grounds for proposal rejection.

Exceptions taken shall not affect the overall performance and quality of equipment, materials and/or services required by the City. The Purchasing Manager or designated agent shall make the final decision regarding the acceptability of equipment, materials and/or services with exceptions.

Proposal shall be made in the format specified below. All requested exhibits shall be submitted with the completed Proposal and in the designated format. No oral, telegraph, telephone, facsimile or electronic proposals will be accepted. Failure to comply with all requirements may result in proposal rejection.

2.1.1 PROPOSAL PREPARATION:

Proposal shall be submitted in a three-ring binder with section tabs (A through Z as needed) with responses in the order described below. In those instances where specific questions are asked, each question shall be repeated in the proposal with the response following the question. Extraneous or marketing information shall not be included.

If a service requirement cannot be met, Proposer shall indicate “No Proposal” in the relevant section of the proposal. In this case, proposer may offer an alternative equivalent service.

2.1.2 ACCEPTANCE/REJECTION OF IRREGULAR PROPOSALS:

An agreement shall be awarded to the proposer whose proposal most closely satisfies the needs of the City and is deemed the most advantageous to the City. The City reserves the right to reject any or all proposals or to waive any informalities or minor irregularities in a proposal. #9..
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42 2.1.3 COMPLETE PROPOSAL SUBMITTAL:

The following documents constitute the makeup of a complete proposal submittal:
• Proposal Acknowledgement (Signature Form)
• Pricing Schedule (Signature Form)
• References
• Exceptions, Clarifications, Amendments (if applicable) • Financial Interest Disclosure (Signature Form)
• Company History Statement
• Minimum Requirements
• Addenda Acknowledgement page (if applicable)
• Debarment and Suspension
• Specific Requirements
• Programs
• Third-party Administrator Questionnaire
Failure to furnish any of these documents may result in disqualification.

2.1.4 PROPOSAL PREPARATION:

Proposals shall be prepared in the order listed in Section 2.1.3 Complete Proposal Submittal. Proposals shall be tabbed with dividers. Tabbed dividers shall be clearly marked indicating the appropriate document.

2.2 COMPLIANCE:

Proposers are required to sign the “Pricing Schedule, Financial Interest Disclosure and Proposal Acknowledgement Form” of this proposal document, thereby acknowledging they are in full compliance with all requirements of RFP No. 2021-44, and any addendum to such proposal. Failure to comply may result in disqualification.

The proposer guarantees that the offered equipment, material or services meet all safety requirements applicable in accordance with Cal-OSHA regulations and any other rule or regulation required by the City of Modesto.

2.3 NON-COMPLIANCE:

If you cannot comply with a specification requirement, note as an addendum on the Exceptions, Clarifications, Amendments Form specification paragraph, your exception, and your recommendation. The Purchasing Manager will evaluate your recommendation. If after evaluation it is determined that the proposer is not in compliance with the specification, the proposal may be rejected.

2.4 PRICING FORMAT:

All labor, materials, parts, equipment, tools, licenses and insurance necessary to perform the services shall be included in the proposed pricing.

Unless otherwise stated, the proposer agrees that, in the event of a price decline, the benefit of such lower pricing shall be extended to the City.

2.5 PRICING SCHEDULE:

Proposers shall use the pricing schedule provided in this document to present their proposal. No alterations should be made to the pricing schedule. Any exceptions, amendments or adjustments should be noted on the “Exception, Clarification, Amendments” section on page 13. #9..
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43 2.6 AWARD OF PROPOSAL:

Proposals shall be evaluated by a committee and will be ranked in accordance with the RFP section entitled “Evaluation Criteria.”
The committee shall recommend award to the proposer who, in its opinion, has submitted a proposal that best serves the overall interests of the City, and attains the highest overall point score. Award may not necessarily be made to the proposer with the lowest price.

The City reserves the right to decline to award a contract if it is determined that the proposed pricing is not competitively priced based on similar contracts with public agencies within the State of California.

The City reserves the right to select that proposal, which best suits the City’s needs. Regardless of City staff’s recommendation, the City Council reserves the right to award a contract to the proposer that best suits the City’s needs as determined by the City Council whether or not said award is consistent with City staff’s recommendation for award.

2.7 EVALUATION PROCESS:

Proposals shall be evaluated using a three (3) step process:

Level 1 – Minimum Qualifications Review: The City shall perform an initial responsiveness review to determine compliance and shall notify disqualified Proposers. Proposers that do not meet the “Minimum Qualifications” requirements shall be deemed non-responsive and/or/non-responsible to this RFP and will receive no further consideration.

Level 2 – Proposal Content and Cost Ratings: Proposals that meet Level 1 Minimum Qualifications Review shall be evaluated based on the evaluation criteria “Proposal Evaluation Criteria”. Proposer submittals shall be evaluated and scored. Proposer cost information shall be evaluated as part of Level 2 evaluation process.

Level 3 – Short List (Oral Presentations): At the sole discretion of the Evaluation Committee, a “short list” of proposers may be developed of the highest rated written submissions, based on Level 1 and Level 2 rankings. If the Evaluation Committee chooses, these proposers would be invited to give presentations. Final scoring of “short list” proposals shall be completed upon the conclusion of presentations.

2.8 TERM OF AGREEMENT:

The term of the agreement shall be for a period of two (2) years, with three (3) one-year extension options at the sole discretion of City, for a total of up to five (5) years.

A. Pricing shall remain firm for the first two (2) years of any contract, which may be awarded pursuant to this RFP.

B. Price increases for subsequent agreement years, three, four and five, shall not exceed the Consumer Price Index (CPI) for West Urban Area in any one agreement year, and shall be negotiated through the Purchasing Division. Requests for price increases shall be submitted by Contractor(s) in writing, sixty (60) days prior to the annual anniversary date of the agreement to be effective for the subsequent year.

2.9 QUANTITIES:

The successful proposer shall be required to provide whatever quantities may be required during the agreement term. No minimum or maximum is guaranteed or implied.
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44 2.10 FUNDING:

All annual extensions are based upon continuous funding for that purpose by the City Council. Failure to fund any annual extension shall result in an immediate termination of the agreement without redress.

2.11 INSPECTION AND ACCEPTANCE:

Whenever the product or service provided by the supplier has been delivered to the delivery point, the designated agent shall make the final inspection and acceptance. If upon initial inspection the product or service is found to be defective in its construction or deficient in any of the requirements of this specification, the supplier shall remedy or remove said product in an acceptable manner at the supplier's expense. No compensation shall be allowed for such correction of product, labor, or transportation of product.

2.12 CITY BUSINESS LICENSE:

Prior to beginning any service, that shall be furnished under this specification and proposal, the Proposer shall secure the appropriate Business/Delivery license from the City of Modesto. Business/Delivery license information may be obtained by calling (209) 577-5389.

2.13 OTHER GOVERNMENT/PUBLICLY FUNDED AGENCIES:

If mutually agreeable to all parties, the issuance of any resultant contract/purchase order referencing these specifications and modified by mutual agreement between all parties may be extended to other government or publicly funded agencies. It shall be understood that all terms and conditions as specified herein shall apply.

2.14 NON-DISCRIMINATION:

A. During the performance of this contract, Contractor and its subcontractors shall not unlawfully discriminate against any employee or applicant for employment because of race, color, ancestry, religion, sex, national origin, marital status, age, medical condition (cancer related), physical handicap (including AIDS), or sexual orientation. Equal employment opportunity extends, but is not limited to recruitment, compensation, benefits, layoff, termination, and all other conditions of employment.

Contractor and subcontractors shall ensure that the evaluation and treatment of their employees and applicants for employment are free of such discrimination. Contractor and subcontractors shall comply with the provisions of the Fair Employment and Housing Act (Government Code, Section 12900 et seq.) and the applicable regulations promulgated thereunder (California Administrative Code, Title 2, Section 7285.0 et seq.). The applicable regulations of the Fair Employment and Housing Commission implementing Government Code, Section 12900, set forth in Chapter 5 of Division 4 of Title 2 of the California Administrative Code are incorporated into this contract by reference and made a part hereof as if set forth in full.

B. Contractor and its subcontractors shall give written notice of their obligations under this clause to labor organizations with which they have a collective bargaining or other agreement.

C. Contractor shall include the nondiscrimination and compliance provisions of this clause in all subcontracts to perform work under the contract.

D. Contractor shall permit access by representatives of the Department of Fair Employment and Housing and the City upon reasonable notice at any time during the normal business hours, but in no case less than twenty-four (24) hours’ notice, to such of its books, records, accounts, other sources of information and its facilities as said Department or City shall require to ascertain compliance with this clause. #9..
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45 2.15 NON-DISCRIMINATION OF THE HANDICAPPED:

CERTIFICATION OF PROPOSALDER REGARDING NON-DISCRIMINATION OF THE

HANDICAPPED
By executing this agreement, the proposer hereby certifies that he/she is in compliance with The Americans with Disabilities Act of 1990, the applicable administrative requirements promulgated in response thereto, and any other applicable Federal laws and regulations relating to handicap discrimination and participation, and will continue to do so for at least the duration of the agreement and any extensions thereof.

2.16 DRUG FREE WORKPLACE:

Proposer/Contractor certifies that he/she is in compliance with Sections 8350 - 8355 of Chapter 5.5 of the Government Code, Drug Free Workplace Act. Every person or organization awarded a contract/purchase order or grant for the procurement of any property or service from any state agency (city) shall certify to the contracting or granting agency that it will provide a drug free workplace.

2.17 INDEMNITY:

The CONTRACTOR shall hold the CITY, its agents, officers, employees, and volunteers, harmless from and save, defend and indemnify them against any and all claims, losses, liabilities and damages from every cause, including but not limited to injury to person or property or wrongful death, with the indemnity to include reasonable attorney's fees, and all costs and expenses, arising directly or indirectly out of any act or omission of CONTRACTOR, whether or not the act or omission arises from the sole negligence or other liability of CITY, or its agents, officers, employees, or volunteers relating to or during the performance of its obligations under the Agreement.

2.18 ASSIGNMENT OF RIGHTS:

CONTRACTOR offers and agrees, and will require all subcontractors and suppliers to agree, to assign to the CITY all rights, title, and interest in and to all causes of action it and they may have under Section 4 of the Clayton Act (15 United States code, Section 15) or under the Cartwright Act (Business and Professions Code, Section 16700 et seq.), arising from the purchase of goods, services, or materials pursuant to this contract or any subcontract. The assignment made by CONTRACTOR and all assignments made by subcontractors and suppliers shall be made and become effective at the time the CITY tender’s final payment to CONTRACTOR, without further acknowledgment by the parties (Government Code, Sections 4550-4554).

2.19 CITY PROCESS/PROCEDURE APPROVALS:

CITY approval of any process or procedure shall not relieve the proposer of his/her responsibility to furnish the required items and service meeting all specifications contained herein.

2.20 PROPOSAL/SELLER REPRESENTATION:

The proposer/seller represents that:

A. He/She has had an opportunity to examine and has examined any and all of the documents, including specifications, any resultant purchase order and supporting data, and that he/she has, from the information contained in such documents, specifications, and data, fully acquainted him/her with all conditions relevant to the work.

B. He/She has made all reasonable investigations essential to a full understanding of the difficulties, which may be encountered in performing the work.
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46 C. He/She will complete the work for the compensation stated above.

D. He/She assumes full and complete responsibility for all conditions relevant to the work and all risks in connection therewith.

E. In addition, thereto, the proposer/seller represents that he/she is fully qualified to do the work in accordance with the terms of any Purchase Order issued within the time specified in it.

F. Anything mentioned in the specifications and not in the Purchase Order, or mentioned in the Purchase Order and not mentioned in the specifications, shall be of like effect as if shown or mentioned in both.

In case of difference between the specifications and the Purchase Order, the Purchase Order shall govern.

2.21 FAILURE TO PERFORM SATISFACTORY:

It is agreed and understood that if the CONTRACTOR fails to perform the work as specified herein, CITY's representative may (1) consent to accept such unsatisfactory service with an appropriate adjustment in contract price, based on established cost factors, (2) have such required work done by CITY forces or otherwise, and charge the cost thereof to the CONTRACTOR, or (3) recommend termination of contract between said CONTRACTOR and the City of Modesto. Those discrepancies and deficiencies in the work that remains uncorrected after the date set for correction may be the necessary justification for a billing adjustment in the month following the occurrence. Unless otherwise negotiated, billing adjustments for this incomplete or uncorrected work shall be permanent retention of 100% of the estimated monthly cost for the work not corrected or completed.

2.22 CONTRACTOR'S RESPONSIBILITY FOR DAMAGES:

If CONTRACTOR damages any property belonging to the CITY, the CITY may either retain from the money due to CONTRACTOR an amount sufficient to repair the damage or require CONTRACTOR to repair the damage to the satisfaction of the CITY at CONTRACTOR's expense.

2.23 LABOR FORCE AND SUPERVISION:

CONTRACTOR shall provide sufficient labor at all times to carry out the project properly and shall ensure that fully experienced competent licensed workers who are skilled in the type of work required are employed.

CONTRACTOR shall ensure that supervision is provided at all times while any work under this contract is being performed. If, in the judgment of the CITY, any person is incompetent or disorderly, CONTRACTOR shall promptly remove such person from the work for the duration of the contract.

2.24 PROTEST AND APPEAL PROCEDURES:

Potential offerors, bidders, contractors, and subcontractors wishing to protest or appeal a procurement or contracting decision by the City of Modesto must follow the procedures provided by the section. Protests or appeals which are not submitted in accordance with these procedures will not be reviewed.

DEFINITIONS
For the purposes of this procedure: "Days" means working days in which City Hall is open for business, excluding holidays and weekends.
"Filing Date" or "Submission Date" means the date of receipt by the City Clerk’s office of the City of Modesto. "Interested Party" means an actual or prospective bidder or offeror, or any contractor or subcontractor identified by name in any bid or proposal.
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47 "Bid" includes the term "offer" or "proposal" as used in the context of formal, informal, or negotiated procurements.
"Announced Decision" includes the term “Notice of Intent to Award Letter”. Once the City has issued an Announced Decision, the date noted will begin the time that an Interested Party may lodge a protest.

Procurements valued at $50,000 or less normally will not have an Announced Decision.

A. PROTEST PROCEDURES

1. Any interested party may lodge a written protest to an Announced Decision with the City of Modesto's Purchasing Manager no later than ten (10) days after the Announced Decision.

2. The protest shall be delivered or sent by registered mail and postmarked by the deadline, or protest will be automatically rejected. Protestors who choose to be represented by legal counsel are responsible for the associated expenses.

3. The protest shall be accompanied by a certified or cashier's check in the amount of $300.00, (EXCEPT FOR PROTESTS OF FEDERALLY FUNDED PROJECTS) or in such other sum as the City may establish, made payable to the Clerk of the City of Modesto. Protests filed without the requisite fee will be rejected without any additional review.

4. The protest filed with the Purchasing Manager shall:
a. Include the name, address, and business telephone number of the protestor; b. Identify the project under protest by name, Request for Bid (RFB)/Request for Proposal (RFP) number, and bid/RFP date;
c. Contain a concise statement of the grounds for protest; d. Include all supporting documentation, if any. Documentation submitted after filing deadline will not be reviewed.

All protests shall either be delivered to:

City Clerk’s Office
Attn: Purchasing Manager
1010 Tenth St. Suite 6600
Modesto CA 95354
Or mailed to:

City Clerk’s Office
Attn: Purchasing Manager
PO Box 642
Modesto CA 95353
B. PROTEST REVIEW (ANNOUNCED DECISION)

1. Protest to Purchasing Manager
Upon receipt of a complete and timely protest, the Purchasing Manager shall review all the submitted materials and shall create and retain a written record of the review. The Purchasing Manager shall respond at least generally to each material issue raised in the protest not later #9..
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48 than ten (10) days after receipt of the protest. Notice of the Purchasing Manager's decision may be given by letter mailed through U.S. Postal Service.

2. Appeal to Deputy City Manager
The Purchasing Manager's decision may be appealed in writing to the City of Modesto's Deputy City Manager(s) no later than ten (10) days after the date of the Purchasing Manager’s Decision.

The scope of the appeal shall be limited by the issues raised in the initial protest to the Purchasing Manager. The Deputy City Manager shall not be permitted to review any newly raised issues. The Deputy City Manager shall review the appeal, accompanying supporting documents, if any, and the written record of the protest review by the Purchasing Manager.

A written record of the Deputy City Manager's review shall be created and maintained. The Deputy City Manager shall give notice of his or her decision to the protestor within ten (10) days after receipt of appeal.

All protest appeals shall either be delivered to:

City Clerk’s Office
Attn: Deputy City Manager
1010 Tenth St. Suite 6600
Modesto CA 95354
Or mailed to:

City Clerk’s Office
Attn: Deputy City Manager
PO Box 642
Modesto CA 95353

3. Appeal to City Council
Any protestor seeking to appeal to the decision of the Deputy City Manager may appeal in writing to the City Council by filing with the City Clerk a written notice of such appeal not later than fifteen (15) business days after the date of the Deputy City Manager's decision.

The City Clerk will calendar the protest for Council hearing and give notice of the time and place of the hearing as provided in Modesto Municipal Code Sections 1-4.01 through 1-4.05.

The City Council is the highest authority of the City of Modesto. It is possible that the City Council may reverse the decision of any City staff member at the hearing, or provide other direction to staff. In such cases, staff cannot reverse a City Council decision.

All protests shall either be delivered to:

City Clerk’s Office
Attn: City Council
1010 Tenth St. Suite 6600
Modesto CA 95354
Or mailed to:
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49 City Clerk’s Office
Attn: City Council
PO Box 642
Modesto CA 95353
C. PROTESTS OF PROCUREMENTS EXCEEDING $250,000.00
Interested parties protesting procurements exceeding $250,000.00 shall comply with the procedures contained herein, except that in lieu of appeal to the Deputy City Manager, a protestor may request that the protest be heard and decided at an administrative hearing.

A written request for administrative hearing shall be accompanied by a certified or cashier's check in the amount of $1,500.00, (EXCEPT FOR PROTESTS OF FEDERALLY FUNDED PROJECTS; Refer to Purchasing Procedures Manual for the Transit Division and Federal Transit Administration Funded Purchases, Chapter 14) payable to the City of Modesto, and shall be received by the Purchasing Manager not later than fifteen (15) days after dispatch of the Purchasing Manager's decision. The request for hearing shall include the specific grounds of the appeal.

The City of Modesto shall select and engage an impartial and qualified person to act as hearing officer in the pending protest. The protestor shall have the right to twice reject the selected hearing officer, provided that the City is notified of such rejection within three (3) days of notice to protestor of the name of the hearing officer.

The protest shall be heard not later than twenty (20) days after receipt of protestor's request for hearing and the selection of a hearing officer. Protests not heard in a timely manner shall be deemed withdrawn, unless the City and the protestor mutually agree otherwise in writing. The protestor’s failure to accept a hearing officer after the third attempt by City staff to identify an impartial hearing officer shall be deemed a withdrawal of the protest.

The costs of the hearing officer and expenses of the protest shall be borne by the protestor. The sums deposited with the request for hearing shall be credited to the costs of the hearing officer and other hearing expenses.

The decision of the hearing officer shall be deemed as the final decision of the City, and no other appeal to City Staff or body shall be permitted.

D. PROCUREMENTS OBTAINED WITH FEDERAL FUNDS

1. If the protested procurement involves federal funds, e.g., from the Federal Transit Administration (FTA) of the United States, the Deputy City Manager, City Council, or hearing officer shall give notice, accompanying their respective decisions, to the protestor that he or she has the right to appeal to the appropriate federal agency, for which an agency name, contact (where available) and address shall be provided by City staff. Such an appeal shall be filed with the appropriate agency within seven (7) business days of the dispatch or rejection notices to the protestor. Federal agencies may entertain protests alleging that the City has failed to adopt written protest procedures or has failed to follow such procedures. Appeals to the Federal Transit Administration (FTA) shall comply with FTA Circular 4220.1E and the amendments and supplements thereto. Additional information regarding protesting procurements obtained with Federal Funds can be found in the Purchasing Procedures Manual for the Transit Division and Federal Transit Administration Funded Purchases, Chapter 14. #9..
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50 2. The City Council is the highest authority of the City of Modesto. It is possible that the City Council may reverse the decision of any City staff member at the hearing before Council on the procurement at hand. In such cases, no internal appeal is possible since staff may in no case reverse a City Council decision. In such an event, a disappointed transit bidder or a contract involving expenditures of Federal funds shall have the right to appeal the City Council decision directly to the Federal Transit Administration.

2.25 PAYMENT:
• Paper Payment Method:

All invoices shall be paid in full within thirty (30) days after completion and acceptance of services by the City, and receipt of a properly prepared invoice.
• Electronic Payment Method:

The City of Modesto provides an E-pay Program which involves payment of invoices by a secure Visa account number assigned to the supplier after award of bid or contract. Notification of payments and required invoice information are issued to the supplier’s designed Accounts Receivable contact by email remittance advice at time of payment.

During the evaluation process preference may be shown to proposers that agree to accept E-pay for payment of invoices. Please indicate on the Pricing Schedule whether or not your company will accept the City’s E-pay Program.

Invoice to: City of Modesto
Attn: Accounts Payable
P.O. Box 642
Modesto, CA 95353
Email to: [email protected]

2.26 SAMPLE ANNUAL AGREEMENT:

Please review the Sample Annual Agreement. This Agreement maybe modified and subject to change. #9..
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51 EXHIBIT A

SELF INSURED ANNUAL REPORTS
FY16/17
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52 FY17/18
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53 FY18/19
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54 FY19/20
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55 EXHIBIT B
Workers’ Compensation Claims Administration Standards
Adopted: December 6, 1985
Last Amended: July 1, 2019

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 conflicted 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 bloodborne pathogen exposure protocol.

C. Communication

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

2. Incoming Correspondence
All correspondence 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.
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56 4. Ongoing Claimant Contact
On cases 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
Mandatory 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
Three-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 selfadministered 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 claim’s examiner or supervisor within 90 calendar days of employer receipt of the claim form.

C. AOE/COE Investigation
If 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.
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57 2. The initial reserve shall be electronically posted to the claim within 14 calendar days of receipt of the claim.

E. Indexing
All 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.

PRISM 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 selfadministered 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 selfadministered 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.
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58 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 selfadministered 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.
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59 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 differentials 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- #9..
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60 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 selfadministered 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 nongovernmental 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 thirdparty 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. #9..
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61 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.

Following is the history of amendments to this document:

Amended: 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
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62 Exhibit C
EWC Reporting
CSAC EXCESS INSURANCE AUTHORITY EXCESS WORKERS’ COMPENSATION CLAIM

REPORTING AND REIMBURSEMENT PROCEDURES
In accordance with the Conditions Section of the Memorandum of Coverage:

1. All Workers’ Compensation claims meeting the following conditions are to be reported to the PRISM within five (5) working days of the day on which it is known the criterion is met. a. Any occurrence for which total incurred (total paid to date plus remaining reserves) exceed 50% of the member’s SIR.
b. The reopening of any claim in which further award might exceed 50% of the member’s SIR.
c. Any occurrence involving:
• Death
• Injury to the spinal cord
• Amputation of a major extremity
• Serious head injury
• Severe burns
• Permanent total disability as defined by law
• An occurrence involving serious injury to two (2) or more employees

2. EIA has developed a First Report Form that requires narrative discussion of the pertinent issues. When properly completed this should eliminate the need to forward any file material to EIA.

3. Subsequent to reporting, additional information including a complete copy of the member’s claim file may be requested by the EIA at any time.

4. The EIA, at its own discretion, may become actively involved in the day to day handling of any claim.

5. Although the member’s third-party administrator should be performing all reporting, it is the ultimate responsibility of the member to report to the EIA.

6. Once total payments per occurrence exceed the SIR, the member or its third-party administrator shall submit a PRISM reimbursement request form summarizing the amounts paid for Indemnity, Medical, Vocation Rehabilitation and Expenses, a record of any dollars recovered for duplicate payments, and a data processing run that specifically includes:
a. Check or warrant number
b. Issue date
c. Payee
d. Paid Amount
e. Disability period or dates of service
f. Payment Type
After the initial reimbursement, subsequent reimbursement requests shall be submitted in the same manner as described above, on a quarterly or semi-annual basis depending on claim payment activity.

7. In accordance with the Conditions Section of the Memorandum of Coverage, no settlement, either Compromise and Release or Stipulation, may be entered into without the prior written consent of EIA.
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63 8. In the absence of full documentation of payments, the EIA will make partial reimbursements for those amounts in excess of the SIR for which valid evidence of payment has been provided, as outlined in paragraph 6 above. The balance of amounts to be reimbursed will be paid upon receipt of valid evidence of payment.
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Workers’ Compensation Claims Management Program

SAMPLE STANDARD AGREEMENT

FOR CONSULTANT SERVICES
THIS AGREEMENT, made and entered into in the City of Modesto, State of California, this day of , 2022 (“Effective Date”), by and between the CITY OF MODESTO, a municipal corporation of the State of California, hereinafter referred to as "City", and ___________________________, a California corporation, hereinafter referred to as "Consultant."
This Agreement is made with regard to the following recitals:

A. The City has determined that a Workers’ Compensation Claims Management Program is needed to process claims for the City.

B. Consultant represents that it is qualified, willing and able to provide the services to prepare said document(s).

NOW, THEREFORE, in consideration of this agreement, and the mutual promises, covenants, and stipulations hereinafter contained, the parties agree as follows:

1. SCOPE OF SERVICES.

Consultant shall undertake and complete the preparation of the scope of work as set forth and described in the RFP documents attached hereto and referred to as Exhibit "A" or "project". The Consultant shall perform the services as described in Exhibit "A" in a manner compatible with the standards of its profession, and shall produce a fully complete project that is acceptable to City.

2. TERM OF AGREEMENT.

This Agreement is effective for a term date of Month, Day, Year to Month, Day, Year, with the option to extend on an annual basis for up to three (3) additional years and will continue in effect until City's acceptance of and payment for all services #9..
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Workers’ Compensation Claims Management Program
authorized by City and performed by Consultant, unless terminated earlier in accordance with the provisions of the termination clause in this Agreement.

Price increases for subsequent years shall not exceed the Consumer Price Index (CPI) for West Urban Area in any one agreement year, and shall be negotiated through the Purchasing Division. Requests for price increases shall be submitted by Consultant(s) in writing, at least sixty (60) days prior to the annual anniversary date of the agreement to be effective for the subsequent year.

3. COMPENSATION.

Consultant agrees to accept a sum not to exceed $XX AND XX/100 DOLLARS ($XXX,XXX.XX) as full remuneration for performing all services and furnishing all staffing and materials called for in Exhibit "A" and for performance by Consultant of all of its duties and obligations under this Agreement.

The Compensation shall be paid pursuant in the manner and at the times set forth below:

All work to be performed under this Agreement shall be billed at the rates set forth in Exhibit “B” attached hereto, Consultant shall submit monthly invoices to City which include detailed tasks, hours worked, and billable rates for all work completed, and detailed receipts for any out-of-pocket, reimbursable costs paid by Consultant in connection with work performed on this project.

4. OBLIGATIONS OF CONSULTANT.

Throughout the term of this Agreement, Consultant shall possess, or secure all licenses, permits, qualifications and approvals legally required to conduct business.

Consultant warrants that it has all of the necessary professional capabilities and experience, as well as all tools, instrumentalities, facilities and other resources necessary to provide the City with the services contemplated by this Agreement. Consultant further warrants that it will follow #9..
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Workers’ Compensation Claims Management Program
the best current, generally accepted and professional practices to make findings, render opinions, prepare factual presentations, and provide professional advice and recommendations regarding this project.

5. PERFORMANCE BY KEY EMPLOYEE.

Consultant has represented to City that NAME, TITLE, will be the person primarily responsible for the performance of the services referred to in this Agreement.

City has entered into this Agreement in reliance on that representation by Consultant. Consultant therefore agrees that 100 percent (100%) or more of the time to be devoted to the project that is the subject of this Agreement will be that of the above-named person.

6. OWNERSHIP OF DOCUMENTS/TITLE TO DATA.

All materials, documents, data or information obtained from the City data files or any City medium furnished to Consultant in the performance of this Agreement will at all times remain the property of the City. Such data or information may not be used or copied for #9..
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direct or indirect use by Consultant after termination of this Agreement without written consent of the City.

7. NEWS AND INFORMATION RELEASE.

Consultant agrees that it will not issue any news releases in connection with either the award of this Agreement, or any subsequent amendment of or efforts under this Agreement, without first obtaining review and approval of said news releases from City through the City Manager.

8. INTEREST OF CONTRACTOR.

Consultant warrants that it presently has no interest and shall not acquire any interest, direct or indirect, which would conflict in any manner or degree with the performance of services required to be performed under this Agreement. Consultant warrants that, in performance of this Agreement, Consultant shall not employ any person having any such interest. Consultant agrees to file a Statement of Economic Interests with the City Clerk at the start and end of this agreement if so required at the option of City.

9. AMENDMENTS.

Both parties to this Agreement understand that it may become desirable or necessary during the execution of this Agreement, for City or Consultant to modify the scope of services provided for under this Agreement. Any material extension or change in the scope of work shall be discussed with City and the change and cost shall be memorialized in a written amendment to the original agreement prior to the performance of the additional work.

10. INDEPENDENT CONTRACTOR.

All acts of Consultant, its agents, officers, and employees and all others acting on behalf of Consultant relating to the performance of this Agreement, shall be performed as independent contractors and not as agents, officers, or employees of City. Consultant, by virtue of this Agreement, has no authority to bind or incur any obligation on behalf of City.

Consultant has no authority or responsibility to exercise any rights or power vested in the City.

No agent, officer, or employee of the City is to be considered an employee of Consultant. It is understood by both Consultant and City that this Agreement shall not under any circumstances be construed or considered to create an employer-employee relationship or a joint venture.

Consultant, its agents, officers and employees are and, at all times during the terms of this Agreement, shall represent and conduct themselves as independent contractors and not as employees of City.

Consultant shall determine the method, details and means of performing the work and services to be provided by Consultant under this Agreement. Consultant shall be responsible to City only for the requirements and results specified in this Agreement, and, except as expressly provided in this Agreement, shall not be subjected to City's control with respect to the physical action or activities of the Consultant in fulfillment of this Agreement. Consultant has control over the manner and means of performing the services under this Agreement.

Consultant is permitted to provide services to others during the same period service is provided to City under this Agreement. If necessary, Consultant has the responsibility for employing other persons or firms to assist Consultant in fulfilling the terms and obligations under this Agreement.

If in the performance of this Agreement any third persons are employed by Consultant, such persons shall be entirely and exclusively under the direction, supervision, and control of Consultant. All terms of employment including hours, wages, working conditions, #9..
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discipline, hiring, and discharging or any other term of employment or requirement of law shall be determined by the Consultant.

It is further understood and agreed that Consultant must issue W-2 forms or other forms as required by law for income and employment tax purposes for all of Consultant's personnel.

11. ASSIGNMENT.

Neither this Agreement nor any portion thereof shall be subcontracted or assigned without the express prior written consent of the City in each and every instance.

12. PATENT/COPYRIGHT MATERIALS.

Unless otherwise expressly provided in the Agreement, Consultant shall be solely responsible for obtaining the right to use any patented or copyrighted materials in the performance of this Agreement. Consultant shall furnish a warranty of such right to use to City at the request of City.

13. NOTICES.

Any and all notices permitted or required to be given hereunder shall be deemed duly given and effective (a) upon actual delivery, if delivery is by hand; or (b) five (5) days after delivery into the United States mail if delivery is by postage paid registered or certified (return receipt requested) mail. Each such notice shall be sent to the parties at the address respectively #9..
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indicated below or to any other address as the respective parties may designate from time to time.

FOR Consultant:

Name:

Address:

Attention:

Phone: ( )
FOR CITY:

Name:

Address:

Attention:

Phone: ( )

14. INSURANCE REQUIREMENTS.

The Consultant shall provide at its own expense and maintain at all times the following insurance with insurance companies licensed in the State of California and shall provide evidence of such insurance to the City as may be required by the Risk Manager of the City. The policies or certificates thereof shall provide that, thirty (30) days prior to cancellation or material change in the policy, notices of same shall be given to the Risk Manager of the City via PINS Advantage Insurance Program, for all of the following stated insurance policies. (a) General Liability insurance with a minimum limit of liability per occurrence of $1,000,000 for bodily injury and property damage. This insurance shall indicate on the certificate of insurance the following coverages and indicate the policy aggregate limit applying to: premises and operations; broad form contractual; independent consultants and subconsultants; products and completed operations; and/or professional liability. (b) Automobile Liability insurance with a minimum limit of liability per occurrence of $1,000,000 for bodily injury and property damage. This insurance shall cover any automobile for bodily injury and property damage.
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(d) Professional Liability (Errors and Omissions) Insurance with a minimum limit of $1,000,000 per claim, $2,000,000 policy aggregate. If coverage is on a claim made basis it shall be maintained for at least three (3) years following completion of the work.

If at any time any of said policies shall be unsatisfactory to the City, as to form or substance, or if a company issuing such policy shall be unsatisfactory to the City, the Consultant shall promptly obtain a new policy, submit the same to the Risk Management via PINS for approval and submit a certificate thereof as hereinabove provided. Upon failure of the Consultant to furnish, deliver or maintain such insurance and certificates as above provided, this Agreement, at the election of the City, may be forthwith declared suspended or terminated.

Failure of the Consultant to obtain and/or maintain any required insurance shall not relieve the Consultant from any liability under this Agreement, nor shall the insurance requirements be construed to conflict with or otherwise limit the obligations of the Consultant concerning indemnification. The City, its agents, officers, employees, and volunteers shall be named as an additional insured on all insurance policies required herein, except Workers' Compensation and Professional Liability. Consultant shall provide City with separate endorsements evidencing proof of the City’s additional insured status as to both the general liability and automobile liability insurance policies. The Workers' Compensation insurer shall agree to waive all rights of subrogation against the City, its agents, officers, employees, and volunteers for losses arising from work performed by Consultant for the City. In addition, Consultant shall provide City with a Workers Compensation subrogation waiver by way of a separate endorsement. The Consultant's insurance policy(es) shall include a provision that the coverage is primary as respects the City; shall include no special limitations to coverage provided to additional insured; and, shall be placed with insurer(s) with acceptable Best's rating of A: VII or with approval of the Risk Manager. The Consultant must deliver certificates evidencing existence of the insurance listed above to the City prior to the time the agreement is signed. #9..
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All endorsements referenced above must include the applicable policy number.

15. TERMINATION OF AGREEMENT.

Termination by City for Default of Consultant
Should Consultant default in the performance of this Agreement or materially breach any of its provisions, at its option, City may terminate this Agreement by giving written notification to Consultant. The termination date shall be the effective date of the notice. For the purposes of this section, material breach of this Agreement shall include, but not be limited to, any of the following: failure to perform required services or duties, willful destruction of City's property by Consultant, dishonesty or theft.

Termination by City for Convenience
TheCitymay also terminate theConsultant's performance underthe Agreement, eitherin whole orin part, at its own discretion, or when conditions encountered duringthe work make it impossible orimpracticable to proceed, or when theCityis prevented fromproceedingwith the Agreement by act of God, by law, or by official action of a public authority, or upon a determination by the City that such termination is in the best interest and convenience of the City, or whenever the City is prohibited from completing the work for any reason. TheCityshall provide no lessthan ten (10) calendar days written notice of its intent to terminate the Agreement for convenience, and shall endeavor to provide the Consultant with consultation with the City prior to termination.

Termination by City for Lack of Budgeted Funds
The City may terminate this Agreement effective July 1 of any given year upon the City's determination to not appropriate sufficient funds for this Agreement for the ensuing fiscal year. In such event City shall give Consultant not less than 30 days written notice of termination.
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Termination by City for Change of Consultant's Tax Status If City determines that Consultant does not meet the requirements of federal and state tax laws for independent contractor status, City may terminate this Agreement by giving written notice to Consultant. The termination date shall be the effective date of the notice.

Post-Termination Procedures
If this Agreement is terminated pursuant to this Section, Consultant shall:

2. Terminate all orders and sub-consultants except as necessary to complete any portion of the work that is not terminated;

4. Deliver or otherwise make available to the City all data, drawings, specifications, reports, estimates,summaries and such other information and material as mayhave been accumulated by the Consultant in performing the work whether completed or in process;

5. Settle outstanding liabilities and claims, subject to the approval of City;
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6. Complete performance of such part of the work as has not been terminated;

7. Take such other actions as may be necessary, or as may be directed by the City for the protection and preservation of the Work and/or property related to the work;

8. If City so requests, and at City's cost, Consultant shall provide sufficient oral or written status reports to make City reasonably aware of the status of Consultant's work on the project.

City will pay Consultant an amount based on the percentage of satisfactory work completed in accordance with the notice of termination. If the Agreement is terminated pursuant to the subparagraph entitled Termination by City for Default of Consultant, Consultant understands and agrees that City may, in City's sole discretion, refuse to pay Consultant for that portion of Consultant's services which were performed by Consultant on the project prior to the termination date and which remain unacceptable and/or not useful to City as of the termination date. The final payment to the Consultant after termination for convenience shall be limited to amounts due and owing under the Agreement at time of termination, including the following:
a. The cost of settling and paying valid claims arising out of the termination of the work such as sub-consultant agreements or contracts for materials;
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b. The Agreement price allocable to the portion of the work properly performed or goods supplied to the work site by the Consultant as of the date of termination, as determined in accordance with the notice of termination, reduced by any sums previously paid to the Consultant.

16. INDEMNITY.

The Consultant shall hold the City, its agents, officers, employees, and volunteers, harmless from and save, defend and indemnify them against any and all claims, losses, liabilities, judgments or damages from every cause, including but not limited to injury to person or property or wrongful death, including reasonable costs and expenses of defense of any judicial or administrative action, arising directly or indirectly out of any act or omission of Consultant whether or not the act or omission arises from the sole negligence or other liability of City, or its agents, officers, and employees or volunteers relating to or during the performance of its obligations under this agreement.

Consultant's obligation to defend, indemnify, and hold the City, its agents, officers, and employees harmless under the provisions of this paragraph is not limited to or restricted by any requirement in this Agreement for Consultant to procure and maintain a policy of insurance.

17. ENTIRE AGREEMENT.

This Agreement and its exhibits contain the entire understanding between Consultant and City. Additional or new terms contained in this Agreement which vary from Consultant's proposal are controlling and are deemed accepted by Consultant by shipment of any article or other commencement of performance hereunder. All previous proposals, offers and communications relative to this Agreement, whether oral or written, are hereby superseded except to the extent that they have been incorporated into this Agreement. No future waiver of #9..
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or exception to any of the terms, conditions, and provisions of this Agreement shall be considered valid unless specifically agreed to in writing by all the parties.

18. PARTIAL INVALIDITY.

If any provision in this Agreement is held by a court of competent jurisdiction to be invalid, void, or unenforceable, the remaining provisions shall nevertheless continue in full force without being impaired or invalidated in any way.

19. WAIVER.

The waiver by any party to this Agreement of a breach of any provision hereof shall be in writing and shall not operate or be construed as a waiver of any other or subsequent breach hereof unless specifically stated in writing.

20. AUDIT.

Consultant agrees to retain reports, records, documents, and files related to charges under this Agreement for a period of four (4) years following the date of final payment for Consultant services. City's representative shall have the right to reproduce any of the aforesaid documents.

21. GOVERNING LAW.

This Agreement shall be governed according to the laws of the State of California.

22. HEADINGS NOT CONTROLLING.

Headings used in the Agreement are for reference purposes only and shall not be considered in construing this Agreement.
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23. COMPLIANCE WITH LAWS.

24. CITY BUSINESS LICENSE.

Consultant shall have a City of Modesto business license. #9..
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IN WITNESS WHEREOF, the City of Modesto, a municipal corporation, has authorized the execution of this Agreement in duplicate by its City Manager and attestation by its City Clerk under authority of Resolution No. 2022- adopted by the Council of the City of Modesto on the day of ,2022, and CONSULTANT, has caused this Agreement to be duly executed in duplicate as of the Effective Date.

CITY OF MODESTO, CONSULTANT, INC.
a municipal corporation a California corporation*
By ___________________________ By________________________________ JOSEPH P. LOPEZ, City Manager Name Title

By ________________________________
Name Title
ATTEST:
(Seal)
By ___________________________
DANA SANCHEZ, Interim City Clerk
Consultant’s Federal ID #XX-XXXXXXX
APPROVED AS TO FORM:

By ________________________________
JOSE M. SANCHEZ, City Attorney
APPROVED AS TO FORM:

By ________________________________
CHRISTINA D. ALGER,
Director of Human Resources (Risk)
* Corporations - signature of two (2) officers
required or one (1) officer plus corporate seal
* LLC - signature of two (2) officers required
Partnership - signature of a partner required
Sole Proprietorship - signature of proprietor
required
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Athens Administrators, Inc.

P.O. Box 696
Concord, CA 94522
Specification No. 2021-44
Workers’ Compensation Claims Management Program
Proposal Opening Date: December 28, 2021, At 11:00 A.M.

City Clerk
City of Modesto
1010 10th Street, Suite 6600
Modesto, CA 95354
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ORIGINAL
Response to Request for Proposal (Specification No. 2021-44) Due December 28, 2021, 11:00AM
Prepared for

CITY OF MODESTO
Prepared by:

Third Party Administrator of Workers’ Compensation Claims 2552 Stanwell Drive
Concord, CA 94520
Kevin Cichurski, Director of Sales • Office – (925) 826-1103; Cell – (925) 822-7224 • [email protected] #9..
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City of Modesto
REQUEST FOR PROPOSAL AND SPECIFICATIONS NO. 2021-44
FOR
WORKERS’ COMPENSATION CLAIMS MANAGEMENT PROGRAM
Table of Contents Tab
Cover Letter 1
Proposal Acknowledgement 2
Pricing Schedule 3
References 4
Financial Interest Disclosure 5
Company History Statement 6
Minimum Requirements 7
Addenda Acknowledgement 8
Debarment and Suspension Statement 9
Specific Requirements 10
Programs 11
Third-party Administrator Questionnaire 12
Questionnaire Attachments
Organizational Chart 13
Concord Office WC Department Organizational Chart 14
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Athens Litigation Guidelines 21
Additional Response Attachments
Athens Administrators_ Self-Insured Administrators Certificate 2020_2023 22 Athens Administrators_CA DOI Independent Adjuster Lic._Exp. 05.31.2022 23 Athens Administrators_State of California Certificate of Status 24 Transition Plan Tracking_Timeline 15
Onboarding Checklist 16
Sample RMIS System Reports 17
Sample CalOSHA Reports 18
Sample Stewardship Report 19
Workers’ Compensation Claims Best Practices 20
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December 15, 2021
Carol Wattle, Buyer
City of Modesto
1010 10th Street, Suite 6600
Modesto, CA 95354
RE: Response to Request for Proposal (Specification Number 2021-44) For Workers’ Compensation Claims Management Program
Dear Ms. Wattle:

Athens Administrators, Inc., a local Bay Area California S Corporation of approximately 390 employees, is pleased to submit our proposal to provide Claims Management of Workers’ Compensation Benefits Including Managed Care & OSHA Reporting services for City of Modesto. We have read the City’s request for proposal and can comply with all the expectations stated within this document. We are confident in our ability to design and implement a program that will satisfy your specific needs and exceed your expectations. We also believe that we will be able to achieve significant reductions in the overall cost of your workers’ compensation program.

This will be accomplished through a high level of communication with your organization as well as applying unique approaches to claim administration that will be applied by experienced staff in a closely managed environment.

Athens Administrators has provided workers’ compensation claims services to self-insured public municipalities throughout California for forty-five (45) years. Since our incorporation in 1976, Athens Administrators has been a family-owned organization. Being privately held, we are able to provide exceptional customer service and have a tremendous amount of flexibility when it comes to developing and implementing programs for our valued client-partners.

We currently have Public Agency clients located throughout the State of California. Our Public Agency clientele include Cities, Transportation Districts, Counties, Park Districts, Fire Districts, Housing Authorities, School Districts, Utility Districts and Water Districts. Athens has a high level of expertise in providing service to California based Public Agencies.

Reasons to Partner with Athens
Athens constantly works to distinguish ourselves for service, innovation and results produced within the California marketplace. We work hard to be better than our competition. We believe that there are several key reasons why we are the best choice TPA for the City.

These include;
→ Value: It is important to offer a great product at a competitive price. Athens maximizes technology and we manage a very efficient company. This allows us to operate in a cost efficient way which allows us to deliver great service at the most competitive prices. → Service/People: The key to successful TPA services is the people who work the claims and that interact with injured workers on a daily basis. Athens’ core business model is to take care of our people and to create an environment that attracts and retains the very best. We have been recognized as a Best Place to Work in the San Francisco Bay area (13) times since 2005. Our staff is stable and happy and they take great care of our clients.

Many TPA’s will claim to “have a great culture”, but only Athens has proof! #9..
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→ Communication: Through the life of a claim communication is crucial. Outside of the conventional methods of communication; phone calls, email and letters, Athens has recently released an outstanding new tool; client claims app and direct text messaging. In today’s fast paced world this is a must have. To date it has been well received by our early adopting clients.
→ Results: TPA’s are regularly audited by clients, reinsurance carriers and by the State. We are proud of the results that we have achieved over the years. In our latest audit, three of our California Workers’ Compensation locations (Concord, Sacramento and Orange) were audited by the Division of Workers’ Compensation. In all three instances we received exceptional audit results. We believe that this points to the consistently high quality claim administration that occurs throughout our entire company. In fact we have passed every audit conducted by the State since our foundation in 1976! → Transparency: Athens provides detailed pricing for all services. There are no hidden or unknown fees.

We have read and understand the entire request for proposal document. Athens Administrators intends to adhere to the provisions described within the RFP and would commit to enter into a binding contract. We have no conflicts of interest that would limit our ability to provide the requested services. We agree to be bound to the terms of our proposal and offer for a period of (120) one-hundred twenty calendar days following the close of the RFP on December 28, 2021, 11:00 AM. Lastly, we have received and included signed copies of all city issued addendums to this RFP as well as attached all applicable licenses to operate and do business in California.

Our core team consists of myself as President, Doug Gibb, EVP Workers’ Compensation Claims and Jeanette Mason, Claims Director. Kevin Cichurski, Sales Director, will be the main contact person for the RFP solicitation process and can be reached at Office (925) 826-1103, Cell (925) 822-7224, Fax (925) 521-8509, via email at [email protected] or at 2552 Stanwell Drive, Concord, CA 94520.

We understand that going through a RFP process may be challenging, but if selected, you can be assured that Athens Administrators will do everything possible to make the transition as seamless as possible for not only the City of Modesto, but also for your injured workers. You will have my full support and commitment that Athens Administrators will deliver as promised and I will always be available directly to respond to any problems or concerns you may have. I will also be the individual responsible for contractual terms outlined in our proposal. Please feel free to contact me directly to discuss our proposal. I can be reached at (925) 826-1100 or toll free 866-482-3535 extension 1100, Fax (925) 609-5401, email [email protected].

Best Regards,
James R. Jenkins, President
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REQUEST FOR PROPOSAL AND SPECIFICATIONS NO. 2021-44
WORKERS’ COMPENSATION CLAIMS MANAGEMENT PROGRAM
11 REFERENCES
All proposers must provide a list of five (5) current or former clients in the area provided below, identifying prior experience with the same type of services requested by the City under Scope of Work. References shall have similar volume and requirements to those outlined in these specifications, terms and conditions.

Proposer’s failing to provide references shall be deemed unacceptable.

Company Name: East Bay Regional Park District
Address: 2950 Peralta Oaks Court
City, State, Zip Code: Oakland, CA 94605
Contact Person: Sean Donnelly, Risk Management
Email Address: [email protected]
Telephone Number: (510) 544-2171
Type of Business: Public Agency
Date of Service: 2012 - present
Annual Contract Value $243,000
Company Name: City of Stockton
Address: 400 E Main Street, 3rd Floor
City, State, Zip Code: Stockton, CA 95202
Contact Person: Timothy Claiborne, Risk Manager, Safety Officer Email Address: [email protected]
Telephone Number: (209) 937-8618
Type of Business: Public Municipality
Date of Service: 2018 - present
Annual Contract Value $705,223
Company Name: County of Marin
Address: 3501 Civic Center Drive
City, State, Zip Code: San Rafael, CA 94903
Contact Person: Karen Shelar, Risk Manager
Email Address: [email protected]
Telephone Number: (415) 473-6445
Type of Business: Public Agency
Date of Service: 2019 - present
Annual Contract Value $342,000
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REQUEST FOR PROPOSAL AND SPECIFICATIONS NO. 2021-44
WORKERS’ COMPENSATION CLAIMS MANAGEMENT PROGRAM
12 Company Name (Proposer): Athens Administrators, Inc.

REFERENCES-CONTINUED
Company Name: County of Solano
Address: 675 W. Texas Street, Suite 1800
City, State, Zip Code Fairfield, CA 94533
Contact Person: Melissa Tharp, Risk Analyst
Email Address: [email protected]
Telephone Number: (707) 784-6186
Type of Business: Public Agency
Date of Service: 2015 - present
Annual Contract Value $464,000
Company Name: City of Ventura
Address: 501 Poli Street, Suite 210
City, State, Zip Code Ventura, CA 93001
Contact Person: Lisa Oland, Risk Manager
Email Address: [email protected]
Telephone Number: (805) 654-7760
Type of Business: Public Municipality
Date of Service: 2017 - present
Annual Contract Value $223,000
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Company History Statement
Foundation of Athens Administrators
Founded in 1976, we have delivered over 45 years of measurably outstanding service and results.

We provide third party workers’ compensation, liability, and managed care services to a variety of organizations. Engaged, effective and constantly evolving, Athens Administrators offers companies an industry leading claims administration partner as committed to their success as they are. We are real people delivering real results, offering our clients expert guidance with a personal touch as we help them navigate the many complexities of the claims administration landscape.

Athens Administrators is wholly owned, private, “S” type corporation owned by Jim Jenkins, Chairman and James Jenkins, President. Athens Administrators is a third generation, familyowned Northern California based business. In 1976, Athens Administrators was established to begin servicing self‐insured, workers’ compensation clients. Since that time, we have consistently grown and expanded. Today we have 380 employees in our organization and manage tens of thousands of open claims encompassing $2.5 billion in total incurred, with a significant amount of public entity experience that includes the administration of claims that involved LC 4850 benefits. Athens maintains four (4) workers’ compensation office locations within California (Concord, Orange, Agoura Hills and San Diego).

Mission
The Mission of the Athens brand is to partner with clients to create specialized solutions that deliver measurable results, saving our clients time, money, and heartache in the process.

Vision
The Vision of the Athens brand is to become a model for a highly effective, industry leading claims administration organization that is valued and admired for both the results it delivers to customers and the positive impact it has on employees, the industry, and the community. We are committed to doing a great job and exceeding expectations at all levels of the Company, for every client.

Core Values
We believe what sets us apart as an employer and service provider is our Core Values:
- Commitment to Service
- Commitment to Results
- Honesty and Integrity
- Caring Family Culture
They drive our culture, and our culture drives our business to be successful. #9..
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Philosophy & Approach
Athens Administrators’ philosophy is to build strong, long-term partnerships and provide the highest level of claims administration services for our clients. Our focus is to always be excellent in everything we do. We believe in:
 Partnership – We support our clients’ objectives and philosophies by setting goals and regularly communicating with the objective of never surprising our clients. We measure our performance and frequently report back. We are always accountable for our actions.
 People – The people at Athens drive results for our clients. We attract the highest caliber staff and equip them with all of the necessary resources to succeed.  Technology – We continually invest in systems to provide reliable data, which enables all stakeholders to make powerful decisions.
 Service –The key to our success is a sense of urgency to constantly deliver exceptional service to our clients through professionalism, communication and quality.
 Problem Solving – We always ask questions and take the next logical steps. We don’t stop at barriers, we keep moving ahead until we can provide a solution.  Maximum Cost Savings – We achieve maximum cost savings by focusing on return to work, reducing litigation, curtailing medical costs and expediting claim closure.

Our approach is to partner with our clients to provide service that translates into lasting benefits.

Through innovative methods and technologies, we bring solutions to life in ways that save our clients time, effort and money.

By creating close relationships with our clients, we can understand exactly what they need and how best to deliver solutions for their unique business challenges. And we foster an open, collaborative work environment that makes us a team working toward the same goal. #9..
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REQUEST FOR PROPOSAL AND SPECIFICATIONS NO. 2021-44
WORKERS’ COMPENSATION CLAIMS MANAGEMENT PROGRAM

The company history statement shall be prepared on company letterhead and provided with the proposal submittal.

Please see included Company History statement included as separate attachment.

MINIMUM QUALIFICATIONS
Minimum Qualifications are mandatory for proposal consideration, and at a minimum shall include the following:

Financial Stability (Provided in a sealed separate envelope):

Please see included Financial Statements in sealed separate envelope filed with original proposal document.

One complete set of Financial Statements shall be submitted in a sealed separate envelope filed with the (original proposal document), marked with the following:

FINANCIAL STATEMENTS

NAME AND ADDRESS OF PROPOSER
SPECIFICATION NO. RFP 2021-44
WORKERS’ COMPENSATION CLAIMS MANAGEMENT PROGRAM
PROPOSAL OPENING DATE: TUESDAY, DECEMBER 28, 2021 AT 11:00 A.M. 17 #9..
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18 REQUEST FOR PROPOSAL AND SPECIFICATIONS NO. 2021-44
WORKERS’ COMPENSATION CLAIMS MANAGEMENT PROGRAM

This document is only required to be returned should addenda have been issued.

The Proposal is submitted with respect to the changes to the request for proposal and specifications included in addenda numbers:

LIST ALL ADDENDA NUMBERS: ____________________________________________________ Company Name (Proposer):

Addenda #1
Athens Administrators, Inc.
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TECHNICAL RFP RESPONSE City of Modesto
Specific Requirements
REQUEST FOR PROPOSAL AND SPECIFICATIONS NO. 2021-44
WORKERS’ COMPENSATION CLAIMS MANAGEMENT PROGRAM

SPECIFIC REQUIREMENTS
Proposer shall provide detailed information on the following:

Contractor shall be licensed with the California Department of Industrial Relations, Self-Insurance Plans (SIP). A copy of the license shall be provided to the City as part of the proposal response.

We have included within our proposal submission the below documents:

1. California Department of Industrial Relations License to Administer-Expiration June 30, 2023

2. Department of Insurance State of California Claims Adjuster License-Expiration May 31, 2022

3. California Secretary of State Certificate of Status: Active (Good Standing) Proposer shall list their physical office location address, City and State, administering the City’s claims.

If the successful proposer has multiple adjusting locations the City reserves the right to choose which office will adjust the City’s claims.

Athens Administrators proposes that the City’s claims be administered from our Corporate Headquarters in Concord, CA.
 Physical address:

Athens Administrators, Inc.
2552 Stanwell Drive
Concord, CA 94520
Phone (866) 482-3535
 Mailing address:

Athens Administrators, Inc.

P.O. Box 696
Concord, CA 94522
Phone (866) 482-3535
Because of the need to be fully aware of and compliant with the terms of SB899, Contractor shall have a minimum of five (5) years’ experience working with public agencies with public safety employees of combined size equal to the City. The experience shall be within the past eight (8) years. Please provide detailed history.
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Since 1976, for the past 45 years, Athens Administrators has provided claims administration services to public agencies, including cities, counties, and fire districts, throughout California that includes the administration of claims that involved LC 4850 benefits and the providing of benefits to public safety officers. In summary:
• We understand public safety officer presumptions
• We timely and effective administer Labor Code 4850 benefits • We provide high-level stewardship reports that analyze your program on a fiscal year basis • Understand that we are an extension of our public entity clients • Show complete transparency with the public funds that you have entrusted us with To demonstrate our experience, below is a sample listing of self-insured, public agency clients with public safety employees, for whom Athens provides workers’ compensation claims administration services. The scope of work performed for each is Workers’ Compensation Claims Administration, Managed Care, Bill Review and Utilization Review. In addition to the references we have provided, if the city would like to contact any of the below clients, we would be happy to provide their contact information.

Client Claims (annually) Inception
Bay Area Rapid Transit District (BART) 624 2005-current Ventura County Self-Funding Authority (VCSSFA) 555 2019-current County of San Mateo 554 2017-current
City of Stockton 296 2018-current
Fire Agencies Self-Insured System (FASIS) JPA (191 Fire Districts) 261 2005-current County of Imperial 247 2015-current
County of Solano 226 2015-current
City of Ventura 80 2017-current
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TECHNICAL RFP RESPONSE City of Modesto – Programs Response REQUEST FOR PROPOSAL AND SPECIFICATIONS NO. 2021-44 WORKERS’

COMPENSATION CLAIMS MANAGEMENT PROGRAM PROGRAMS
Proposer shall provide a detailed overview of their firm’s processes on the following programs:

A. Claims Management
A Stewardship Approach
Athens takes a “Stewardship” approach to managing claims programs. A true partnership between the customer and the administrator is imperative to the successful management of a workers’ compensation program. This relationship takes a high level of communication, trust and a lot of work.

Our process is interactive and dynamic. We monitor our performance on an on-going basis, analyze effectiveness and review our findings to identify accident cause and source. We present the hard data found in the format of our Sample Stewardship Report to our customers who can then benchmark results and determine strategies to optimize their unique programs.

We also bring to each of our client’s programs state-of-the-art claim cost containment techniques at the onset of all claims. These techniques and standards of performance include thorough investigation of all questionable claims, timely and accurate provision of benefits, management of medical treatment, using the most cost-effective application of all managed care disciplines, litigation management, negotiation/resolution of claims and a strong commitment to returning the employee to work.

Our “Stewardship” approach ensures that adjusters are focused on identifying key issues that have a large financial impact on the overall claim and proactively utilize all available internal and external cost containment resources to address and resolve these issues in an expedient fashion.

The key to good claims management, avoiding penalties and keeping deadlines, is an effective diary system that enables an adjuster to properly manage each claim in an expedient manner.

Adjusters are required to review open Indemnity claims at least every 30 days. Our RIMS system has an automated diary system that is utilized by all our staff. A detailed list of diaries is displayed each time a user logs onto the computer. The automated diary system sets the adjuster diary for 28 days and a Supervisor Diary for 30 days from the date the claim is entered.

A second manual diary is also maintained. At a minimum the claims unit supervisors are required to review open Indemnity claims every 90 days.

Companywide Claims Closing Incentive Program in Place – Fraction of the Action We recognize, as do our clients, that "the longer claims stay open, the more they will cost". As such, we have developed an internal recognition incentive program for our staff called Fraction #9..
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of the Action, which rewards our claim staff up to two extra paid vacation days per quarter if they meet their claim closing goals and their fines and penalties goals. Specifically, for every new claim entered in each quarter, they must close at least 1.25 claims. Everyone participates in this program and bonuses are granted for both individual and team results. Thus, eligibility extends from the mail room staff through the unit supervisors. Competition and peer recognition is accentuated by quarterly posting of individual and team performance and results.

This process is closely monitored and controlled to prevent premature closings.

Lastly, it is our commitment to address the concerns and recommendations from the City in an immediate fashion. We believe that the staffing model provided to the City will allow this, since at the very minimum the City will have a one point-contact person by way of designated supervisor, along with the rest of our executive team if needed.

B. General Program Administration
Athens Administrators understands that the City has issued this request for proposal for a thirdparty administrator to provide workers’ compensation claims management services. As we have provided these services for 45 years, Athens is uniquely qualified. In reading the City’s requirements and reviewing the project schedule, we are able to meet them as stated.

Athens also understands that if we earn the City’s business, we become an extension of the City responsible for its funds and well-being of its employees.

The claims process has become very complex and highly regulated. The focus of our claims team is to manage the claim, control costs, and bring the claim to quick resolutions. To do this there must be a plan and a way to track the process. This is accomplished through detailed workflows, innovative programs, and a tight diary system.

We understand that our role includes cost savings for the City through claim closures, medical management, and managed care cost containment and litigation management.

As stated previously, Athens utilizes a “Stewardship” approach to managing claims programs.

A true partnership between the customer and the administrator is imperative to the successful management of a workers’ compensation program. This relationship takes a high level of communication, trust and a lot of work. Our hands-on team approach is what has led to the development of many strong partnerships over the years. This involves partnering with our clients to assess specific needs and to then develop customized claims management programs that are designed to combat claim exposures and costs. The process is interactive and dynamic.

We monitor our performance on an on-going basis, analyze effectiveness and review our findings to identify accident cause and source. We present the hard data to our customers who can then benchmark results and with our assistance, determine strategies to optimize their unique programs.

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develop customized claims management programs that are designed to combat claim exposures and costs. The key elements of the program are:
 Define - Learn and evaluate needs of the customer
 Perform - Deliver and be accountable to expectations
 Measure - Analyze effectiveness
 Report – Present hard data
 Recommend – Suggest proactive strategies to improve results The process is interactive and dynamic. We monitor our performance on an on-going basis, analyze effectiveness and review our findings to identify accident cause and source. We present the hard data found in the format of our Stewardship Report to our customers who can then benchmark results and determine strategies to optimize their unique programs.

We also bring to each of our client’s programs state-of-the-art claim cost containment techniques at the onset of all claims. These techniques and standards of performance include thorough investigation of all questionable claims, timely and accurate provision of benefits, management of medical treatment, using the most cost-effective application of all managed care disciplines, litigation management, and a strong commitment to returning the employee to work. Our clients are not just the employers but also the employees who have sustained industrial injuries or illnesses while working within the course and scope of their employment.

We focus upon promptly providing these employees the benefits due to them and maintaining open and on-going communication during the course of their claims. Programs that provide this positive approach will produce lower overall workers’ compensation costs, including significantly reduced litigation rates. Our “Stewardship” approach ensures that the examiners are focused on identifying key issues that have a large financial impact on the overall claim and proactively utilize all available internal and external cost containment resources to address and resolve these issues in an expedient fashion.

Additionally, Athens Administrators, along with the City’s input, will develop customized Special Account Instructions. These standards will provide the general approach to our claims administration for the City, which will include instructions and policies on processing all claims.

Athens Administrators has approximately 60% of our business in the public sector arena. With Athens Administrators being so involved and familiar in this arena, we are confident that we would be able to create a successful and cost-effective program for the City and we are uniquely suited to address the specific challenges within the public entity industry.

Specifically:
 Understand that we are an extension of our public entity clients  Show complete transparency with the public funds that you have entrusted us with. #9..
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 We timely and effective administer Labor Code 4850 benefits  We provide high-level stewardship reports that analyze your program on a fiscal year basis  We understand public safety officer presumptions

C. General Claims Administration
Our approach revolves around the life of the claim. Elements include:

Claim Notification
Claims are reported promptly and can be done via phone, fax, e-mail, or the web.

Initial Supervisor Review
Immediately upon receipt, the claims supervisor reviews the claim to identify any potential red flags and to provide initial direction to the claims examiner.

Claim Set-Up
The claim is set up in our SIMS claims system. Custom codes are used for each client to capture required information.

Initial Investigation – 3 Point Contact
The initial investigation is critical to learn the facts of the claim, to confirm coverage, obtain medical information, and to identify any issues or red flags, including:
 Inconsistencies with the claim
 Subrogation potential
 Witnesses
 Pre-existing conditions
 Nature or extent of injuries
 Lost time and available modified work
The initial contact with the injured worker allows the examiner to establish a connection, provide contact information, answer questions, and limit the risk of litigation.

ISO Claim Search
All indemnity claims are submitted to ISO when the claim is received. Subsequent submissions are done every 6 months.

Initial Claim Evaluation and Reserve Analysis
Reserves are based on all information available and reflect the probable ultimate cost of the claims. Reserves are determined by the examiner with oversight and approval by the supervisor.

Compensability Determination
A decision to accept, delay or deny the claim is made within 14 days. Claims placed on delay are reviewed by both the examiner and the supervisor every 30 days until a compensability decision is made. Final decisions are reviewed first with the client.

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Determination of Work Status/Availability of Modified Work Communication with the employer and coordination of benefits is critical. The examiner facilitates the process to notify the medical provider of modified work and obtain work restrictions.

Timely Delivery of Benefits and Notifications
Appropriate benefits are provided timely with required notices. A customized “Care Card” is sent to the injured worker.

Diaries Are Established and Maintained
Diaries are the key to timely claim resolution and lower costs. Automatic diaries for the examiner and supervisor are set and are updated and maintained throughout the life of the claim.

On-Going Communication with All Parties
The examiner will provide regular information and status to the employer and maintain contact with the injured worker while off work.

Document Management, Record Keeping, Reporting
All claim documents are reviewed and approved. They are electronically attached to the claim in our claims management system. Data and information is collected and entered into the claims system. All transactions are maintained for audit purposes. Regular, detailed notes are entered into the system by the claims team. Individual claims reports are provided as requested to the client.

Continuing Return to Work Coordination
The examiner works closely with employer contacts, including Human Resources and Payroll, to coordinate benefits and to facilitate the injured employee’s return to work.

Medical Management
The claims team obtains regular status from the treating doctor and monitors all medical treatment. Medical treatment plans are reviewed for reasonableness. Utilization Review is performed when appropriate. The examiner manages the Nurse Case Manager and schedule QME and medical legal evaluations. All medical bills are submitted for Bill Review. The examiner monitors the Prescription Drug Card and drug usage.

Investigation
The examiner constantly reviews the claim and will recognize any red flags that might occur.

A referral to an investigator will be made if needed with client approval. The examiner will refer the claim to the Special Investigation Unit if there is any suspected fraud.

Vendor Management
The claims team reviews all vendor services and approves all invoices. All bills and invoices are reviewed before being paid.

Litigation Management
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settlements.

Continued Claim Review with Timely Accurate Reserving
Subsequent reviews are performed every 60 days by the examiner and every 90 days by the supervisor. Reserves are adjusted, if necessary, as the case develops.

Permanent Disability
The examiner strives to return the injured worker as soon as possible to pre-injury status. If there are permanent restrictions, they will evaluate the level of permanent disability, identify apportionment, and seek contribution from third party co-defendants.

Settlement and Claim Resolution
Each case is evaluated for settlement potential and value. Authority and approval are provided by the supervisor and client at agreed upon authority levels. The examiner negotiates nonlitigated cases.

Potential Future Medical Award
Claims with ongoing Future Medical Awards will remain open as long as the injured worker utilizes medical treatment. These claims will continue to be closely monitored. Treatment plans will be reviewed, and Utilization Review will be performed when appropriate. There are continued efforts to settle these claims.

Subrogation Efforts
The examiner identifies potential subrogation and seeks recovery from responsible third parties.

Excess Reporting
Claims are monitored for excess policy thresholds. The examiner reports directly to the appropriate excess carrier.

Claim Closure
Once all claim issues have been resolved and payments made, the claim will be promptly closed.

Excess Reporting
The reporting of potential excess cases to the excess carrier is typically based on our client partner’s requirements within the Scope of Service along with the excess carrier’s requirements. Typical reporting requirements followed by our examiners include:
a. when a total reserve for the occurrence exceeds 50% of the City’s SIR

b. when the re-opening of any claim in which further award might exceed 50% of the City’s SIR
c. when any occurrence may involve:
• fatality
• brain injury
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• paraplegics and quadriplegics
• injury to the spinal cord
• amputation of a major extremity
• serious health injury
• serious burns, defined as 2nd or 3rd degree burns involving 25% or more of the body
• permanent total disability as defined by law possible disability of more than nine (9) months
• an occurrence involving serious injury to two (2) or more employees
Claims are monitored for excess policy thresholds and our examiners report directly to the carrier and document the file.

D. Accounting Control

Bank account setups, reconciliations, deposits, and cash disbursements are managed by Athens Administrators' Finance department and are segregated from the Claims department. A separate funding account is utilized for each client to pay claim benefits. Funds are not commingled. To ensure proper segregation of duties, Finance employees who are responsible for bank account setup do not have access to enter payee data, modify payment batches, or print checks.

Two types of bank accounts are utilized to fund benefit payments. If the client elects to establish their payment registers are typically provided to the client as requested.

Alternatively, the client may request that Athens Administrators establish a funding account with the client providing funds for deposit into that account. Athens Administrators' Finance department sets up, reconciles, and manages all funding accounts.

Signature cards for both types of accounts are completed. Athens Administrators has multiple signers, and every check has at least two signatures.

Bank Account Management and Monitoring
Athens Administrators provides each client with system-generated activity reports, including payment registers and financial reconciliation reports. The frequency and distribution of these reports is determined by each client.

If the client utilizes their own bank account, Athens Administrators' Finance department provides payment information to assist them with their own reconciliation. If Athens Administrators maintains a funding account for the client, the timeframes, and procedures for funding these accounts are agreed upon with the client. Funds are received either by check or electronic transfer. We recommend a funding level of twice the average monthly payout. This enables Athens Administrators to continue paying benefits into the second month while the account is replenished for the prior month. Additional requests for funding are made in the event of a large payment or when the account balance drops below the required funding level.

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benefit payments are automatically issued using the client's bank and check information.

Payment Authority
All claim payments are made using the claims management system. Users may enter payments subject to their individual payment authority level. Payments can also be scheduled to recur at specific date intervals subject to the same rules. Payments exceeding an individual user authority level must be entered by another user with higher authority as assigned in system maintenance. Each payment is automatically processed at the time of entry and must be verified before it will be saved. There must be adequate reserves on the claim, the payment category must match the reserve category for that claim, and service dates must be valid. Each payment is automatically searched against a database in the system for OF AC compliance and duplicate payments. Payments can only be made to the claimant, a beneficiary, or a previously entered vendor. Payments can only be made from bank accounts assigned to the client and to that claim.

All payment transactions are dated and identify the user who entered the payment. Payments cannot be deleted and the date and number of payments cannot be edited. Payments can be transferred from one claim to another by users with system authority. The event table maintains a record of all transfer transactions. A payment comment can be added to each claim to alert the payer of pertinent information.

Payments can be entered or approved in the claims management system by the claims staff according to authority levels. Payments over $10,000 must be entered by a supervisor.

Payments over $25,000 must be entered by a division manager. Payments over $100,000 must be entered by the Director. Payments over $300,000 must be entered by the EVP, Workers’ Compensation.

Payments can be entered manually or imported through electronic interface. Payments entered manually are validated by the system at the time of entry for the user's authority level, adequate claim reserves, and active vendor. Payments that are received electronically are uploaded into a payment module that automatically performs the same validation .

After payments have been entered, Athens Finance department performs the payment processing function in the claims management system. Each funding account is reviewed by a Finance representative to ensure that adequate funds are available. A formal check for adequate reserves, payment authority, and vendor validation is performed during payment processing after which the payments are changed to a ready to print status.

All payments are saved within the claims management system. Each payment identifies the claim, payment information including check number, amount, date and payment type, and vendor or payee information. System generated reports are provided to the client and utilized by Athens Administrators staff to reconcile against the claim and the funding account.

When requested by the client, payment information is provided electronically to the bank for positive pay programs and possible fraud detection. These electronic files are provided daily using security protocols required by each bank.
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E. Medical Administration
Cost Containment Services
Our cost containment and medical management programs are offered through Athens Managed Care, Inc. (AMC). We created Athens Managed Care so that we could help provide the highest quality of proactive management of our Workers’ Compensation cases and to help lower claim costs while delivering improved health results for patients.

Athens Managed care offers:
• Experienced Managed Care Team
• Fully Integrated with Claims Systems
• Complete Transparency with Bill Review, Claims and Case Management • Aggressive Claims Management Strategies
• Client Specific Criteria Development
• Highly Efficient Referral Process
• Highest Level of Timeliness, Communication and Accuracy Athens Managed Care services include:
• Bill review
• Utilization review
• Nurse case management
• Pharmacy benefits program
• MPN, PPO networks
• DME networks
• Private investigation
• Radiology network
• Copy services
• Transportation and translation services
The claims team obtains regular status from the treating doctor and monitors all medical treatment. Medical treatment plans are reviewed for reasonableness. Utilization Review is performed when appropriate. The examiner manages the Nurse Case Manager and schedule QME and medical legal evaluations. All medical bills are submitted for Bill Review. The examiner monitors the Prescription Drug Card and drug usage.

Bill Review (Organization Owned)
Our bill review service operations are not run in the traditional manner where either service is done in-house by leasing software or service bureau. We employ a unique hybrid model that we feel maximizes savings, increases turn-around time and provides our clients with the best possible outcomes.
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Currently, AMC, Inc.’s employees total (14) fourteen. All of our staff is experienced in workers’ compensation bill review rules and regulations. Continuing education is constantly being provided and our new hires go through an extensive training program.

Professional qualifications and major job responsibilities of bill review staff include:
a. Administrative staff
All managed care components of the City’s program will be overseen by Athens Managed Care Cost Containment Director, Leann Farlander. She has 24 years of workers’ compensation medical bill review experience and will work closely with the bill review staff. Leann will be tasked with monitoring your program to ensure that we producing the best possible outcomes and achieving the highest level of savings. b. Review staff
All bill review staff dedicated to the City’s account will have at least 5 years of workers’ compensation experience.
c. Provider inquiries staff
The provider inquiries staff is required to have 3 years of workers’ compensation experience, great communication skills and the ability to navigate challenging provider calls.

d. Auditing staff
The auditing staff is required to have 5 years of workers’ compensation experience as they are the most experienced. They have a great understanding of the CA official medical fee schedule and a thorough knowledge of the state’s regulations.

Athens Managed Care, Inc. has a partnership with Accuro Solutions to provide medical bill review, state reporting and PPO networks. All of these services are overseen by Athens Managed Care. This unit is tasked with monitoring the work product, interfacing with our clients and guaranteeing that our program standards are adhered to.

Our software is utilized nationally throughout a wide variety of organizations. The flexibility of this software allows for unique customization to meet the needs of our clients.

We believe that the seamless integration between the claims team and the bill review analyst is invaluable creating an overall ease to the process. The claims team can easily access the resources they need to get things completed in an efficient, expedited manner.

Athens Administrators will ensure that medical bills are reduced to the Official Medical Fee Schedule rates established by the Administrative Director of Workers' Compensation.

Athens Administrators has flexibility and options when it comes to choosing your PPO Networks for Bill Review purposes. We utilize multiple PPO networks, such as Blue Cross and First Health. Our bill review software is state-of-the-art software that is updated on a regular basis to reflect current fee schedules and PPO networks. The medical bill review software system is used to detect a broad range of questionable billing practices, excessive and duplicate charges, over-utilization, and unnecessary services. #9..
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Our qualified trained staff reviews each bill and medical report to determine appropriateness of treatment and to ensure provider compliance with fee schedule ground rules.

Our Cost Containment Program incorporates multiple strategies to control costs, as follows:
• Before costs are incurred: through pre-authorization of inpatient and outpatient treatment plans, according to guidelines and channeling to network providers whenever possible.
• During the life of the claim: by channeling specialty care to network providers, when possible, within the confines of the workers’ compensation statute, early identification of red flags, and through concurrent review of treatment plans against medical necessity and appropriateness guidelines and length of stay/treatment criteria. • Retrospectively: through comprehensive fee schedule audit procedures and application of workers’ compensation network discounts (when applicable).

Once they are scanned the bills are routed to the owning examiner. The examiner then determines if the bill is payable and routes it to Athens Managed Care. A file is created daily and uploaded for processing nightly. All paper bills are converted to an electronic format and OCR is used when processing.

The City will be provided quarterly and monthly bill savings reports in your desired format.

Also, Generate Explanations of Reductions (EOR) containing all required information will be produced for every provider bill that is processed.

Any bill that is not considered your standard medical i.e. physical therapy, chiropractic bill is given special handling and is routed to a more experienced analyst for processing.

Special handling bills are listed below:
• Surgery bills
• In/Out patient hospital bills
• Med-legal
• High level office visits
• By report codes or unlisted CPT codes
• OMFS exempt facilities/services
• Hearing aides
• Air Ambulance
• Critical acute care facilities

Turn-around times are as follows:
• Standard bills: 2-3 business days
• Hospital bills: 5-7 business days
• Negotiations: 3-5 business days
• Complex surgery bills: 5-7 business days
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• Med-legal bills: 3-5 business days
Every bill is date stamped when it is received and that is captured in the bill review system.

There are several turn-around reports that we generate to ensure timelines are met.

Our bill review system has the ability to identify duplicate bills and not issue over payments.

There are numerous data elements: patient name, claim number, DOS, CPT code billed, dollar amount, provider Tax ID#, ICD.9 codes that are crossed checked before a payment recommendation is made. This process ensures that duplicates are zeroed out and no allowance is made
Procedures for handling pending payments with no provider in the system If a provider is not in the bill review system it is placed in pend status and a vendor add request is sent to the claims administrator. We have a dedicated person who performs this task. They obtain the W9 and then add the provider to the daily transfer file. Once the file is uploaded the bill is un-pended and reviewed for payment.

Assisting the City with the new Independent Bill Review process AMC handles all aspects of the IMR process for our clients, the steps are listed below.

Step one –
EOR is received by the provider if they feel that they are due additional monies they can submit a request for a “secondary bill review”
Step two –
Secondary bill review request, the provider has 90 days to submit Step three –
Final EOR determination, the claims administrator has 14 calendar days from receipt of a Request for Second Review to respond with a final written determination on each of the items or amounts in dispute by issuing a final EOR
Step four -
Request Independent Bill Review (IBR) California guidelines state that to qualify for IBR, the following pre-conditions must be met:

1. The provider previously submitted a Second Bill Review within designated timelines.

2. The provider has received the final EOR and still disputes the application of the fee schedule.

3. The provider then has 30 calendar days from receipt of the EOR to elect IBR if they still disagree with reimbursement and wish to pursue an independent determination

All our medial/pharmacy bills are put through our bill review software and all state mandated fee schedules rules and regulations are applied. California utilizes the Medi-Cal fee schedule to ensure that reimbursement costs are applied to the billing. The rates are updated accordingly #9..
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and are reviewed to the prevailing schedule. After the bill is reviewed, a highly experienced expert confirms that the proper reductions were taken.

Utilization Review (Organization Owned)
Athens Managed Care is a URO – Utilization Review Organization and URAC accredited. Our highly experienced teams of nurse(s) and utilization review specialists perform utilization review for Athens Administrators clients. Having our UR process imbedded into our claims handling processes helps to expedite the very sensitive UR timeframes. With the adoption of the new UR regulations it is a huge advantage to have a seamless integrated solution.

Our utilization review program provides prospective, concurrent and retrospective reviews to determine appropriateness of care, frequency and care setting. AMC’s experienced staff of utilization review specialist and peer review physicians utilize medical treatment protocols and expert systems technology to determine the medical appropriateness of care as well as frequency, duration and setting.

Their professional case management staff has an average of 8.5 years of experience in managing California Workers’ Compensation injuries. Additionally, AMC provides our clients with bilingual case management nurses throughout California that include Field & Telephonic services. At the request of the client, AMC offers dedicated, on-site nurses.

All UR and NCM personnel work on the same internet-based software allowing for real-time updates and easy accessibility.

The benefits of having the UR unit connected to the examiners is bountiful. • Communication – Seamless communication
• Information – Robust reporting of your managed care results • Control - Ability to customize your approach to utilization review. • Speed - Expedited timelines in accordance with the guidelines and regulations of SB863
• Efficiency – Integrated referral process leads to quicker service delivery & lower claim costs.
• Relationships – Creating a better connection.

Service Standards and Guidelines
Athens Managed Care works directly with our medical director and peer review providers in order to ensure all processes are in compliance with Labor Code 4610. We began our program by teaming with a knowledgeable medical director who understands the workers compensation system and what is needed for a successful Utilization Review program. We then contracted with a peer review company who has long time experience with regulations and timeframes.

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involved with handling cases understand new regulations, trends in treatment and new case laws which may affect the review process. Our suggested Adjuster Approval Guidelines were reviewed by our director and peer review providers to ensure appropriateness of directing care outside the medical review.

Our software program is completely customizable to the data and workflows needed to ensure the best product is generated. The system generates the due date based on date received, jurisdictions and types of reviews. This provides accurate timeframes without the worry of miscalculations. All records and determinations made save within the system for future viewing. This allows reviewers a complete history of treatment done to date when handling a new request for authorization.

Our Utilization Review program integrates with claims staff to ensure a streamlined process for all parties. Direct communications with examiners allows reviewers to quickly move through the review process, decreasing timeframes and getting determinations to all parties quickly. Our Managed Care team has direct access to the claims system to review important information such as claim status, accepted body parties, and medical history information. This creates a more complete, timely review that is accurate and defendable. This decreases the amount of appeals and overturned Independent Medical Reviews in the future.

Determinations to approve, modify, delay, or deny requests by a physician prior to, retrospectively, or concurrent with the provisions of medical treatment services to employees are done as follows:

Upon receipt of a request for Utilization Review, the file is processed into our program and a notification of case receipt is emailed to the assigned claims staff. The receipt outlines the date received by the adjuster, treatment being requested and all parties associated with the claim.

This allows for a quick check to ensure accuracy in our data and acknowledgment that the file was received. As the case is moved through the Utilization Review process, letters are generated as needed and sent via email to the assigned claims staff and faxed and/or mailed to all appropriate parties. All reviews are flagged with a follow up via fax or email (if necessary) to ensure deliver to the handling claims examiner.

Utilization Review Interaction with Clients and the Independent Medical Review Process (IMR)
Athens Managed Care monitors all Independent Medical Review outcomes. Upon receipt of the Notification of Assignment, claims staff forwards the notice to the Managed Care team.

This document is loaded to the review in our program and flagged for any future reporting requests. We discuss with the claims staff the review and provide any documentation that may have been received on the Managed Care side that they are not showing in the claim file. Once the determination is received from the IMR provider, the claims staff submits the outcome to the Managed Care team. This is also uploaded to the review file and flagged for future reporting. Should the determination be overturned, the Utilization Review department will send out the required written documentation on behalf of the claims staff. Any determinations that are overturned are discussed with the peer review provider to review the rationale and guidelines utilized by the IMR provider to determine if any changes need to be made in the Utilization Review workflow.
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Athens Administrators - Adjuster Authorization Guidelines Below treatments/services should be authorized at the adjuster level. Any treatment/service that falls outside this list or is for a body part that is not accepted, should be referred directly to Utilization Review.
• Plain x‐rays for all orthopedic injuries
• MRI/CT after major trauma, or with documentation of neurological deficit • EMG/NCS after four (4) weeks of conservative treatment (CTS/cubital tunnel syndrome, cervical/lumbar radiculopathy), or less than four (4) weeks of conservative treatment with documented neurological deficit
• Routine pre‐op testing (CBC, chem. panel, CXR, EKG)
• Pain Buster (for shoulder/knee arthroscopy)
• Neoprene brace
• Other braces under $200.00
• Chiropractic treatment – 6 visits or less
• Physical Therapy / Occupational Therapy – 6 visits or less • Physical Therapy / Occupational Therapy – initial 12 post‐op visits • Acupuncture – 6 visits or less
• Home Health Care – post‐op 6 visits or less for assistance with daily activities only; medical Home Health Care (wound care) through UR
• Specialist Referral for consult only; Spine Surgeons, Pain Management, Psychiatrist/Psychologist, General Surgeons should go through UR; request for consult and treatment should go through UR
• Ergonomic Evaluations.

AMC understands that not all clients are the same and that these protocols may not fit the City’s program. These UR protocols can be customized to meet the City’s unique needs.

Athens takes a proactive approach to Utilization Review and is fully compliant with regulatory requirements. Athens currently utilizes Fair Isaac for most of our utilization review. We have worked closely with Fair Isaac to develop efficient work flows in order to meet the stringent time frames for medical management. Frequency, duration, and site of care are reviewed for each case. Once a treatment is pre-authorized, the appropriate documents are submitted to the treating facility and so noted in the claim record for the examiner, auditors and Clients. This information is accessible to all authorized participants. With the efficiencies brought about by AthenScan, our paperless document image system, our examiners are able to electronically submit utilization referrals immediately from their desktop. The Utilization Review responses are returned within 48 to 72 hours of the request or sooner in accordance with any applicable State requirement(s). The examiner receives these results electronically and they are also loaded into our bill review software to ensure that only certified treatment is paid. UR results can also be provided electronically to the employer or defense attorney as requested. Our software allows us to monitor and track these services.

Mechanism for identifying inappropriate utilization patterns Our utilization review software platform allows us to capture a large range of data to review a variety of patterns in treatment. Included in the monthly reporting is a breakdown of the percentage of outcomes, peer review outcomes and percentage of treatments based on category #9..
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types. This reporting allows us to review at a high-level spike in treatment categories and drill down to determine a reason. Our system can also look at individual claims to review provider patterns. Should there be a concern as to the treatment a specific injured worker is receiving or the treatment history of a specific provider, we can review the claims provider history to see how many cases have been reviewed, when the provider first submitted a request and the approval percentage rating. With this type of information, we can easily identify providers that are not meeting the standards of care in correlation with evidence-based medicine and regulated guidelines.

Nurse Case Management
Our goal is to insure efficient, reasonable, and appropriate treatment, support return-to-work efforts, and control or reduce costs. We always consult with the client regarding the desirability of retaining the services. These services are only utilized with the prior consent and approval of the client.

Case Management Services
Athens Managed Care (AMC) understands that the City may occasionally need nurse case managers with specific expertise in addition to the UR process.

AMC oversees a team of Registered Telephonic and Field Case Management Nurses both onsite at Athens Administrators and in the field, who are qualified, licensed professionals with experience in treatment planning, medical and specialty case management.

Our nurse case managers have experience with the following:

Amputations Multiple trauma
Blood-born pathogen exposure Musculoskeletal disorders
Burns Neurological issues
Cardiac Occupational Medicine
Catastrophic case management Onsite case management for employer Catastrophic injury Orthopedic injuries / rehabilitation Case management Patient assessment and education
Chronic pain Physical / occupational rehabilitation
Discharge Planning Reflex sympathetic dystrophy (RSD)
Disease and infection control Repetitive stress
Field case management Risk management
General medicine Spinal cord injury
Head injuries Telephonic case management
Infectious diseases Traumatic brain injury
Initial evaluations Triage
Intensive care Utilization review
Internal medicine Vascular injuries
Kidney transplant Wound / incision site care
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Medical Management
The claims team obtains regular status from the treating doctor and monitors all medical treatment. Medical treatment plans are reviewed for reasonableness.

Utilization Review is performed when appropriate. The examiner manages the Nurse Case Manager and schedules QME and medical legal evaluations. All medical bills are submitted for Bill Review.

Cases that would benefit from medical case management. Some cases require an on-site nurse for field case or limited task assignments. It is recommended the following cases be considered for these types of assignments:
• Lost time of 21 days or more
• Back surgery/fusion or second back injury
• Rotator cuff tear, ACL tear, meniscus tear
• Treater delaying RTW or P&S report
• Slow healing fractures
• Diseases or disorders (RSD, Chronic Pain Syndrome)
• Multiple medical providers, frequent changes in providers • Prolonged light duty with no progression to regular duty • History of multiple work injuries
• Continued missed appointments
• Chronic illness
• Accepted psychiatric issues
• Catastrophic Injuries: Burns, head injuries, spinal cord injuries • No progress noted 6 weeks post-surgery
• Complicated family dynamics
• Hospitalization
• Major multiple fractures, cardiac
• Amputations
Activities to expect from a Case Manager: Upon referral of a case management assignment, the Case Manager follows these timelines:
• Referral Source Contact: Within in (1) day of case assignment, verify and or obtain missing information.
• Attorney Contact (if represented): Within one (1) day of case assignment • Injured worker/Physician/Employer Contact: Within one (1) day of case assignment or attorney authorization
• Initial Interview: Meet as soon as possible with the injured worker, and if possible, attend the next medical appointment or visit hospital or physician office. • Initial Report: Within the first seven (7) days of case assignment Medical Provider Networks
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necessary. Athens Administrators would be available to help evaluate and if necessary, amend the City’s MPN with no additional charges for this service.

Athens can assist the City with selecting medical providers. A review of your current top treaters will be evaluated and reviewed with the City, our nurse case managers and claims examiners. We will help to identity the treaters who you want in the MPN and exclude the ones you do not want in the network.

Additionally, Anthem has and supports hundreds of approved MPNs for clients who are the applicant utilizing Anthem's network and Compliance Vaults for customization, provider finder, affirmations, MAA, outcomes analytics, and more.

Anthem’s service model is transformational because they understand the complexities of MPN compliance and believe in making it easy for adjusters, injured workers and other key stakeholders to obtain quality care within the MPN. Anthem’s MPN includes an expert team that manages compliance with all the regulations and the network performance including enforcing referring within network, prohibition against out of office dispensing, compliance with all required reports, treatment in accordance with MTUS and client’s utilization review.

Anthem’s un-wavering commitment to the quality of their provider data and the client experience is proven by dedicated call centers that verifies over 100K records every year to ensure our provider directory information accuracy. Their proprietary compliance technology includes real time updates for any changes of the provider’s directory information including real time removal of providers that are deceased, retired, or no longer with the group, etc.

Anthem also performs real time removal of all DWC suspended providers or those that are on the California Medical Board Hot List from the network and MPN daily to ensure compliance.

Anthem has direct contracts with providers as the preferred provider network that is utilized for any MPN. Anthem contracts with most providers in the State and represent a significant if not the most significant payor relationship they have. Our clout is leveraged on the client’s behalf to a degree that no other MPN service provider or network can. Only the Chiropractic and Acupuncture networks are leased from American Specialty Health Plan (ASHP).

F. Litigation Management
While we have clients who mandate referral to defense counsel upon receipt of Notices of Representation and Applications for Adjudication, we do not believe that files should automatically be referred to defense attorneys. We have highly trained and experienced claims experts, and they should be able to handle matters of litigation outside the need for #9..
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depositions or WCAB appearances. Even when files are referred to defense attorneys, we continue to direct the claim, and we never defer to defense counsel on matters that can be handled by the claims examiner, which would include the subpoena of records, setting medical or medical-legal appointments, and lodging objections to the treating physicians.

We recognize that there are some cases that are better referred to defense counsel in order to achieve maximum results. These cases generally involve serious complex claims, very questionable claims where significant discovery, including depositions, are required or where there is a great likelihood that the case will go to trial. Referral to a defense attorney only occurs when approved by the City.

When a decision to refer to defense counsel has been made, the examiner will send a narrative letter to the attorney with an outline of the case, the issues and clear directions for further handling by the attorney. This letter must be reviewed and approved by the Claims Supervisor. The examiner will remain actively involved in the claim, continue to direct all legal activity and perform as much of the routing handling as possible on these cases. Once a claim has been referred to defense counsel, the examiner will continue to oversee all activity on the claim.

Settlements
Athens will submit a written analysis of a case, including settlement options and recommendations to Risk Management at least ten working days prior to any settlement offer or conference. Authority will be obtained from Risk Management before any settlement is entered in to. Athens has a customizable settlement authority template which includes financials on the claim (paid, reserved, and incurred). We will work with the City to determine the preferred method of receipt of the authority request (email, U.S. mail, or fax).

Athens, in conjunction with our clients, carefully selects attorneys that are known to us and continue to provide good legal defense. Athens’ philosophy is to select the best individual attorneys, not the firm. Referral to a defense attorney only occurs when approved by the client. We recognize that there are some cases that are better referred to defense counsel in order to achieve maximum results. These cases generally involve serious complex claims, very questionable claims where significant discovery, including depositions, are required or where there is a great likelihood that the case will go to trial. Each client can customize a legal panel based on their choice and/or we can recommend those vendors that will provide the best legal defense and outcome.

Defense attorneys who bill at the traditional fee for service method must agree to work within specific guidelines similar to those outlined below. These guidelines were developed as part of our litigation cost control program in an effort to maintain control over the legal billing process. All legal expenses and bills must be itemized and are reviewed prior to payment. • Itemized by date of activity
• Identify all billing entities
• When there are multiple files, no duplication of charges • All billings should reflect actual time spent
• Prorate all multiple appearances between employers
• Itemize all expense items
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• No bill for inquiries
Monitoring quality and cost of legal work
Athens Administrators values the relationships with all partners and believes that any successful relationship is based on clear and concise expectations for both parties well prior to commencing work together. These entry level discussions should focus on claims handling philosophies, expectations of representation of the City and Athens, as well as agreed upon hourly rates for the service. Once these agreements are in place, Athens Administrators sends a litigation plan and budget request on all legal referrals. The adjuster will aggressively follow up on both items from defense counsel. Upon receipt, a detailed review of both the plan and budget will be completed and documented in claim notes by the adjuster. This review will focus on the proposed legal analysis, legal recommendations, timelines/expected duration of litigation as well as the estimated costs. If we are in agreement with the legal recommendations, action plan and costs, we will continue to work with our attorney and monitor the monthly expenditures to ensure that what is approved is in line with what is being incurred. Should there be a discrepancy identified in the initial review/cost analysis by our adjuster, Athens Administrators will contact the defense attorney to discuss and ensure complete agreement is reached between all parties with full documentation in claim notes.

Additionally, Defense attorneys who bill at the traditional fee for service method must agree to work within specific guidelines like those outlined below. These guidelines were developed as part of our litigation cost control program to maintain control over the legal billing process. All legal expenses and bills must be itemized and are reviewed prior to payment.

• Hourly rates to be broken down in to 1/10ths
• Itemized by date of activity
• Identify all billing entities
• When there are multiple files, no duplication of charges • All billings should reflect actual time spent
• No minimum billing rates
• Prorate all multiple appearances between employers
• Itemize all expense items
• Mileage will be reimbursed at the current IRS rate
• Incoming faxes will not be billed
• Outgoing faxes will be paid on an itemized long distance phone rate • Postage will be paid as an actual itemized cost
• Only bill for long distance phone calls at itemized long-distance rate • No bill for local phone calls
• No bill for inquiries
G. Investigation Management

Investigations
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believe such an investigation is necessary and also obtain the client’s consent prior to making the assignment.

When using outside investigators, we coordinate our assignments with the client and possibly the defense attorney on the claim. Athens works with the client to identify a client contact person so that no unexpected communication is made. Athens has an extremely comprehensive Special Investigation Unit (SIU) program. This program is focused on AntiFraud compliance; which includes maintaining a formal Fraud Plan, annual filings, and training. Through this program, fraud training is available to both Athens staff and directly to our clients.

The claims team receives on-going extensive training on fraud procedures and reporting to the Fraud Bureau. We are experts at identifying and pursuing fraudulent claims activity. We conduct thorough investigations, which includes taking recorded statements on all questionable and delayed claims and utilizing a formal red flag checklist to identify potential fraudulent claims. “Red Flags” or indicators that may prompt an investigation include:
• Anonymous phone call or letter alleging possible fraud • Three or more Index Returns in the past two years involving the claimant • Claimant does not report the injury in a timely manner • Claimant only receives mail at a PO Box and will not provide a home address • Claimant possesses an unusual knowledge about workers’ compensation benefits and claim procedures
• Claimant has received a disciplinary action, been terminated or is disgruntled just prior to the accident
• Claimant is never home
• Claimant’s accident description differs from the medical history • Injury is un-witnessed
• Claimant is known to be active in sports or other strenuous activities • Claimant has calloused, dirty or stained hands
• Claimant misses appointments or refuses treatment
• Conflicting medical reports or inconsistent findings
• Medical reports appear to photocopies or boilerplate reports • Claimant immediately seeks an attorney
These situations often require that a field investigator evaluate the employees in their home environment, listen to their version of events and facts, and personally assess their credibility and witness potential at deposition and/or trial. (This same criterion is often employed in evaluating and securing the statement of key witnesses.) Should the resultant field investigator's report raise additional questions including possible fraud, we may recommend that sub rosa investigation be pursued. Criteria that might trigger such a request by Athens could include:
 Receipt of applicant's medical report that varies greatly from our doctors' as to degree and duration of disability.
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 Missed medical appointments and/or refusal to cooperate with scheduled examinations.  Index Bureau returns indicating a prior pattern of industrial and non-industrial claims.  Evidence of conflicting testimony in deposition.
 Evidence of a second, previously undisclosed job.
 Receipt of a phone call from a co-worker or personal acquaintance as to possible fraud.

Claims requiring outside field investigation require notifying the client as to our reasons we believe such an investigation is necessary and obtain the client’s consent prior to making the assignment. When using outside investigators, Athens provides the action plan instructions and always controls the assignment. Our primary objective is to aggressively investigate and defend the City’s interests while settling claims at the earliest possible time, for the least expense to the City.

Fraud
We are experts at identifying and pursuing fraudulent claims activity. Our staff has received extensive training on fraud procedures and reporting to the Fraud Bureau. In addition to identifying potential fraudulent claims, The City’s senior examiner will develop an aggressive action plan to guide and monitor further fraud investigation, coordinate efforts with the local District Attorney’s office and keep key City personnel apprised of all updates. We have online access for reporting claims to the Fraud Unit. All potential fraud cases are given to the unit supervisors for screening. All fraud referrals are reviewed by the SIU manager before final submission. We have reported many cases to the Bureau, resulting in conviction, sentencing and restitution for our clients!
Investigative services are contracted. Our best-in-class partner, RJN Investigations, has provided California public agencies these services for 28 years. Disclaimer: While Athens Administrators partners with our investigative partner, the City is under no obligation to utilize them and we are open to whomever the City wishes to use for their investigative services.

H. Auditing
Athens Administrators has a formal written Quality Control Program. Our approach to the management of our clients’ claims and programs centers on quality, service and results. We are committed to a constant focus on these key elements of our total claims management approach.

Our knowledgeable, dedicated operations management team provides strong leadership and objectives. There are (4) levels of supervision and accountability: President, oversees the entire claims operations, Chief Operations Officer manages the claims technical processes and overall claims results and claims operations, and Division Manager monitors supervisory compliance with best practice performance standards, client specific special account instructions, legal and regulatory compliance. The designated Division Manager and supervisor will monitor the City’ Workers’ Compensation claims in accordance with our Supervisory Audit Procedures.

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responsibility of this position is to ensure that the processes and procedures of the Claims Department meet the overall quality expectations and are in compliance with state and federal regulations and customer requirements. This position involves analyzing and reviewing insurance claims for accuracy by performing routine and focused audits of all aspects of the claims process, including coverage, documentation, coding, payments, reserves, claim denials, and claim closure. Individual findings and recommendations will be provided as feedback to the claims staff. Both detailed and summary results will be provided and reviewed with the EVP Workers’ Compensation Claims.

Audits vary from program to program and are not scheduled on a regular basis to ensure that quality is always given on every claim, not just before an audit.

Additionally, Athens Administrators conducts internal file reviews and roundtables. This includes random audits by our internal Quality Control specialist, supervisory reviews of examiner files and roundtables for all catastrophic claims and claims which include a fatality.

Our roundtable review panel is comprised of the EVP, Workers’ Compensation Claims, Divisional Claim Managers, Claims Supervisors and Senior Claim Examiners. Our Quality Control specialists completes random reviews throughout each quarter and our roundtable reviews are completed as frequently as necessary.

Examiners are required to review open Indemnity claims at least every 30 days. Our computer system has an automated diary system that is utilized by all our staff. A detailed list of diaries is displayed each time a user logs onto the computer. The automated diary system sets and examiner diary for 28 days and a Supervisor Diary for 30 days from the date the claim is entered. A second manual diary is also maintained. At a minimum the claims unit supervisors are required to review open Indemnity claims every 90 days. These timeframes are our best practices but may be modified within the client’s special claim handling instructions.

Additionally, annually, Athens Administrators also engages an independent auditor (Armeruno) to provide an Independent Service Auditor's Report on a Description of a Service Organization's System and the Suitability of the Design and Operating Effectiveness of Controls.
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City of Modesto
Third-Party Administrator Questionnaire Response
REQUEST FOR PROPOSAL AND SPECIFICATIONS NO.
2021-44 WORKERS’ COMPENSATION CLAIMS

MANAGEMENT PROGRAM

THIRD-PARTY ADMINISTRATOR QUESTIONNAIRE
This section of the RFP provides a series of questions which will give the City an overview of the claim’sadministrator for the type and extent of services required.

Proposer shall repeat the question in their response and provide the answer immediately following.

A. About the Firm

1. Give a brief history of your firm since inception, including:

For 45 years, since 1976, Athens Administrators has been providing claims administration services to public agencies in the State of California. As noted in our cover letter, we currently support hundreds of Cities, Counties, Park Districts, Transportation Districts, Fire Districts, Housing Authorities, School Districts, Utility Districts and Water Districts.

Athens Administrators has approximately 60% of our business in the public sector arena. • A list of principals
We are a stable and independent company and are fully owned and operated by the Jenkins family and led by Jim Jenkins, Chairman and James Jenkins, President. We believe that being a privately held organization in the marketplace today gives us a competitive advantage for providing flexible options for our clients. • An organizational chart
Please see the included organizational chart in attachments • Size and location(s) of your firm, including numbers of employees at each location Today we have over 380 full time employees in our organization, and we manage over 22,000 open claims encompassing $2.5 billion in total incurred.

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Athens Administrators has four (4) California locations in:
• Concord (177 Employees)
• San Diego (21 Employees)
• Orange (63 Employees)
• Sacramento (8 Employees)
• A description of the types of services provided by your firm and the number of year provided, and
• The contact person(s) for this RFP process
Kevin Cichurski, Director of Sales
Phone: (925) 826-1103
Email: [email protected]

2. Discuss any major changes in your firm’s structure or ownership over the past three (3) years. Discuss anticipated changes in your firm’s structure or ownership in the next three (3) years.

Athens Administrators has not had any changes to our structure or ownership in the past three years and we do not anticipate any in the coming three years.

3. Discuss your firm’s affiliation, if any, with a parent firm.

As Athens Administrators is a wholly owned family-owned organization, we do not have any affiliations with parent firms.

SERVICE YEARS

OFFEERED
Workers’ Compensation Claims Administration 45
P&C Liability Claims Administration 13
Medical Bill Review (MBR) 45
Preferred Provider Organization (PPO) 45
Medical Provider Network (MPN) 11
Internal Bill Negotiation 45
Specialty Bill Review (SBR) 45
PBM 11
(Index/ISO) 23
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4. Discuss your firm’s affiliation with:
• Medical service providers
For your MPN solutions, we work with Anthem Blue Cross which provides exceptional coverage in the Modesto area.

We have worked with several of our clients to help choose and file MPN’s. We are experienced in working in an MPN environment and can take over the management of an existing MPN if necessary. Athens Administrators would be available to help evaluate and if necessary, amend the City’s MPN with no additional charges for this service.

Our preferred recommended MPN partner is Anthem MPN. Unlike other MPNs who only include entire groups, Anthem’s outcomes based MPNs are customized at the individual physician level based on meeting proprietary ranking criteria. Anthem’s MPN participant clients have achieved significantly better savings results than their previous MPN partners. Additionally, Anthem has and supports hundreds of approved MPNs for clients who are the applicant utilizing Anthem's network and Compliance Vaults for customization, provider finder, affirmations, MAA, outcomes analytics, and more.

Anthem has direct contracts with providers as the preferred provider network that is utilized for any MPN. Anthem contracts with most providers in the State and represent a significant if not the most significant payor relationship they have. Our clout is leveraged on the client’s behalf to a degree that no other MPN service provider or #9..
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network can. Only the Chiropractic and Acupuncture networks are leased from American Specialty Health Plan (ASHP).

During the Medical Access Assistant scheduling process, the adjuster is alerted if a compliant appointment initial primary or specialty care with an MPN provider is not available to ensure proper notification to the injured worker to prevent any penalty exposure. Typically, our experience has shown that the injured worker prefers to continue with the MAA assisting in the location and scheduling of an appointment within the MPN list of providers.
• Utilization review services
Athens Managed Care is a URO – Utilization Review Organization and URAC accredited. Our highly experienced teams of nurse(s) and utilization review specialists perform utilization review for Athens Administrators clients. Having our UR process imbedded into our claims handling processes helps to expedite the very sensitive UR timeframes. With the adoption of the new UR regulations it is a huge advantage to have a seamless integrated solution.

AMC offers a team of Registered Nurses who are contracted through RehabWest but are monitored and supervised by AMC. These qualified, licensed professionals have experience in treatment planning, medical and specialty case management with a focus on return-to-work. Their professional case management staff has an average of 8.5 years of experience in managing California Workers’ Compensation injuries. Additionally, AMC provides our clients with bilingual case management nurses throughout California that include Field & Telephonic services. At the request of the client, AMC offers dedicated, on-site nurses.

All UR and NCM personnel work on the same internet-based software allowing for real-time updates and easy accessibility.

The benefits of having the UR unit connected to the examiners include:
• Communication – Seamless communication
• Information – Robust reporting of your managed care results • Control - Ability to customize your approach to utilization review. • Speed - Expedited timelines in accordance with the guidelines and regulations of SB863
• Efficiency – Integrated referral process leads to quicker service delivery & lower claim costs.
• Relationships – Creating a better connection.
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• Medical bill review services
Our bill review service operations are not run in the traditional manner where either service is done in-house by leasing software or service bureau. We employ a unique hybrid model that we feel maximizes savings, increases turn-around time and provides our clients with the best possible outcomes.

Currently, AMC, Inc.’s employees total (14) fourteen. All of our staff is experienced in workers’ compensation bill review rules and regulations. Continuing education is constantly being provided and our new hires go through an extensive training program.

Our software is utilized nationally throughout a wide variety of organizations. The flexibility of this software allows for unique customization to meet the needs of our clients. We believe that the seamless integration between the claims team and the bill review analyst is invaluable creating an overall ease to the process. The claims team can easily access the resources they need to get things completed in an efficient, expedited manner.

Athens Administrators will ensure that medical bills are reduced to the Official Medical Fee Schedule rates established by the Administrative Director of Workers' Compensation. Athens Administrators has flexibility and options when it comes to choosing your PPO Networks for Bill Review purposes. We utilize multiple PPO networks, such as Blue Cross and First Health. Our bill review software is state-of-theart software that is updated on a regular basis to reflect current fee schedules and PPO networks. The medical bill review software system is used to detect a broad range of questionable billing practices, excessive and duplicate charges, over-utilization, and unnecessary services.

Our qualified trained staff reviews each bill and medical report to determine appropriateness of treatment and to ensure provider compliance with fee schedule ground rules.

Our Cost Containment Program incorporates multiple strategies to control costs, as follows:
• Before costs are incurred: through pre-authorization of inpatient and outpatient treatment plans, according to guidelines and channeling to network providers whenever possible.
• During the life of the claim: by channeling specialty care to network providers, when possible, within the confines of the workers’ compensation statute, early identification of red flags, and through concurrent review of treatment plans against #9..
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medical necessity and appropriateness guidelines and length of stay/treatment criteria.
• Retrospectively: through comprehensive fee schedule audit procedures and application of workers’ compensation network discounts (when applicable).

Athens Administrators utilizes the claims software SIMS and we currently have an EDI established for bill review data exchange. Athens Managed Care (AMC) can accept paper or electronic provider bills. All bills are sent to our main mailroom for preparation and scanning. Once they are scanned the bills are routed to the owning examiner. The examiner then determines if the bill is payable and routes it to Athens Managed Care. A file is created daily and uploaded for processing nightly. All paper bills are converted to an electronic format and OCR is used when processing.

The City will be provided quarterly and monthly bill savings reports in your desired format. Also, Generate Explanations of Reductions (EOR) containing all required information will be produced for every provider bill that is processed.

Any bill that is not considered your standard medical i.e. physical therapy, chiropractic bill is given special handling and is routed to a more experienced analyst for processing.

5. Describe your firm’s mission and goals as related to corporate growth, customer service, quality assurance/quality control management and affirmative action standards.

Corporate Mission/Vision/Growth
MISSION STATEMENT: The Mission of the Athens brand is to provide discerning organizations with comprehensive, leading-edge claims administration solutions through delivery of highly personal service, thoughtful strategy and superior quantitative and #9..
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qualitative results.

VISION STATEMENT: The Vision of the Athens brand is to become a model for a highly effective, industry leading claims administration organization that is valued and admired for both the results it delivers to customers and the positive impact it has on employees, the industry and the community.

Alignment with our mission and vision statement is reviewed annually at our management strategic planning session.

Athens Administrators corporate growth goals are to continue to grow organically.

Athens has never acquired another entity to grow nor is that a part of our strategic mission.

Customer Service
A cornerstone of our customer service philosophy is client communication. Athens Administrators takes a proactive approach on every claim to establish and maintain open and positive lines of communication. We will assist injured City employees through the entire workers’ compensation process, respond to their questions and concerns and provide timely appropriate benefits in accordance with regulations. Every new claim reported is entered into our claims management system within 24 hours and will be triaged by the assigned City claim supervisor to identify all key technical issues, nature and scope of the injury and provide instructions to the senior examiners. Contact is made with the injured employee, the City risk manager and medical provider within 24 hours.

We continue to communicate with the injured employee on a regular basis and bi-weekly while off work. Examiners will conduct regular follow-up throughout the life of the claim file, which includes providing information, guidance and assistance regarding permanent disability ratings, Qualified Medical Exams and the settlement process.

Contact is made verbally and followed up in writing to appropriately document the activity in claim file.

We also recommend regular telephonic follow-up with the injured worker(s) as long as the employee remains on temporary total disability. It is important to maintain open and positive lines of communication with the employees, to provide assistance, respond to their questions, and to avoid unnecessary litigation and/or change of physicians. Athens will return phone calls to injured City employees within one (1) working day. All correspondence from employees will be responded to within five (5) days of receipt.

Athens Administrators will develop customized Special Account Instructions for the City. These standards will outline the customized approach to claims administration, which will include specific procedures for claims management and communication with the City and all parties associated with the workers’ compensation process.

Orientation meetings are conducted with new clients to introduce our staff and provide all parties with the opportunity to become acquainted.

Athens Administrators will attend all in-person claims meetings as requested. With the City’s key staff and department heads, this will include quarterly claim reviews, #9..
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administrative hearings, Board Meetings and site visits when necessary. The claims selection criteria for the review process will be discussed with the City in advance. Our focus will be to review claims in which we can have the greatest impact on the overall claims cost and successful resolution. We are flexible in claim review criteria, meeting destinations and in providing a conference call “schedule” for multiple locations, so that all parties can participate in the claim review process.

At Athens Administrators, we proactively work with our client partners to ensure complete satisfaction with the services we provide. If an issue should arise, our client’s first point of contact would be the account manager and claims supervisor assigned to oversee their account. It is important to note that our clients have direct access to our entire management team, either in person, telephonically and through electronic communication. We are always available to hear concerns and will work collaboratively to develop solutions if they should arise.

We continually review and assess our customer service to our clients for improvement.

Part of our approach includes surveys to our clients on our performance. As we are graded on how we perform, we work with our clients to improve on their expectations where needed. We encourage open and honest feedback at every step of our partnership.

Quality Control
Athens has a dedicated Quality Control specialist. The primary responsibility of this position is to ensure that the processes and procedures of the Claims Department meet the overall quality expectations and are in compliance with state and federal regulations and customer requirements. This position involves analyzing and reviewing insurance claims for accuracy by performing routine and focused audits of all aspects of the claims process, including coverage, documentation, coding, payments, reserves, claim denials, and claim closure. Individual findings and recommendations will be provided as feedback to the claims staff. Both detailed and summary results will be provided and reviewed with the EVP Workers’ Compensation.

Our approach to the management of our clients’ claims and programs centers on quality, service and results. We are committed to a constant focus on these key elements of our total claims management approach.

Our knowledgeable, dedicated operations management team provides strong leadership and objectives. There are (4) levels of supervision and accountability: President, oversees the entire claims operations, EVP Workers’ Compensation manages the claims technical processes and overall claims results and claims operations, and Division Manager monitors supervisory compliance with best practice performance standards, client specific special account instructions, legal and regulatory compliance. The designated Division Manager and supervisor will monitor the City’s Workers’ Compensation claims in accordance with our Supervisory Audit Procedures.

Athens internal audit team reviews claims to assure legal and regulatory compliance, as well as conformity to best practices and client-specific performance standards. Athens has various types of internal audit procedures that are performed at all levels of the claims management program on an on-going basis. Athens Administrators provides strong #9..
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supervisory oversight. We do not allow our supervisors and managers to carry caseloads as they are focused on providing continuous oversight of the claims and programs. In addition to the Diary Management System, the supervisor subsequently reviews claims at regularly timed intervals (not less than every 90 days) or when specific events occur such as surgery or litigation, when the claim meets reserving or payment thresholds, and in the course of continuous random audits. The supervisor reviews delayed claims every 30 days until a decision is rendered. Higher value claims or claims with complex issues are also reviewed by the Division Manager.

Affirmative Action Standards
Athens Administrators is an Equal Opportunity Employer and strives to foster a culture of nondiscriminatory behavior. The Company follows established policies and procedures to ensure that individuals are treated in a fair and consistent manner throughout their relationship with the Company. This mission extends internally through recruitment and employment processes and externally through partnerships with vendors, suppliers and clients. On an annual basis Athens Administrators submits an EEO-1 survey to ensure compliance with the U.S. Equal Employment Opportunity Commission.

Athens Administrators currently has hundreds of public agency and private employer clients. Currently, our client ratio is 60% public agency and 40% private employer. As mentioned in our cover letter, our public agency clients consist of Cities, Counties, Hundreds of Fire Protection Districts, Transportation Districts, Housing Authorities, Utility Districts, Water Districts and County Hospitals.

While we do have public agency clients of varying sizes, we do have those with over 1,000 employees. These include:

Client Name Years Served Client Contact Phone Number
Fire Agency Self-Insurance System (FASIS) 16 Howard Wood (707) 447-2252 Bay Area Rapid Transit (BART) 15 Jesse Alcantara (510) 464-6250 City of Stockton 3 Timothy Claiborne (209) 937-8618
County of Marin 2 Karen Shelar (415) 473-6445
County of Imperial 6 Rodolfo Aguayo (760) 482-4488
Solano County 6 Melissa Tharp (707) 784-6186
San Francisco USD 7 Ken Neu (415) 241-6309
East Bay Municipal Water District 13 Vladimir Besarabov (510) 287-0177 East Bay Regional Parks District 9 Sean Donnelly (510) 544-2171 San Diego County Office of Education 7 Felicia Amenta (858) 571-7221 #9..
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8. Provide a history of CSAC-EIA audit results for the past five (5) years, if applicable, including an explanation of any negative findings.
2017: No PRISM audits conducted
2018: 84% score
2019 79% score
2020 85% score
2021 88% score

9. Provide a history of State audit results for the past five (5) years including an explanation for any penalties that may have been assessed.

Athens Administrators has always passed our DWC audits at the PAR level with no penalties assessed.

Below are the State audits conducted over the past five (5) years:
*1.68032 is a passing score with lower being better and a higher performing organization

2020 Athens/Concord – 0.81277
2018 Athens/San Diego – 0.37697
2017 Athens/Orange – 0.89923

Utilization Review State audit (with 100% being highest achievable):

2021 – 100%
2020 – 98.9%
We have passed the PAR audit every time since we were founded in 1976.

No penalties ever assessed.

10. Submit a detailed implementation plan, including the expected timeline for each of the following:
a) Staff recruitment and training.
b) Data conversion of the City’s existing electronic claim files. c) Transfer of existing hard copy files from current TPA. d) Distribution of all required notifications (vendors, claimants, WCAB, etc.). e) Providing printed forms.
f) Training and coordination of IT systems and operational procedures with City staff Please see Transition Plan Tracking & Timeline and Onboarding Checklist Attachments Client Name: Crestwood Behavioral Health Inc
Contact Person: Troy Gupton , Director of Workers Compensation and Risk Management Telephone: (916) 206-2448
Reason: The program moved to a fully insured, guaranteed cost one with State Fund. #9..
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We understand that transitioning to another TPA can be a stressful and confusing event. We have developed a process that ensures a smooth transition of all data and uninterrupted services to your employees.

Athens Administrators has extensive experience in the takeover and transitioning of large programs from other employers, third party administrators and carriers. Athens adheres to estimated industry guidelines for transfer of claims administration. We normally recommend 60 days for a smooth transition of existing claim files. Upon notification of award of contract, an implementation meeting will be scheduled immediately with the City to discuss our customized formal transition plan and detailed timeline. Our formal transition plan includes a step-by-step schedule of instructions for the transition of all claims and financial data. Our schedule minimizes the delays and issues that are often associated with the movement of an existing workers’ compensation program.

The formal transition plan addresses the following critical areas: staffing, program orientation and current law education for City staff, data conversion, physical file transfer, data scanning, benefit payments, pending UR authorizations, notification distribution, forms and banking program procedures. This plan has emerged from years of hands-on practical experience in facilitating takeovers and transitions of programs. Our plan minimizes the risks, delays and issues that are often associated with the movement of an existing workers’ compensation program.

The transition plan includes four primary phases; the Implementation, the Organization and Assimilation of Files, Staffing, Hiring and Training, and Orientation and Notification of Internal and External Customers. Our sample transition plan details each of these steps. If awarded, Athens will work with the City to create their own customized transition plan to address all unique needs.

The conversion process also allows the ideal opportunity for the City to review and make changes to your current claim coding and location structures.

Implementation Phase
Upon notification of award of contract, an implementation meeting will be scheduled immediately with all key City personnel to develop a customized formal transition plan and detailed timeline.

We will identify specific claims handling instructions and interface specifications that meet the goals of the City.

Organization & Assimilation of Files
Athens takes a proactive approach to ensure seamless transition by securing agreed upon action plans (i.e. identifying priority claims, hearing dates, delays, ongoing payments, utilization review, etc.). We use a task force approach, triaging all incoming claims by senior technical staff, identifying all key facts, issues and develop a proactive action plan to move the claim towards closure. Reserves are reviewed and allocated for probable ultimate cost and through this formal process, we are usually able to achieve immediate cost reductions and file closures.

In accordance with generally accepted guidelines and state regulations, we would request lists of benefit payments and due dates, delayed claims and their due dates, on-going Utilization Reviews and their due dates, trial dates and future diaries. We will review all open claim files and once #9..
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completed, we will have all prior financial and claim detail data previously captured. We will add to this data our new diary dates, manual payments, trial, dates and begin entering new activity.

Staffing Plan for Recruiting, Hiring and Training
Our responsive staffing model and plan will ensure effective recruiting, hiring and training of all key claims personnel. Athens is committed to continuously interviewing claims professionals at all levels on an ongoing basis.

This proactive approach identifies qualified talent and ensures we always have resources available for additional staffing. Our hiring process includes a face-to-face interview with two claims managers or supervisors, a written claims test, and background and reference checks. We are usually able to connect with interviewees through the efforts of our human resources department.

We have an internal recruiter who will assist us in finding excellent candidates. Our overall salary and benefit compensation is in line with market conditions and we also have a variety of internal incentive programs.

Athens requires all staff to attend and complete training sessions regarding legislative, legal and regulatory changes in the workers’ compensation industry. We conduct training on a regular basis in the areas of subrogation, fraud, medical management and other key training areas within our Best Practices Performance Standards. Individual training programs and goals are formulated on an annual basis and reviewed with the examiner during quarterly performance evaluations. Our supervisors provide constant coaching and counseling to our technical staff for ongoing claims handling development and future internal promotions.

Orientation & Notification of Internal & External Customers Orientation meetings are conducted with new clients to introduce our staff and provide all parties with the opportunity to become acquainted. These orientation meetings also provide the opportunity to develop special claims handling requirements and procedures unique to each and every client. Upon notification of award of contract, we will meet immediately with key personnel to discuss and identify specific claims handling instructions, transition plan, and interface specifications that meet the goals of the City.

Our formal transition plan ensures prompt written notification (2 weeks prior to effective date) to all injured employees with open claims, frequently utilized vendor partners and other applicable parties informing them Athens Administrators will be the new TPA.

Athens will provide required and agreed upon claim reporting information and electronic forms including:
• Employers Report of Work Injury or Illness (5020)
• Employee’s Claim Form (DWC1)
• Work Injury posters and notices
• Instructions for reporting claims
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Customer Training
Athens Administrators will continuously inform each client of changes or proposed changes in statues, rules and regulations and case law affecting the workers’ compensation program. We offer employer training programs covering a variety of subjects including: “Workers’ Comp 101”, legislative changes, return-to-work programs, system training, fraud, and how workers’ compensation creates ADA and FEHA risks. Our knowledgeable licensed staff will be available as needed. We also provide full training on our claims management system.

Please see Transition Plan Tracking & Timeline and Onboarding Checklist Attachments B. About Your Firm’s Management Information System(s)

1. Describe the type of data processing hardware and software proposed for this contract.

Discuss your firm’s experience in using the system, whether the system is owned and operated in-house or through an agreement with another provider, the general capabilities of this system, compatibility with other existing systems for continuity of data and transferring of historical data, and any projected upgrades or changes during the term of this contract.

Athens maintains a state-of-the-art in-house RMIS system supported by our internal IT team. Our claims management system is a state-of-the-art, cloud-based software package and available 24/7/365. It is a uniquely flexible system that includes a complete document management system that is embedded in the claims system. The system is customizable and supports client-specific data fields, hierarchical location structures and unique business rules.

Our RMIS system provides convenience and access to real-time and “point in time” financials for generating customized Ad Hoc reports, multiple program reports for data downloads and monthly loss reports which can be exported into other applications such as .pdf or excel. These reports can be provided at any interval as set forth by the City through our customized reporting schedule. Both standard and specialized reports are available to be generated.

The City would have real-time access to our claims management system 24/7/365. New claims can be entered remotely and all data including notes and financials can be viewed.

Self-serve reports are also available via the web. In addition to claims information, all investigative films, reports and statements are available and are included in the electronic file as additional attachments.

City staff will have the ability to create their own reports as well as having Athens IT staff support and develop them as requested.
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Access to the system can be configured with different authority levels as described by the City, with all of the security controls overseen and implemented by our Claims Operation team. All historical data can be archived in the system if the City so desires, with data being backed up on a daily basis.

Our claims management system incorporates a full spectrum of data elements including relevant dates, claims detail, temporary modified duty, temporary partial disability, financial information, narrative notes, litigation fields, subrogation information, lien information, lost time information, Medicare, and state reporting information. The list of data fields is proprietary and cannot be included. In addition to the standard fields included in the claims system, Athens has added many custom codes and fields. We can add any additional fields that may be required. Any field that is captured in the system can be reported on.

At Athens Administrators, we are continuously focused on how we can make the claims process as seamless as possible for our clients and their injured workers. Keeping this focus, we have added another service option and it is our new Athens app. With different login procedures, the Athens App allows risk management professionals and injured workers to access appropriate and real time information on their claims 24 hours a day, 7 days a week.

Once you have access to our Athens Administrators Claims Portal, you download the Athens App and you will be able to see specific claim information through the Athens App as well. Through the Risk Managers portal, you will be able to search losses based on:
• Claim Number
• Injured Workers Name
• Date of Loss
• Open/Closed Status
• Date of Injury
Once you select a claim, you will have access to see:
• Date of Injury
• Nature of Injury
• Claim Number
• Accepted/Denial Date
• Open/Closed Status
• Litigation Status
• Examiner Contact Information
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Include in each description the interval at which the reports are generated. Provide a onepage example of each of 5 reports listed and explain how each will assist the City of Modesto in managing its program.

Our web based RMIS system provides convenience and access to real-time and “point in time” financials for generating customized Ad Hoc reports, multiple program reports for data downloads and monthly loss reports which can be exported into other applications.

These reports can be provided at any interval as set forth by the City through our customized reporting schedule.

Our system offers on-line real time access to our client’s claims information, including examiner notes and financial information. Athens’ claims management system can accommodate unlimited levels of location coding and customizable codes and descriptions.

Through the use of custom code sets, we are able to extract accurate, detailed, and relevant data that satisfies the needs of each client. We have a web-based entry of 5020’s (Employers' First Report of Industrial Injury or Illness), Self-Insurers Annual Report generation, 1099 reporting to the IRS, OSHA reports, and electronic interface with the Index Bureau and WCIS. Athens’ claims management system can produce all required regulatory reports and data exports and we are state EDI compliant.

There are hundreds of data elements tracked in our system but at a minimum there are 48 that form the basis of available bordereau reports. The Systema SIMS claims management system has extensive capability to customize reports and additional data fields may be added at a client’s request to allow for increased reporting. Reportable bordereau fields include but are not limited to:
• Program and Locations
• Program Year
• Policy Number
• Jurisdiction
• Policy From and Through Dates
• Broker
• Claim Number
• Claimant Name
• Status
• Days Open
• Claim Type
• Insured Reported Date
• Accepted Date
• Loss Date
• Received Date
• Entry Date
• Closed Date
• Reopened Date
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• Delayed Date
• Denied Date
• Body Part
• Nature of Injury
• Agent
• Cause of Injury
• Class Code
• Occupation
• Examiner
• Life Pension
• PD Rating
• Litigated
• Future Medical
• Age At Injury
• Death Date
• Hire Date
• Termination Date
• Stip Amount
• C&R Amount
• Lost Days
• Restricted Days
• Indemnity Paid, Reserves, & Incurred
• Medical Paid, Reserves, & Incurred
• Expense Paid, Reserves, & Incurred
• Total Paid, Reserves, & Incurred
• Recoveries
• Net Incurred
• Loss Description
Athens has a full suite of reports to produce data on both the claims administration, managed care and bill reviews services we provide. Our RMIS system provides convenience and access to real-time and “point in time” financials for generating customized Ad Hoc reports, multiple program reports for data downloads and monthly loss reports which can be exported into other applications such as .pdf or excel. These reports can be provided at any interval as set forth by the City through our customized reporting schedule. Both standard and specialized reports are available to be generated.

Below is a partial representation of the client reports available:

Report Title Report Description
Bordereau Detailed excel loss run
Claim Cost Summary List of claims with paid amounts during specified period.

Claim Log Report Database Standard Claim Log - No Financials Claimant Type Changes List of claims in period with loss type changes Claimants With Multiple Claims Lists claimants with multiple claims Claims Activity Report Database Lists claims with activity during the period and checks off the type of activity
Claims Summary By Fiscal Year Summary report of claims in each year by loss type #9..
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Claims Summary By Year With Groupings Claim Summary by Year can be run for all locations at a selected lower level
Claims with Defense or Applicant Attorney Assigned Lists claims that had an attorney assigned in the period Closed Claims List of closed claims in a date range
Cumulative Trauma Claim Log 1004 List claims by Program with Cumulative Trauma custom field Days Without Injury Report Database Lists each location with the date of the last injury and the number of days elapsed
Delayed Claims List of delayed claims in a date range
Denied Claims List of denied claims in a date range
Detail Loss Run Report Database Loss run with detailed claim information Excel Loss Run Basic Excel claim listing
Excess Bordereau A shortened version of the Bordereau; includes Excess Report Date & Excess Decontrolled Date.

Financial Reconciliation By Bank Accounting - Check Register that lists payments by bank.

Financial Reconciliation By Program Report Database Basic Check Register Financial Reconciliation By Program With Summary Check register that lists payments by program (not by bank).

Incurred Change With Subtotal Lists claim with selected amount of incurred change in the period.

Incurred Changes Lists claims with selected amount of incurred change in the month.

Incurred Loss Triangle Incurred loss development report that shows trending over multiple years.

Medical Cost Containment Details Cost Containment costs paid in chosen period.

Mod Duty and TD Day Summary Summary by program of all claims with loss days and Mod Duty days entered.

More than 60 days TTD Lists claims with TTD paid in the last 30 days; having more than 60 days of TTD. Includes last payment date.

New Claims Report Shows new claims entered in the time period OSHA_Form300_Org Select Designed to mimic the federal OSHA form.

OSHA_Form300a Designed to mimic the federal OSHA form.

Outstanding Checks Report Database Lists checks that have not been marked as Cleared with the bank.

Paid Loss Triangle Paid loss development report; shows trending over multiple years; supports multiple program selection provides LOB breakouts
Payment Type Totals Report Database List of total paid, average and number of payments for each pay type.

Reinsurance List of claims above the Notice Amount or SIR for Excess reporting requirements
Reopened Claims Returns Reopened Claims for specified date range, across all Programs WC Management Summary Report Database Claims summary by location level When developing adhoc reports on your account, there is an option for capturing data at a certain valuation date on most reports. Listed below is a sampling of the more common reports utilized by clients:
• Claims Log
• Payment Type Totals
• Transaction Register (can be done nightly as requested above) • Claims Summary by Year
• Loss Triangle – Paid Loss
• Management Summary
• Claims Activity – Claims Cost Detail, Claims Cost Summary Indemnity Claims, Claims over $25,000
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• Frequency Analysis – Loss Agency, Body Part, Loss Cause, Day of Week, Job Code, Loss Age, Loss Nature
• OSHA 300 AND 300A
• Claims Summary by Year report
• Claims Cost Detail report
• Financial Reconciliation report
In addition to these reports, Athens provides its clients with very comprehensive annual reports, which provide both a global and a detailed analysis of all claim, risk management (including safety), and financial program evaluations. This is done in colored graphic/chart form for easy reading by management and includes our analysis of any deficiencies in the program and very specific recommendations for program improvement. The reports are department/cost-center specific and, as requested by our clients, more frequent specialfocus reports can be done if the need arises.

City Risk Management staff will have the ability to create their own reports as well as having Athens IT staff support and develop them as requested. There is no additional cost for our reports.

The Athens claim management system is a pure browser-based on-line system with in the cloud access and can be accessed on or off-site with a web-based connection. City would have real-time access to our claims management system. New claims can be entered remotely and all data including notes and financials can be viewed. And self-serve reports are also available via the web. In addition to claims information, all investigative films, reports and statements are available and are included in the electronic file as additional attachments.

The City can choose at what interval reports are generated but our typical clients have us set up a monthly run of their report package which would be automatically generated and forwarded to the City.

Please see sample reports

3. Describe the unique features of the management information reports provided by your firm which are not typically provided by other TPAs.

Unique features of our reports include:
• Dedicated account claim portal
• The ability to drill down to the smallest detail level (Ie. Age, body part, time of day, day of week, etc.)
• Available on-demand via secure log-in
• Reports query includes hundreds of data elements and have the ability to add additional ones as requested.
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• Integrated with Claims, Financial and Safety dashboards • Our claims administration system has the ability to import almost any type of electronic media including video clips, audio and photos. The following extensions are files that our RMIS can currently export, accept and upload. New extensions can be added as required.
• .doc • .pdf • .wmv • .docx • .txt • .tif • .zip • .html • .xls • .jpeg • .wav. • .xlsx • .wma • .mp3 • .jpeg • .txt • .ppt • .ppsx • .pptm • .pptx All captured media can be link to a specific incident or claim file.

All claims are assigned a claim type that is used in reporting and tracking. The claim type is updated as required when case facts change. OSHA reports detail the claim type on the reports, and are typically created excluding first aid, information only, and denied files.

Our claims system (SIMS) includes an OSHA module that allows us to flag an injury if it is or in not recordable. If the claim is flagged as not-recordable, it will not show up on the OSHA report. Our OSHA reports are generated annually, on an ad-hoc basis, or at the interval requested by the client. The report can be run for the organization as a whole, or by location.

Please see Sample OSHA 300 Log report

6. Describe you firm’s ability to provide the City of Modesto with a minimum of 3 MIS user connections on existing personal computers allowing for full database access and standard/ad hoc report writing/generating.

Our system, SIMS Claims™ is a pure browser-based on-line system. As such, we can provide access to the minimum (3) three City users who can connect into the system utilizing existing personal computers. Full, real time database access is available along with report writing/generating.

Athens' claims management system includes web-based access that clients can utilize to enter new claims, review existing claims, and generate reports. Each user ID is assigned to an access group that restricts that login’s access to only that client’s data. New claims can be entered by the client via the website. Claims entered using the web are assigned a pending status until they are reviewed and determined before the coding is completed #9..
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in the claims management system.

Web clients can view their claims and run reports using the client report module.

7. Discuss the MIS technical support services provided by your firm. Include the location of MIS staff and how many clients are serviced from that location.

Athens Administrators has an in-house IT Department. They offer external, support services to all our client partners. This includes technical support for our SIMS claims system including report generation and troubleshooting services. Our IT staff is located in our Concord, CA corporate office and service all our clients from this location.

C. Claims Administration Services

Athens’ infrastructure has been meticulously planned over our forty-year history. Our management and staffing model is one of our biggest strengths as an organization. It has been designed to guarantee consistent levels of quality control. Our proposed staffing model for the City of Modesto will be located in Concord, CA and provides a significant advantage to Athens in the daily management of our processes, procedures and outcomes for the City. Additionally, every account receives regular attention from the highest levels of management in our company including the President, EVP, Claims and Division Managers.

As the City would be assigned a fully dedicated examiner team, we would immediately begin identifying the claim supervisor and examiners upon notification of contract award.

It is our philosophy at Athens Administrators that we do not transfer or disrupt current employer/adjuster relationships for new incoming programs. Maintaining staff stability for our programs has helped us achieve a client retention over 98% for the past five years. We would encourage and invite the City to be involved in the final selection of their claims administration team. Note: Athens would agree to hire those examiners recommended by the City which on your current program. (The suggested candidates would need to go through Athens Human Resources vetting and our hiring practices.) POSITION (Examiner Staff Will Be Fully Dedicated Only To City of Modesto STAFFING Unit Supervisor 1 Fully Designated
Senior Claim Examiner 2 Fully Dedicated
Assistant Claim Examiner 1 Fully Dedicated
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City of Modesto Proposed Staffing
James Jenkins,
President
Douglas Gibb, EVP,
Workers
Compensation
Jeanette Mason,
Claims Director
Russ Quinn, Division
Claims Director
TBD, Claims Unit
Supervisor
TBD, Dedicated
Senior Claims
Examiner
TBD, Dedicated
Senior Claims
Examiner
TBD, Dedicated
Assistant Claim
Examiner
Leann Farlander, AVP,
Cost Containment,
Athens Managed Care
Emily Hart, Director,
Claim Operations
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Staff Position Descriptions
Athens Administrators requires the following minimal qualifications for each of the identified positions:

Unit Supervisor – Minimum 9 years’ experience as a manager with Self-Insured State Certification and Public Agency account experience.

Senior Claim Examiner – Minimum 7 years workers’ compensation claims handling experience, public agency experience, Self-Insured State Certification, and/or IEA certification equivalent.

Future Medical Claim Examiner – Minimum 3 years future medical claims handling experience, public entity experience.

Assistant Claim Examiner – Minimum 3 years assistant claims examiner duties, public entity experience and IEA technical training preferred.

The qualifications and roles of the hired positions include:

Claims Supervisor
Upon award of the contract, Athens Administrators will commit to providing a qualified Supervisor for your program.

The Claims Supervisor, at no time, will ever carry a caseload, which will allow them to be fully dedicated to supervising and overseeing your program. They will provide a more detailed technical oversight to your workers’ compensation program and also ensure that the requirements in your Scope of Services are either met or exceeded. The supervisor will also participate in internal claim audits and reviews.

The Supervisor will provide daily oversight of the program and works directly with the examiners and assistants.

Senior Claims Examiners
Upon award of the contract, Athens Administrators will commit to providing qualified Senior Claims Examiners. The qualified candidates will have a minimum of seven (7) years’ experience in adjusting and will be certified to administer self-insured workers’ compensation programs including public agency experience.

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is to provide proactive claims management of the individual claims they handle and to promote the overall success of the claims program. This equates to delivering at all times quality service, communications, and results for the employers and their injured workers.

In order to achieve the senior examiners must be experienced, with manageable caseloads and have adequate clerical and administrative support provided to them in order that they may fulfill their roles. All of our technical staff is state certified to administer self-insured workers’ compensation claims.

Future Medical Examiners
This person plays a vital, but focused role to adjust workers’ compensation future medical claims. They ensure timely processing of claims and payment of benefits, managing and directing medical treatment, and negotiating settlements. It’s a more focused and specialized effort.

Assistant Claim Examiners
The assistant examiners also have many and varied duties. Their essential role is to provide full administrative support to their senior examiners and handle the medical only claims.

This supporting role allows the senior examiners to be proactive case managers and not get bogged down in clerical/administrative tasks. Our assistant examiners are technical claims people who have completed or are in the process of completing all of their Insurance Educational Association courses in workers’ compensation and, in many instances, who have passed the Self-Insurance Plans Administrators Exam.

Our supervisory staff are responsible for our staff as follows:

Divisional Claim Manager: On average has two to three claim supervisor direct reports.

Claim Supervisor: On average has three to five senior claim examiner and up to three assistant claim examiner direct reports.

Our current staff has the following average experience:

Claim Supervisor: 20 Years’ industry experience; 7 Years with Athens Senior Claim Examiner: 12 Years’ industry experience; 5 Years with Athens Future Medical Examiner: 10 Years’ industry experience; 9 Years with Athens Assistant Claim Examiner: 7 Years’ industry experience; 5 Years with Athens Examiner Staff Training
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training in order to keep up with legislative, legal, and regulatory changes in our industry.

We empower our staff by providing ongoing continuing education. We conduct training on a regular basis (typically once a month) in the areas of subrogation, fraud, medical management and other key training areas within our Best Practices Performance Standards.

Athens Administrators also annually certifies that each claims examiner handling workers’ compensation or liability claims is in compliance with all legal and regulatory licensing and continuing educational requirements. Where required by law or regulation, Athens will provide copies of all such certifications at least annually to our clients.

Athens examiners are well versed and trained in those special areas of workers’ compensation that relate to public employees, safety officers, PERS and other public employee retirement programs. We work closely with our clients to develop carefully coordinated benefit delivery systems so that all benefits can be properly paid to the employees. All of our supervisors and technical staff are state certified to administer selfinsured workers’ compensation claims. Our technical staff is focused on identifying key issues that have a large financial impact on the overall claim. Such exposures are subrogation, fraud, apportionment, litigation management, and investigation of questionable claims. The examiners proactively utilize all available internal and external resources to address and resolve these issues to reduce the bottom line costs.

Prior to any team member being assigned to your account, we encourage a meeting with each proposed examiner to ensure that they will be the right fit for you and your risk management team.

Athens evaluates candidates’ industry expertise, education and technical qualifications as well as traits and characteristics that align with the Company culture. We have high standards and expectations and candidates must meet all of the job qualifications and requirements to be considered. We will not settle for less even if it takes longer to fill a position. Our interview process is extremely thorough. We prepare specific questions for every position and we press for specifics throughout the interview. We ask behavioral interview questions to get beyond surface level responses. We look for contrary evidence throughout the interview. We retain a database of candidates that have interviewed in the past and contact them if they were strong contenders. All final candidates undergo additional screenings which include background checks, thorough reference checks, skill assessments and management behavioral assessments. The entire recruitment process is reviewed for each candidate to help make a final determination.

2. Please indicate which of the personnel you plan to use to staff this claims unit have attained certification to administer self-insured claims (SIP Certification) and when all staff members will be certified.

All claim management and examiner personnel we plan to utilize on the City’s program will be SIP certified at contract inception.

3. Discuss your firm’s standard ratio for case closures as related to new claims.

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comparisons are calculated. Explain other criteria used to determine the appropriateness of closing claims.

The expectation for Athens’ examiners is at least a 100% closing ratio which is closing the same number of claims as received on average. However, our goal is to achieve a 105% – 110% closing ratio. We provide examiners month end closing statistics each month to see how they are trending. Management also compiles this data to share during year end performance reviews for a 12-month (1-year) average for the claim closures. We also provide our employees a quarterly incentive program that allows them to earn up to one free day off based on their closure and penalty occurrences. Examiners are expected to obtain a 125% closing ratio. They are required to obtain 21 closures for the quarter in order to be eligible for the incentive of 3.75 bonus hours of PTO.

Athens shares the data/expectations and results for closures on a monthly, quarterly (with incentives) and annual basis with our clients.

4. Please submit your firm’s Claims and Litigation Management Guidelines.

Please see our Claims and Litigation Management Best Practices

5. Explain how the claims adjuster will coordinate legal activities with counsel once a claim is assigned to defense counsel.

While we have clients who mandate referral to defense counsel upon receipt of Notices of Representation and Applications for Adjudication, we do not believe that files should automatically be referred to defense attorneys. We have highly trained and experienced claims experts, and they should be able to handle matters of litigation outside the need for depositions or WCAB appearances. Even when files are referred to defense attorneys, we continue to direct the claim, and we never defer to defense counsel on matters that can be handled by the claims examiner, which would include the subpoena of records, setting medical or medical-legal appointments, and lodging objections to the treating physicians.

Athens Administrators sends a litigation plan and budget request on all legal referrals. The adjuster will aggressively follow up for both of these items from defense counsel. Upon receipt, a detailed review of both the plan and budget will be completed and documented in claim notes by the adjuster. This review will focus on the proposed legal analysis, legal recommendations, timelines/expected duration of litigation as well as the estimated costs. If we are in agreement with the legal recommendations, action plan and costs, we will continue to work with our attorney and monitor the monthly expenditures to ensure that approved is in line with what #9..
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is actually being incurred. Should there be a discrepancy identified in the initial review/cost analysis by our adjuster, Athens Administrators will contact defense attorney to discuss and ensure complete agreement is reached between all parties with full documentation in claim notes.

Athens Administrators values the relationships with all partners and believes that any successful relationship is based on clear and concise expectations for both parties well prior to commencing work together. These entry level discussions should focus on claims handling philosophies, expectations of representation of the City and Athens, as well as agreed upon hourly rates for the service.

Additionally, Defense attorneys who bill at the traditional fee for service method must agree to work within specific guidelines similar to those outlined below. These guidelines were developed as part of our litigation cost control program in an effort to maintain control over the legal billing process. All legal expenses and bills must be itemized and are reviewed prior to payment.
 Hourly rates to be broken down in to 1/10ths
 Itemized by date of activity
 Identify all billing entities
 When there are multiple files, no duplication of charges  All billings should reflect actual time spent
 No minimum billing rates
 Prorate all multiple appearances between employers
 Itemize all expense items
 Mileage will be reimbursed at the current IRS rate
 Incoming faxes will not be billed
 Outgoing faxes will be paid on an itemized long distance phone rate
 Postage will be paid as an actual itemized cost
 Only bill for long distance phone calls at itemized long-distance rate
 No bill for local phone calls
 No bills for inquiries

6. Discuss your interaction with clients in reporting on account management or claims related issues. How frequently do you expect supervisors and/or adjusters to initiate contact with City of Modesto? What is your protocol regarding returning telephone and/or E-Mail messages?
As part of our proposed staffing plan for the City’s program, the Division Manager assigned will also be designated as your account manager. They would be responsible for maintaining high customer satisfaction, being a primary point of contact for the roll out and delivery of services, ensuring issues are dealt with in an efficient manner and understanding when to escalate internally to appropriate members of the management team.

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and maintain open and positive lines of communication with the injured employees. We will assist your injured employees through the entire workers’ compensation process, respond to their questions and concerns and provide timely appropriate benefits in accordance with regulations. Every new claim reported is entered into our claims management system within 24 hours and will be triaged by the supervisor to identify all key technical issues, nature and scope of the injury and provide instructions to the senior examiner. Contact is made with the injured employee, the designated City contact and medical provider within 24 hours. We continue to communicate with the injured employee on a regular basis and bi-weekly while off work.

The supervisor and adjusters dedicated to the City’s account will have daily contact with the City as they manage your claims process. As regards to our telephone/email communications, our requirement is to respond with 24 hours of receipt.

7. Identify the firm’s criteria for designating a claim as a first aid, medical only or indemnity case.

First Aid - defined as any one-time treatment, and any follow-up visit for the purpose of observation of minor scratches, cuts, burns, splinters, or other minor industrial injury, which do not ordinarily require medical care. This one-time treatment, and follow-up visit for the purpose of observation, is considered first aid even though provided by a physician or registered professional personnel.

Medical Only - Any alleged work-related injury or illness for which medical treatment is sought, the claimant is not hospitalized, temporary disability does not exceed the waiting period as defined by the Workers' Compensation Laws of California, and no other Indemnity benefits are claimed.

Indemnity Case - Any alleged work-related claim for which any of the following is claimed:
(1) Temporary Disability
(2) Permanent Disability
(3) Vocational Rehabilitation
(4) Life Pension
(5) Death

Supervisors
Our supervisors do not carry a caseload, enabling them to provide technical oversight of the individual claims and of the employers’ workers’ compensation program, ensuring quality, service, results as well as compliance with regulatory and client-specific program #9..
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performance standards. Every new claim reported is entered into our claims management system within 24 hours and will be triaged by the assigned claim supervisor to identify all key technical issues, nature and scope of the injury and provide instructions to the senior examiners. Our supervisors review claims at regularly timed intervals (not less than every 90 days) or when specific events occur such as surgery or litigation, when the claim meets reserving or payment thresholds, and in the course of continuous random audits. The supervisor reviews delayed claims every 30 days until a decision is rendered. Higher value claims or claims with complex issues are also reviewed by the Division Manager.

Claims (Senior) Examiner
While the duties of the senior claim examiner are many and varied, their essential function is to provide proactive claims management of the individual indemnity claims they handle and to promote the overall success of the claims program. In order to achieve the senior examiners must be experienced, with manageable caseloads not exceeding 140 open indemnity claims, and have adequate clerical and administrative support provided to them in order that they may fulfill their roles.

Assistant Claim Examiner
In our staffing models, we utilize claims assistants on all our programs. Each assistant has a 1 to 1.2 claims examiner ratio. Their essential role is to provide full administrative support to their senior examiners and handle the medical only claims. This supporting role allows the senior examiners to be proactive case managers and not get bogged down in clerical/administrative tasks. The assistant examiners will be technical claims people who have completed or are in the process of completing all of their Insurance Educational Association courses in workers’ compensation and, in many instances, who have passed the Self-Insurance Plans Administrators Exam. They are our next generation of senior claims examiners through our in-house training program. Assistant Claims Examiners handle an average of 30 medical only claims. Additionally, they could also handle First Aid or Info Only claims.

9. Describe the criteria for re-indexing existing claims.

Claims are automatically indexed at 6-month intervals but this can be customized per the City’s request and incorporated into the Special Claims Handling Instructions.

10. Describe the firm’s policies and practices in establishing and maintaining reserves for indemnity, medical care, expenses and future medical benefits.

Our claim reserves reflect the probable ultimate cost of the claim. Reserve estimates are not determined by formulas, but, rather, are based on current information in the file including medical reports, current and anticipated medical treatment and periods of disability, disputed or litigated issues and additional areas of investigation. Initial reserves are posted to the file once the initial investigation is complete and anticipated reserves have been determined. This will be completed no later than 14 days from receipt of the claim. Reserve estimates are not determined by formulas, but, rather, are based on current information in the file including medical reports, current and anticipated medical #9..
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treatment, and periods of disability, disputed or litigated issues, and additional areas of investigation. Medical reserves are based on current information in the file and anticipated future medical treatment. After a claim has been settled with a future medical award, future medical reserves are calculated based on a three-year average and the injured worker’s life expectancy. The claim supervisor must approve any reserve change over $20,000. Management must approve all reserves over $100,000. Reserves are reviewed no less frequently than every 90 days and an explanation of any changes is entered into the claim notepads. Additionally, we notify the City of any reserve changes that exceed a specified amount set by you.

11. Describe the firm’s policies and procedures to ensure timely review and appropriate payment of benefits and bills.

Our policy is to submit bills for review and payment within 30 calendar days of receipt. We are able to generate reports to identify unprocessed documents by aging, which allows us to identify specific bills that have not been routed for review and payment within that timeframe. These reports are run daily and distributed to all levels of management for review.

Regarding timely benefit payments, our claims staff are expected to review mail and address any and all benefits within the statutory timeframes. We are able to generate reports to identify unprocessed documents by aging, which allows us to identify specific types of medical reports and settlement documents that have not been reviewed and addressed. These reports are run daily and distributed to all levels of management for review.

In addition, new claims are placed on a 14-day diary to address any benefits that might be due. Injured workers who are due long term temporary or permanent disability benefits are tracked by both a manual and a computerized diary to ensure they do not fall off payment cycle. Manual tracking books are reconciled with a daily indemnity payment dashboard to further ensure all payments were successfully processed.

12. Describe how the firm will assist and facilitate Return-to-Work activity at the earliest possible opportunity.

Return to Work/Transitional Work Program
Athens’ claims examiners manage every claim to ensure that the modified work is addressed in an expedient manner and that the disability is reasonable based on the nature and extent of the injury and to ensure that the 24 Cap for chiropractic, occupational and physical therapy visits is appropriately applied.

Our software allows us to monitor and track these services. Our Diary Management System tracks key dates to ensure timely actions on decisions/referrals. Claims are monitored on a weekly diary for ongoing temporary disability to address modified work and every 30 days for all other indemnity claims for medical status update.

Athens immediately notifies a client once a physician advises that an employee is released to return to work to mitigate the overall indemnity costs and potential ADA #9..
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and FEHA exposures.

Athens Administrators has been working with its clients for many years in developing, implementing, and coordinating Return to Work programs, which includes working with in-house liaisons for coordination of the program. We have found our customers achieve results if caseloads remain low and the examiner to assistant ratio is sufficient.

With similar accounts the coordination of return to work is managed by our highly trained assistants. We would also commit to a formal on-going RTW Training Program for City.

Additionally, senior claims examiners and their assistants are responsible for all return-to-work efforts on their claims. Our claims team is most knowledgeable about each claim and its unique issues. Return to work efforts are not segmented from the claim, but rather are handled directly by the claims team in the course of managing the entire claim. Work statuses are obtained on a regular basis and communicated back to the client. Medical reports are reviewed and our team ensures that the treating doctor understands the clients modified work programs. Custom forms can be also be utilized. We will meet with City’s key staff and develop a step-by-step program to support your return to modified work program.

Transitional Work Program
Many of our clients have implemented Transitional Work Programs and have asked us to provide data or information to help facilitate these types of programs. We understand that these types of programs provide a system of returning employees back to work quickly and safely after an injury. By immediately identifying any temporary work restrictions given to the injured worker by the treating physician, the Athens Administrators examiner, in conjunction with the Return-to-Work Coordinator, is able to help get the injured worker back to transitional work, which we anticipate will also help the employee recover faster and allow them to return to their regular work assignments.

Our emphasis on close collaboration between Athens Administrators and the designated City contact, we believe, will create positive results for your workers’ compensation program, and help minimize lost workdays.

13. Describe how the firm communicates temporary and permanent work restrictions in a timely manner.

For our clients who offer temporary modified duty, our practice is to proactively reach out to the treating physician’s office before the scheduled medical appointment, provide them a detailed job analysis whenever possible, and to let them #9..
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know our client has a robust return to work program. With that in mind, we ask the physician to let us know what the employee’s capabilities are, rather than presuming the employee should be temporarily totally disabled. We find physicians are more likely to entertain modified duty as an option if we approach them before, rather than after a medical appointment.

In most cases, preferences concerning how and when work restrictions are communicated to the employer are discussed at the time our clients are on-boarded and these preferences are outlined in the customized claims handling instructions for each of our clients. The examiner or assistant examiner maintains a diary to follow up on the employee’s work status following each scheduled medical appointment, and then either calls or sends an e-mail to the client to determine whether or not modified duty is available.

Preferences concerning how permanent work restrictions are communicated also vary by client and are discussed during the onboarding process and documented in the customized claims handling instructions. Once the employee is deemed at MMI with permanent work restrictions, the examiner promptly communicates the work restrictions to the client so they can commence the interactive process. The examiner then sets a diary to ensure the offer of modified or alternate work is timely sent.

Some of our clients prefer to send the offer of modified or alternate work directly to their employees, while others prefer us to complete the form. These preferences are outlined in the client’s customized claims handling instructions.

The claims supervisor uses the document aging reports to identify PR4’s and medical legal reports and ensure the examiner has timely reviewed them and that permanent work restrictions are timely addressed.

Athens Administrators specially codes any penalty that is a result of an Athens’ error. Each quarter we run a report of those payment codes and reimburse our clients those funds. Once claims determines the penalty, they forward a check request to our accounting department to issue payment. We either mail the check to the client or deposit it into their trust account, based on their instructions. We take full responsibility for our errors and make it right with our clients.

Regarding fines and penalties paid to State or Federal regulators, we have passed the PAR audit every time since we were founded in 1976 and in the preceding five years, no penalties have been assessed.

D. Summary

1. Describe in detail your firm’s data processing and staff experience with converting claim and financial records date from former TPAs to your proposed system. Provide the #9..
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client’s company name, type of system converted from, contact name and phone number.

Our claims and IT staff have successfully completed numerous data (claims and financial) conversions from our client’s former TPAs.

Below are recent clients that have had their claim information successfully converted from other TPA’s to Athens Administrators. All the conversions were completed within the required timeframes.

Client Name System or
TPA
Converted
From
Client Contact Phone Number
Alameda-Contra Costa
Transit District
York/Sedgwick Kelley R. Easter-Grant (510) 891-4810
Eskaton Properties York/Sedgwick Ken Fisher (916) 334-0810 County of Marin Tri-Star Karen Shelar (415) 473-6445

2. Describe your firm’s plan for provision of each of the following service elements. Include documentation of your firm’s philosophy, protocol and readiness to provide the following services:
• Utilization Review
• Preferred Provider Organization Network*
• Bill Review Services
*Include the number of members in the PPO to be used and the number of specialties represented. In addition, provide the PPO member’s contract provision language which specifies the percentage below the California Official Medical Fee Schedule to which the PPO member has agreed.

Utilization Review
The DWC has completed an audit of Athens UR services in 2021. With a best possible score of 100%, we are proud to state that Athens utilization review services passed with a final, perfect score of 100%.

Athens Managed Care’s (AMC) utilization review program has been setup in accordance with the policies and regulations implemented by the State of California. Our Utilization Review plan was developed with our management team, medical director, and panel of physicians to ensure all processes are most effective for claims handling as well as employee health. We do have a standard protocol for examiner treatment approval guidelines to decrease the number of unnecessary requests going through the full UR process. These protocols can be reviewed at the client’s directive and discussed with our medical director should changes be requested. Treatments that fall outside the examiner approval guidelines are recommended for full UR review. #9..
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Our utilization review program provides prospective, concurrent and retrospective reviews to determine appropriateness of care, frequency and care setting. AMC’s experienced staff of utilization review specialist and peer review physicians utilize medical treatment protocols and expert systems technology to determine the medical appropriateness of care as well as frequency, duration and setting.

Utilization Review is performed when appropriate. The examiner manages the Nurse Case Manager and schedules QME and medical legal evaluations. All medical bills are submitted for Bill Review.

Activities to expect from a Case Manager: Upon referral of a case management assignment, the Case Manager follows these timelines:
• Referral Source Contact: Within in (1) day of case assignment, verify and or obtain missing information.
• Attorney Contact (if represented): Within one (1) day of case assignment • Injured worker/Physician/Employer Contact: Within one (1) day of case assignment or attorney authorization
• Initial Interview: Meet as soon as possible with the injured worker, and if possible, attend the next medical appointment or visit hospital or physician office. • Initial Report: Within the first seven (7) days of case assignment Athens Managed Care has its own utilization review nurses providing first level review.

We also contract with an outside vendor for overflow coverage for nurse services. This vendor, Shearwater Health, is a URAC accredited organization. All nurse reviewers are #9..
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licensed within the United States. Additionally, we contract with an outside vendor for all physician reviewers. Claims Eval is a URAC accredited organization and provides physician reviewers throughout the United States to ensure appropriate coverage based on state requirements.

All services provided by outside vendors is monitored. This is done through auditing and QA calibrations between Athens Managed Care and the service vendor. Calibrations are done on a bi-weekly basis as well as weekly operations calls.

Preferred Provider Organization Network
Athens Administrators offers the Anthem network to our clients. We feel this is the best option due to the breadth and size of Anthem as well as the steep discounts available through Anthem.

Anthem provides access to a comprehensive network of physicians and hospitals that meet access standards in over 98% of all California zip codes giving the City employees access and choice in California statewide. Anthem’s client base represents over 40% of the workers’ compensation market and the network is utilized by over 300 MPNs. The network has consistently delivered best in class savings below the California official medical fee schedule for workers’ compensation for more than 20 years.

Anthem’s network consists of over 71,135 provider locations in California including direct contracts with 294 general acute care hospitals, 494 ambulatory surgery centers, and 867 Frontline or urgent care clinics. Their comprehensive network also includes skilled nursing and rehabilitation facilities, home health care and Durable Medical Equipment providers, radiology and imaging services, laboratory and other ancillary providers.

Anthem can provide the City substantial unit cost savings below OMFS for medical services rendered by participating providers and facilities based on the confidential Anthem contract rates. PPO Savings is defined as the least amount of the difference between: (a) PPO’s contract rates with Participating Providers and the applicable State’s Workers’ Compensation Fee Schedule; or (b) the Participating Provider’s customary charge and PPO’s contracted rate where no State Workers’ Compensation Fee Schedule applies; or (c) the billed charge by the Participating Providers and PPO’s contract rates with such Providers.

Anthem Workers’ Compensation average book of business yielded 80.12% PPO penetration with some clients yielding as high as 96.8% penetration with pro-active channeling mechanisms.

Anthem’s Network Composition:

Frontline Occupational Clinics 867
Ambulatory Surgery Centers 495
General Acute/Specialty Hospitals 294
Other Health Facilities: 2,399
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Skilled Nursing Facilities, Chemical Dependency (IP/OP), Mental Health (IP/OP), Residential Treatment Center,
Transitional Living, X-ray/Diagnostic Imaging, MRI
Ancillary Providers: 6,762
Home Health, Home Infusion, DME
Labs, X-ray/MRI, Ambulance (Air & Ground),
Hearing Aid Dispensers, Orthotics & Prosthetics
Primary Treating Physicians 9,215
Other Physicians and Health Professionals 51,103
Total 71,135
Bill Review Services
Athens Administrators has in-house bill review service capabilities. Our bill review software is state-of-the-art Windows based software that is updated on a regular basis to reflect current fee schedules and PPO networks. The medical bill review software system is used to detect a broad range of questionable billing practices, excessive and duplicate charges, over-utilization, and unnecessary services. Our qualified trained staff reviews each bill to determine appropriateness of treatment and to ensure provider compliance with fee schedule ground rules.

Athens Managed Care offers an innovative medical bill review program with an average savings per bill of 71%. We offer a complete medical savings solution for all of your innetwork and out-of-network medical bills, including PPO management, medical bill repricing, line-item review, expert fee negotiations, professional review, automated adjudication and electronic reimbursement. Each feature focuses on increasing processing efficiencies and maximizing savings opportunities.

Athens Managed Care specializes in reducing the cost of all medical bills through a combination of robust rules-based technology, clinical expertise, expert review and PPO networks. Athens Managed Care is able to identify unbundled services, re-bundling opportunities, reasonable and customary review, fee schedule analysis, pharmacy review and PPO management.

Our Cost Containment Program incorporates multiple strategies to control costs, as follows:
 Before costs are incurred: through pre-authorization of inpatient and outpatient treatment plans, according to guidelines and channeling to network providers whenever possible.
 During the life of the claim: by channeling specialty care to network providers, when possible, within the confines of the workers’ compensation statute, early identification of red flags, and through concurrent review of treatment plans against medical necessity and appropriateness guidelines and length of stay/treatment criteria.  Retrospectively: through comprehensive fee schedule audit procedures and application of workers’ compensation network discounts (when applicable). #9..
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3. List and describe the features that distinguish your firm from other third-party administrators.

The key to successful TPA services is the people who work the claims and that interact with injured workers on a daily basis. Athens’ core business model is to take care of our people and to create an environment that attracts and retains the very best. We have been recognized as a Best Place to Work in the San Francisco Bay area, Orange County and San Diego. More specifically, for the past 16 years, Athens Administrators has been ranked as one of the best places to work in the San Francisco Bay area. What does this mean for you? It allows us to retain the most professional and hardworking team in our industry, as well as being able to attract new talent that wants to work for a dynamic organization. In 2020, our proposed Concord, CA office proposed to administer the District’s account, received its a ranking of being voted as the 4th best place to work in Bay Area for mid-sized corporations across all industries and the highest of any midsize TPA or related risk management/insurance company!
Our staff is stable and happy and they take great care of our clients. Through Glassdoor.com (an independent internet-based employer ranking website) we are able to see that Athens Administrators clearly outranks our competitors in employee satisfaction. Below are the independent rankings of Athens Administrators:

There are a number of reasons why we believe the City should choose Athens Administrators for their risk management program.

PHILOSOPHY
Athens Administrators’ philosophy is to build strong, long-term partnerships and provide the highest level of claims administration services for our clients. Our focus is to always be excellent in everything we do. We believe in:
 Partnership – We support our clients’ objectives and philosophies by setting goals and regularly communicating with the objective of never surprising our clients. We measure our #9..
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performance and frequently report back. We are always accountable for our actions.  People – The people at Athens drive results for our clients. We attract the highest caliber staff and equip them with all of the necessary resources to succeed.  Technology – We continually invest in systems to provide reliable data, which enables all stakeholders to make powerful decisions.
 Service –The key to our success is a sense of urgency to constantly deliver exceptional service to our clients through professionalism, communication and quality.  Problem Solving – We always ask questions and take the next logical steps. We don’t stop at barriers, we keep moving ahead until we can provide a solution.  Maximum Cost Savings – We achieve maximum cost savings by focusing on return to work, reducing litigation, curtailing medical costs and expediting claim closure.

Core Values:

At every level within our organization, core values support our vision and the shape of our company. We ultimately believe that our loyalty to adhering to these core values assist us in providing exceptional service to our employees, our clients and their injured workers. Below are the core Values for Athens Administrators.
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Beyond our specific public municipality and agency related experience there are a number of additional critical components as to why we believe we are the best claims administration option for the City. The following is a high-level outline of our key strengths that differentiate us from the other third-party administrators in the marketplace today and reflects the overall benefits we can bring to the City of Modesto’s program:

Transparent Flexible Approach to Claims Administration
• No hidden fees or revenue sharing agreements in place • Promotes an open, honest environment for our clients
• Our clients have the ability to hand pick their vendor of choice Company-wide Claims Closing Incentive Program in Place
• Clients enjoy outstanding closing ratios
• Claims are closed faster while ensuring compliance with all state rules/regulations/statutes
• Further supports our total alignment of interests with our customers RMIS Solutions
• AthenScan - Paperless claim files which provide better response time, enhanced communication and better facilitate the decision-making process • Athens Focus - Risk Management dashboard, provides drill down data, refreshed four times per day, including interactive location claim mapping
• Client Direct Specific Portal
• Data Integration Solution
• Secure Data - Successfully implemented and tested Business continuity Catastrophe Plan Quality
Experience/Stability
• Exclusive California focus and expertise
• 45 years of workers’ compensation claims administration public agency experience • Mandatory ongoing continuing education - effective claim resolutions, increased cost containment utilization, use of workers’ compensation laws, regulations and statutes • Fully Licensed/Designated Technical Staff - delivering prompt, timely & correct benefits • Management Structure
Consistent Superior Audit Results
• DWC Audit Results - Athens Administrators consistently passes the Workers’ Compensation PAR audit.

Client Specific Customization of Programs
• We develop and maintain special account instructions for all our customers based on their requirements and specifications for desired results.

Excellent References
Internal Athens Operations
Training/Education
• Mandatory regularly scheduled on-site staff training – procedural, legislative and regulatory
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• On-site workers compensation training to AC Transit
High Employee Retention Rate (Low Turnover)
• Results in long term consistent claims administration • Enhanced communication and client program knowledge/understanding • Satisfied, motivated employees who work hard for our customers We specialize in the management of California Workers’ Compensation claims, we are focused to identify, address and manage all areas of your workers’ compensation program and we believe we bring a unique skill set and different perspective to make your program succeed. #9..
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JENKINS, JAMES
R.

President

CATELANI

HOWARD, JANE
Chief Financial
Officer

HART, EMILY
Director of Claim
Operations and
Compliance
BAKER,

BARBARA
Auditor - Property
and Casualty

HUERTA,

VICTORIA
Workers
Compensation
Claims Auditor

MASYADA,
SUSAN
Corporate Trainer

MILLER, ERIC
Data Quality
Analyst

POPEJOY, GINA
Compliance
Specialist

PARK, NICOLE
Implementation
Specialist

DUARTE, LIBBY
Corporate
Services
Supervisor

BRADFORD,
DAYNA
Corporate
Services Lead

CARDENAS,

CHRISTY
Corporate Service
Assistant

HART, BRIAN
Claim Service
Assistant

HUNTER,
CONNOR
Corporate
Services
Receptionist

NICHOLS,
LACEY
Corporate
Services Assistant

PAIN, ELSA
Administrative
Services Lead

PANTAGES,

CHRISTINA
Claim Service
Assistant

STEVENS, JADE
Corporate
Services Lead
WHITE,

CAMERON
Receptionist

WINFIELD, LISA
Accounting
Manager

GALDOS,

ENRIQUE
Senior Payroll
Specialist

CHAMBERLIN,
PAMELA
Accounting
Specialist II

HAMILTON,

SHEALAMAR
Lead Accounting
Specialist
LOGAN,

RODEMERE R
Accounting
Specialist III

REYES, SONIA
Accounting
Specialist I
TORNO,

ADRIANA
Accounting
Supervisor

QUINONES,
GRACE
Accounting
Specialist III

TIERRA,

JOSELINA
Accounting
Specialist II

ALWAY, LISA
Accounting
Specialist II

LOCKETT, SOFIA
Accounting
Specialist II

MCCARTHY,

MADELIENE
Accounting
Specialist I

BARNWELL,
DON
Information
Technology
Director

BRENNER,
LANDON
Software
Developer

DEGAETANO II,
ARTHUR
Database
Developer II

FONG, RANDALL
Sr. Database
Developer

SAECHAO,
DENNIS
Associate
Infrasructure
Engineer

MCGRATH,
JOHN
Sr. Database
Developer

GIBB, DOUGLAS
Executive Vice
President,
Workers
Compensation
MASON,

JEANETTE
Claims Director

SIMPSON, JULIE
Division Claims
Manager

JOHNSON,
TAFFY
Claims Supervisor

ANDERSON,
KAREN
Future Medical
Claims Examiner

AUTAJAY,

KIMBERLY
Senior Claims
Examiner

GARNER,
CORINA
Senior Claims
Examiner

KING, LINDA
Lead Assistant
Claims Examiner

LACSAMANA,

VINCENT
Assistant Claims
Examiner

MARTINEZ,
MEAGAN
Senior Claims
Examiner

ORDONIO,
DANIEL
Senior Claims
Examiner

RICAFRANCA,
BROOKE
Future Medical
Claims Examiner

RODRIGUEZ,
PAUL
Assistant Claims
Examiner

PETERSEN,
PHALBA
Assistant Claims
Examiner

STENGEL,

JERILYN
Claims Supervisor

BERGUM,

CHRISTINE
Assistant Claims
Examiner

BURROW,
CARLA
Future Medical
Claims Examiner
CROSS,

RANDALL
Assistant Claims
Examiner

ESCLAMADO,
ANDREA
Assistant Claims
Examiner
GIBBS,

VANESSA
Assistant Claims
Examiner

KERKHOFF,

KRISTIN
Senior Claims
Examiner

MONTGOMERY,
MARLA
Future Medical
Claims Examiner

NAVAT, ELENO
Senior Claims
Examiner

PEEK, CURTIS
Senior Claims
Examiner

SCHAEFER,
MARY
Senior Claims
Examiner
STUCK,

VIRGINIA
Assistant Claims
Examiner
WONG,

MATTHEW
Claims Examiner I

VALDERRAMA,

CYNTHIA
Quality Assurance
Lead

VOHRA, VISHAL
Division Claims
Manager

BARRIENTEZ,
VICTOR
Claims Supervisor

BUHRE, ROBERT
Claims Examiner I

HUGHES,

CHRISTOPHER
Claims Examiner I

HURTADO,

ROXANNE
Assistant Claims
Examiner

JAY, LISA
Future Medical
Claims Examiner

RUBIN, JEFFREY
Senior Claims
Examiner

THOMPSON,
NANCY
Senior Claims
Examiner

GUERRERO,
ANDREW
Senior Claims
Examiner

HASSNAOUI,
CHLOE
Assistant Claims
Examiner

SHEPHERD,
JACK
Assistant Claims
Examiner

WALKER, HOLT
Claims Supervisor

AMELING,

STEPHANIE
Senior Claims
Examiner

CHAPIN,

TIMOTHY
Senior Claims
Examiner

CLEVENGER,

DANIELLE
Assistant Claims
Examiner

GILBERT,

GRIFFIN
Senior Claims
Examiner

HYLAND,

AUGUSTINA
Senior Claims
Examiner

MELARA,

JESSICA
Assistant Claims
Examiner

RODRIGUEZ,
MARIA
Assistant Claims
Examiner

TIDWELL,
ELISHA
Assistant Claims
Examiner

WEATHERBY,

STEPHANIE
Assistant Claims
Examiner

MARTINEZ,

ZACHARY
Senior Claims
Examiner

CHERRY,
SHARON
Senior Claims
Examiner

PLEITES, MARIO
Senior Claims
Examiner
QUINN,

RUSSELL
Division Claims
Manager

COLLADO, RYAN
Claims Supervisor

FREDRICKSON,

BARBARA
Senior Claims
Examiner

NATIVIDAD,

JEANNIE
Future Medical
Claims Examiner

QUINTERO,

MYCHELL
Assistant Claims
Examiner

ROBERTS,

KAREN LYNN
Senior Claims
Examiner

SANCHEZ, TINA
Senior Claims
Examiner

TAYLOR, KELLY
Assistant Claims
Examiner

THOMAS,
MARIAN
Future Medical
Claims Examiner

CARRION,
JAVIER
Senior Claims
Examiner

DARSEY,

BRENDEN
Assistant Claims
Examiner

FIERROS,

GLORIANNA
Claims Examiner I

JONES-BISHOP,

LAKISHA
Claims Supervisor

BECKLER, JOHN
Senior Claims
Examiner

DUCUMMON,
ALYSSE
Assistant Claims
Examiner

HAYNES,

CHRISTINA
Assistant Claims
Examiner

JENSEN, ANN
Senior Claims
Examiner

JIMENEZ,

STEPHANNIE
Assistant Claims
Examiner

OSHEA, KAREN
Senior Claims
Examiner

PALOMO,

KRISTINA
Future Medical
Claims Examiner

QUIAMCO,
EDWINA
Future Medical
Claims Examiner
SMITH,

ERNESTINE
Senior Claims
Examiner

SOTO, LANETTE
Claims Examiner I

CERDA, OLGA
Claims Supervisor

ALVAREZ, ALMA
Senior Claims
Examiner

BARNES,
DENISE
Senior Claims
Examiner
EATON JR.,

SCOTTIE
Assistant Claims
Examiner

HEREDIA,

SHANNON
Senior Claims
Examiner

HIRAKAWA,
AMBER
Assistant Claims
Examiner

NICHOLS,

MARIETTE
Senior Claims
Examiner

WATSON,

VENESSA
Senior Claims
Examiner

TRAN, NGA
Claims Supervisor

BARTON,
ASHLEY
Assistant Claims
Examiner

WILSON,

CHRISTINA
Senior Claims
Examiner

WHITE, SUNNY
Division Claims
Manager

LANCASTER,
CASSIE
Claims Supervisor
CANCIO, MA.

THERESE
Claims Examiner I

CHRISTENA,
CRAIG
Senior Claims
Examiner

COLLADO,
ASHLEY
Assistant Claims
Examiner

DE LA PENA,
ELVIRA
Assistant Claims
Examiner

MANUZON,

RHODORA
Senior Claims
Examiner

GASTELLO,
ROSANA
Senior Claims
Examiner

SIMPSON,
BRIANA
Assistant Claims
Examiner
SOTO,

PRISCILLA
Assistant Claims
Examiner

MOREHEAD,
ANDREW
Claims Supervisor

AIELLO, MINDY
Senior Claims
Examiner

CARROLL,

LORAYNE W
Lead Senior
Claims Examiner

COOPER,
ALODIE
Assistant Claims
Examiner

GRAM-REEFER,
AILEEN
Senior Claims
Examiner

JUAN, KATLYN
Assistant Claims
Examiner

LEE, DOROTHEA
Return To Work
Coord EBMUD

MORENO,

KIMBERLY
Future Medical
Claims Examiner

RENINGER,
HEIDI
Senior Claims
Examiner

SEBASTIANI,
STELLA
Lead Senior
Claims Examiner

VANDERFORD,

JENNIFER
Claims Supervisor

ALVARADO,
ERIKA
Senior Claims
Examiner

ANTOINE-FORT,
LEASHA
Assistant Claims
Examiner
GRUBB,
RAQUEL
Senior Claims
Examiner

KENNEDY,

LUCILLE
Lead Senior
Claims Examiner

SOMERA, RHEA
Assistant Claims
Examiner

THOMAS,

SUZANNIE
Future Medical
Claims Examiner

TROXLER,
THOMAS
Senior Claims
Examiner

DERUBEIS,

KATRINA
Claims Supervisor

EASTWOOD,
CINDY
Claims Examiner
II

MCQUADE,

MICHAEL
Assistant Claims
Examiner

PRUNEAU,

STEPHANIE
Senior Claims
Examiner

SILVERSTEIN,
JON
Future Medical
Claims Examiner

SNELL, JENIFER
Senior Claims
Examiner

SUSEE, DENISE
Claims Examiner I

TIDWELL,

CHARLENE
SHANEE
Assistant Claims
Examiner

GEORGE,

ELIZABETH
Division Claims
Manager

BERGUM, BETH
ANN
Lead Senior
Claims Examiner
BORJA,
ROWENA
Assistant Claims
Examiner
CAMPOS

VASQUEZ, EVA
Assistant Claims
Examiner

COURSE,

CHRISTINE
Senior Claims
Examiner

DELFIN, MONICA
Senior Claims
Examiner

HURTADO,

TIFFANY
Assistant Claims
Examiner

MELARA, JERRY
Senior Claims
Examiner

SLUGA, KELLEN
Senior Claims
Examiner

THONGDY,

DALAVANH
Assistant Claims
Examiner

TIDWELL,

CANDICE
Assistant Claims
Examiner
LANDA,

MICHAEL
Executive Vice
President,
Business
Development

CICHURSKI,
KEVIN
Sales Director

ROBRECHT,
HANNAH
Marketing
Specialist

MCCLAIN,
JANET
Executive Vice
President, Human
Resources

GIACOLETTO,
TERYN
Executive
Assistant

INDABURU,

SAMANTHA
Human Resources
Generalist

QUALLS,

CANDICE
Corporate
Recruiter
SOLIS,

JENNIFER
Human Resources
Business Partner

VANVLIET,
TAMARA
Human Resources
Business Partner

PAULAUSKAS,
SIMONA
Human Resources
Coordinator
Concord Organizational Chart
#9..
- 307 -

JENKINS, JAMES
R.

President

GIBB, DOUGLAS
Executive Vice
President,
Workers
Compensation
MASON,

JEANETTE
Claims Director

SIMPSON, JULIE
Division Claims
Manager

JOHNSON,
TAFFY
Claims Supervisor

ANDERSON,
KAREN
Future Medical
Claims Examiner

AUTAJAY,

KIMBERLY
Senior Claims
Examiner

GARNER,
CORINA
Senior Claims
Examiner

KING, LINDA
Lead Assistant
Claims Examiner

LACSAMANA,

VINCENT
Assistant Claims
Examiner

MARTINEZ,
MEAGAN
Senior Claims
Examiner

ORDONIO,
DANIEL
Senior Claims
Examiner

RICAFRANCA,
BROOKE
Future Medical
Claims Examiner

RODRIGUEZ,
PAUL
Assistant Claims
Examiner

PETERSEN,
PHALBA
Assistant Claims
Examiner

STENGEL,

JERILYN
Claims Supervisor

BERGUM,

CHRISTINE
Assistant Claims
Examiner

BURROW,
CARLA
Future Medical
Claims Examiner
CROSS,

RANDALL
Assistant Claims
Examiner

ESCLAMADO,
ANDREA
Assistant Claims
Examiner
GIBBS,

VANESSA
Assistant Claims
Examiner

KERKHOFF,

KRISTIN
Senior Claims
Examiner

MONTGOMERY,
MARLA
Future Medical
Claims Examiner

NAVAT, ELENO
Senior Claims
Examiner

PEEK, CURTIS
Senior Claims
Examiner

SCHAEFER,
MARY
Senior Claims
Examiner
STUCK,

VIRGINIA
Assistant Claims
Examiner
WONG,

MATTHEW
Claims Examiner I

VALDERRAMA,

CYNTHIA
Quality Assurance
Lead

VOHRA, VISHAL
Division Claims
Manager

BARRIENTEZ,
VICTOR
Claims Supervisor

BUHRE, ROBERT
Claims Examiner I

HUGHES,

CHRISTOPHER
Claims Examiner I

HURTADO,

ROXANNE
Assistant Claims
Examiner

JAY, LISA
Future Medical
Claims Examiner

RUBIN, JEFFREY
Senior Claims
Examiner

THOMPSON,
NANCY
Senior Claims
Examiner

GUERRERO,
ANDREW
Senior Claims
Examiner

HASSNAOUI,
CHLOE
Assistant Claims
Examiner

SHEPHERD,
JACK
Assistant Claims
Examiner

WALKER, HOLT
Claims Supervisor

AMELING,

STEPHANIE
Senior Claims
Examiner

CHAPIN,

TIMOTHY
Senior Claims
Examiner

CLEVENGER,

DANIELLE
Assistant Claims
Examiner

GILBERT,

GRIFFIN
Senior Claims
Examiner

HYLAND,

AUGUSTINA
Senior Claims
Examiner

MELARA,

JESSICA
Assistant Claims
Examiner

RODRIGUEZ,
MARIA
Assistant Claims
Examiner

TIDWELL,
ELISHA
Assistant Claims
Examiner

WEATHERBY,

STEPHANIE
Assistant Claims
Examiner

MARTINEZ,

ZACHARY
Senior Claims
Examiner

CHERRY,
SHARON
Senior Claims
Examiner

PLEITES, MARIO
Senior Claims
Examiner
QUINN,

RUSSELL
Division Claims
Manager

COLLADO, RYAN
Claims Supervisor

FREDRICKSON,

BARBARA
Senior Claims
Examiner

NATIVIDAD,

JEANNIE
Future Medical
Claims Examiner

QUINTERO,

MYCHELL
Assistant Claims
Examiner

ROBERTS,

KAREN LYNN
Senior Claims
Examiner

SANCHEZ, TINA
Senior Claims
Examiner

TAYLOR, KELLY
Assistant Claims
Examiner

THOMAS,
MARIAN
Future Medical
Claims Examiner

CARRION,
JAVIER
Senior Claims
Examiner

DARSEY,

BRENDEN
Assistant Claims
Examiner

FIERROS,

GLORIANNA
Claims Examiner I

JONES-BISHOP,

LAKISHA
Claims Supervisor

BECKLER, JOHN
Senior Claims
Examiner

DUCUMMON,
ALYSSE
Assistant Claims
Examiner

HAYNES,

CHRISTINA
Assistant Claims
Examiner

JENSEN, ANN
Senior Claims
Examiner

JIMENEZ,

STEPHANNIE
Assistant Claims
Examiner

OSHEA, KAREN
Senior Claims
Examiner

PALOMO,

KRISTINA
Future Medical
Claims Examiner

QUIAMCO,
EDWINA
Future Medical
Claims Examiner
SMITH,

ERNESTINE
Senior Claims
Examiner

SOTO, LANETTE
Claims Examiner I

CERDA, OLGA
Claims Supervisor

ALVAREZ, ALMA
Senior Claims
Examiner

BARNES,
DENISE
Senior Claims
Examiner
EATON JR.,

SCOTTIE
Assistant Claims
Examiner

HEREDIA,

SHANNON
Senior Claims
Examiner

HIRAKAWA,
AMBER
Assistant Claims
Examiner

NICHOLS,

MARIETTE
Senior Claims
Examiner

WATSON,

VENESSA
Senior Claims
Examiner

TRAN, NGA
Claims Supervisor

BARTON,
ASHLEY
Assistant Claims
Examiner

WILSON,

CHRISTINA
Senior Claims
Examiner

WHITE, SUNNY
Division Claims
Manager

LANCASTER,
CASSIE
Claims Supervisor
CANCIO, MA.

THERESE
Claims Examiner I

CHRISTENA,
CRAIG
Senior Claims
Examiner

COLLADO,
ASHLEY
Assistant Claims
Examiner

DE LA PENA,
ELVIRA
Assistant Claims
Examiner

MANUZON,

RHODORA
Senior Claims
Examiner

GASTELLO,
ROSANA
Senior Claims
Examiner

SIMPSON,
BRIANA
Assistant Claims
Examiner
SOTO,

PRISCILLA
Assistant Claims
Examiner

MOREHEAD,
ANDREW
Claims Supervisor

AIELLO, MINDY
Senior Claims
Examiner

CARROLL,

LORAYNE W
Lead Senior
Claims Examiner

COOPER,
ALODIE
Assistant Claims
Examiner

GRAM-REEFER,
AILEEN
Senior Claims
Examiner

JUAN, KATLYN
Assistant Claims
Examiner

LEE, DOROTHEA
Return To Work
Coord EBMUD

MORENO,

KIMBERLY
Future Medical
Claims Examiner

RENINGER,
HEIDI
Senior Claims
Examiner

SEBASTIANI,
STELLA
Lead Senior
Claims Examiner

VANDERFORD,

JENNIFER
Claims Supervisor

ALVARADO,
ERIKA
Senior Claims
Examiner

ANTOINE-FORT,
LEASHA
Assistant Claims
Examiner
GRUBB,
RAQUEL
Senior Claims
Examiner

KENNEDY,

LUCILLE
Lead Senior
Claims Examiner

SOMERA, RHEA
Assistant Claims
Examiner

THOMAS,

SUZANNIE
Future Medical
Claims Examiner

TROXLER,
THOMAS
Senior Claims
Examiner

DERUBEIS,

KATRINA
Claims Supervisor

EASTWOOD,
CINDY
Claims Examiner
II

MCQUADE,

MICHAEL
Assistant Claims
Examiner

PRUNEAU,

STEPHANIE
Senior Claims
Examiner

SILVERSTEIN,
JON
Future Medical
Claims Examiner

SNELL, JENIFER
Senior Claims
Examiner

SUSEE, DENISE
Claims Examiner I

TIDWELL,

CHARLENE
SHANEE
Assistant Claims
Examiner

GEORGE,

ELIZABETH
Division Claims
Manager

TIDWELL,

CANDICE
Assistant Claims
Examiner

BERGUM, BETH
ANN
Lead Senior
Claims Examiner
BORJA,
ROWENA
Assistant Claims
Examiner
CAMPOS

VASQUEZ, EVA
Assistant Claims
Examiner

COURSE,

CHRISTINE
Senior Claims
Examiner

DELFIN, MONICA
Senior Claims
Examiner

HURTADO,

TIFFANY
Assistant Claims
Examiner

MELARA, JERRY
Senior Claims
Examiner

SLUGA, KELLEN
Senior Claims
Examiner

THONGDY,

DALAVANH
Assistant Claims
Examiner
Concord Workers' Compensation Department
#9..
- 308 -
Kevin Cichurski Director of Sales 925-826-1103
Nicole Park Implementation Specialist 925-826-1050
Doug Gibb EVP, Workers' Compensation 925-826-1283
Jeanette Mason Division Claims Manager 925-826-1160
Leann Farlander AVP, Cost Cointainment 949-296-3961
Janet McClain HR Director 925-826-1288
Emily Kephart Claims Operations Manager 925-826-1112
Libby Duarte Mail Room Supervisior 925-826-1295
Jane Catelani CFO 925-826-1281
Don Barwell Director of IT 925-826-1232
Who Task Description Accountability Due Date Comments
City of Modesto Notify exiting TPA
Athens Contact Client to confirm exiting TPA has been notified.

Athens Contact current TPA to begin transfer discussion Athens Provide exiting TPA with suggested transfer guidelines.

Athens and ICS Agree upon tenative transfer dates
Athens Notify COO, DM, OS
Athens Notify Administrative Services Supervisor w/ contact Athens Obtain IT contact from exiting TPA
Who Task Description Accountability Due Date Comments
Athens Provide IT Director with IT Contact
Athens Notify programmer of conversion project
Athens Notify Self Insurance Plans of change
Athens Request claims data layout, tables and test data from current TPA Claims Data
[email protected]
[email protected]
[email protected]
Notifications
Claims Data Conversion
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
PEOPLE, POWERED.

Proposed Implementation Plan Tracking - City of Modesto Athens Transition Team
[email protected]
[email protected]
#9..

ICS Provide Athens with initial claims data layout, tables and test data Athens Provide claims data layout, tables and test data to programmer Athens Review job codes and location codes with client for possible updates or changes Athens Complete table mapping
Athens Load converted test claims data into test site
Athens Review converted test data for completeness and accuracy Athens Reconcile test data
ICS Send final data
Athens Convert final data and load into test site
Athens Review final data for completeness and accuracy
Athens Reconcile final data
Athens Load final data into live site
Electronic Documents
Athens Request E-Documents layout and test data from current TPA ICS Forward E-Documents layout and test data
Athens Provide E-Documents layout and test data to programmer Athens Complete table mapping
Athens Load converted documents into test site
Athens Review converted documents
Who Task Description Accountability Due Date Comments
Athens Load final documents into live site
Athens Program rules tables
Data Interface
Athens Request Data Specs from partners and stakeholders Athens Complete Programing
Athens Test data integration points
Athens Document interface
Athens Load into live production
Athens Contact client to determine funding account
City of Modesto & Athens Determine who owns bank account Athens Notify Athens CFO of client contact
Athens Complete signature cards
Banking Arrangements
#9..

Athens Determine if data will be sent to bank for Positive Pay Athens Notify programers of new bank for Positive Pay Programming Athens Review reporting requirements with Client
City of Modesto & Athens Determine funding amount
City of Modesto & Athens Fund account
Athens Establish Weekly Meetings
City of Modesto & Athens Develop special claim handling requirements City of Modesto & Athens Discuss and approve vendor panels City of Modesto & Athens Approve UR and NCM guidelines
City of Modesto & Athens Discuss RTW Program and other special procedures City of Modesto & Athens Review and schedule monthly report package City of Modesto & Athens Review new claim intake process Who Task Description Accountability Due Date Comments
City of Modesto & Athens Review MPN with Client
Athens Request any changes from MPN
City of Modesto Send out MPN notification
Athens Provide claim reporting kits
Athens Request user ID's and passwords for client
Athens Provide documentation and training for web claims access City of Modesto & Athens Discuss Training and Orientation City of Modesto & Athens Discuss Site Visits
City of Modesto & Athens Register Medicare Reporting
Athens and ICS Confirm file transfer date
Sedgwick Provide estimated number of boxes
Sedgwick Provide location of boxes for pickup
Sedgwick Confirm number of boxes for pickup
Sedgwick Notify claimant and parties of transfer
Sedgwick Confirm that exiting TPA will pay benefits 2 weeks in advance Athens and ICS Agree upon final cut off date for claim activity Athens Pick up boxes
Athens Deliver boxes to Athens
Athens Inventory boxes of open and closed files
City of Modesto & Athens Identify high exposure or high needs files Claim Files
Client Program
#9..

Athens Begin claims processing manually
Athens Send welcome notices to injured workers
Athens Notify vendors (clinics, attorneys, managed care) Athens Determine claim inventory
City of Modesto & Athens Discuss and approve staffing model and organization structure Who Task Description Accountability Due Date Comments
Athens Interview new and/or existing staff
Athens Present team to client
Athens Hire staff (as necessary)
Staffing
#9..

Client Onboarding - General Information
Program Name Claims Handling Office
Program Contact Account Manager
Program ID Division Manager
Program Period Supervisor
Effective Date Current TPA / Contact
Line of Business Takeover Open Claims
Jurisdiction(s) Total Takeover Claims
Policy Number (if
applicable)
Anticipated Annual
Indemnity Claim Volume
Policy Type Anticipated Annual MO
Claim Volume
Tax ID MPN on account?
Address MPN #/Effective Date
Bill review vendor MPN Name
AMC for NCM? AMC for UR?
Fiscal or Calendar
Year
Paperless status
PBM on Account? Number of physical file
boxes
Broker/Consultant Prior TPA’s transition
coordinator
Excess Carrier Prior TPA’s IT contact
Claims Transfer
Assigned to Notes Completed
Agree to cut-off date for claims
administration
Agree to medical bill review cut-off
date
Agree to advance compensation
timeline
Request hot box
Send notification to claimants
Send notification to
providers/other parties
Provide prior TPA with posttransfer contact
#9..
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Physical File Transfer
Assigned to Notes Completed
Determine backscan details
Schedule pickup of physical files
Program Setup
Assigned to Notes Completed
Establish Organization
Create Codeset ID
Create UI Group Criteria
Establish custom fields
Set up ISO schedule
Add reserve types
Set up Dashboard accounts
Data Transfer
Assigned to Notes Completed
Obtain test data
Agree on due date for final data
transfer
Obtain loss runs
Obtain Medical Bill Review history
Obtain PBM History
Banking
Assigned to Notes Completed
Clarify if Client or Athens will own
bank account
Bill Review fees – determine if
checks or vouchers
Establish bank account
Set up positive pay
Set up Bottomline
Print test check(s)
Reporting
Assigned to Notes Completed
Obtain sample reports
Schedule report distribution
Add RRE to Insurer Table
Create custom reports (if needed)
#9..
- 314 -
Other Details
Assigned to Notes Completed
Complete account instructions
Complete OSIP notification
Obtain 3 year annual report history
Obtain current Profile Report
Update Trading Partner Profile
Set up claim numbering protocol
Obtain Profile Report and update
RRE
Send out MPN letter
Obtain PBM information for Rx
cards
Set up Bill Review in StrataCare
Preferred method of claim
reporting
Schedule claim reporting training
Schedule SIMS training
List of RMIS SIMS users:

Name E-mail address Special Instructions (e.g. no
notes/reports)
List of Claim Compass users:

Name E-mail address Location
#9..
- 315 -
Meeting Information:

Meeting Date Follow-up Items
Athens Transition Team
Kevin Cichurski Director of Sales 925-826-1103 [email protected] Doug Gibb EVP, Workers’ Compensation 925.826.1283 [email protected] Janet McClain EVP, Human Resources 925-826-1288 [email protected] Leann Farlander AVP, Cost Containment 949.296.3961 [email protected] Emily Kephart Claims Operations Manager 925-826-1112 [email protected] Nicole Park Implementation Specialist 925-826-1050 [email protected] Jane Catelani CFO 925-826-1281 [email protected] Lisa Winfield Accounting Manager 925-826-1175 [email protected] Don Barnwell Director of IT 925-826-1232 [email protected] Jeanette Mason Claim Director 925-826-1160 [email protected] Libby Duarte Mail Room Supervisor 925-826-1295 [email protected] #9..
- 316 -
Athens Claim Team
#9..
- 317 -
From 1/1/2015 To 12/31/2019 As Of 12/31/2019
Claim Type Open Closed Total Litg. Paid Incurred Paid Reserve Incurred Recoveries Net Incurred 12/31/2015
First Aid 0 6 6 0 $1,066.28 $1,066.28 $1,066.28 $0.00 $1,066.28 $0.00 $1,066.28 Indemnity 11 76 87 29 $3,099,981.95 $3,737,781.72 $3,099,981.95 $637,799.77 $3,737,781.72 $0.00 $3,737,781.72 Info Only 0 49 49 0 $40.00 $40.00 $40.00 $0.00 $40.00 $0.00 $40.00 Medical Only 1 38 39 0 $23,520.60 $24,602.41 $23,520.60 $1,081.81 $24,602.41 $0.00 $24,602.41 Total: 12 169 181 29 $3,124,608.83 $3,763,490.41 $3,124,608.83 $638,881.58 $3,763,490.41 $0.00 $3,763,490.41 12/31/2016
First Aid 0 5 5 0 $1,371.21 $1,371.21 $1,371.21 $0.00 $1,371.21 $0.00 $1,371.21 Indemnity 17 84 101 28 $2,228,597.94 $2,753,090.16 $2,228,597.94 $524,492.22 $2,753,090.16 ($90,806.11) $2,662,284.05 Info Only 0 50 50 0 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Medical Only 1 45 46 1 $26,797.23 $36,779.23 $26,797.23 $9,982.00 $36,779.23 $0.00 $36,779.23 Total: 18 184 202 29 $2,256,766.38 $2,791,240.60 $2,256,766.38 $534,474.22 $2,791,240.60 ($90,806.11) $2,700,434.49 12/31/2017
First Aid 0 8 8 0 $2,226.02 $2,226.02 $2,226.02 $0.00 $2,226.02 $0.00 $2,226.02 Indemnity 19 65 84 23 $2,198,792.36 $3,282,484.48 $2,198,792.36 $1,083,692.12 $3,282,484.48 $0.00 $3,282,484.48 Info Only 0 51 51 0 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Medical Only 1 29 30 2 $17,124.03 $26,906.03 $17,124.03 $9,782.00 $26,906.03 ($300.00) $26,606.03 Total: 20 153 173 25 $2,218,142.41 $3,311,616.53 $2,218,142.41 $1,093,474.12 $3,311,616.53 ($300.00) $3,311,316.53 12/31/2018
First Aid 0 10 10 0 $3,620.36 $3,620.36 $3,620.36 $0.00 $3,620.36 $0.00 $3,620.36 Indemnity 25 64 89 22 $1,985,527.20 $3,209,341.54 $1,985,527.20 $1,223,814.34 $3,209,341.54 ($9,067.58) $3,200,273.96 Info Only 0 52 52 0 $559.07 $559.07 $559.07 $0.00 $559.07 $0.00 $559.07 Medical Only 1 45 46 1 $73,328.12 $83,409.02 $73,328.12 $10,080.90 $83,409.02 $0.00 $83,409.02 Total: 26 171 197 23 $2,063,034.75 $3,296,929.99 $2,063,034.75 $1,233,895.24 $3,296,929.99 ($9,067.58) $3,287,862.41 12/31/2019
First Aid 0 7 7 0 $1,633.83 $1,633.83 $1,633.83 $0.00 $1,633.83 $0.00 $1,633.83 Indemnity 33 43 76 23 $794,031.50 $1,385,572.89 $794,031.50 $591,541.39 $1,385,572.89 $0.00 $1,385,572.89 Info Only 6 48 54 0 $600.45 $600.45 $600.45 $0.00 $600.45 $0.00 $600.45 Rpt # O080
Report Run: 9/10/2020 6:26:01 AM
1 of 3
Claim Summary By Year - Program Name
Claim Loss Dates From 1/1/2015 Through 12/31/2019
Activity Dates From 1/1/2015 Through 12/31/2019
Period Ending 12/31
As Of 12/31/2019
#9..
- 318 -
From 1/1/2015 To 12/31/2019 As Of 12/31/2019
Claim Type Open Closed Total Litg. Paid Incurred Paid Reserve Incurred Recoveries Net Incurred 12/31/2019
Medical Only 5 28 33 1 $24,337.23 $29,969.14 $24,337.23 $5,631.91 $29,969.14 $0.00 $29,969.14 Total: 44 126 170 24 $820,603.01 $1,417,776.31 $820,603.01 $597,173.30 $1,417,776.31 $0.00 $1,417,776.31 Open Closed Total C Litg. Paid In Period Incurred In
Period
Paid Reserves Incurred Recoveries Net Incurred
Grand Total 120 803 923 130 $10,483,155.38 $14,581,053.84 $10,483,155.38 $4,097,898.46 $14,581,053.84 ($100,173.69) $14,480,880.15 Medical Only 9 185 194 5 $165,107.21 $201,665.83 $165,107.21 $36,558.62 $201,665.83 ($300.00) $201,365.83 Indemnity 105 332 437 125 $10,306,930.95 $14,368,270.79 $10,306,930.95 $4,061,339.84 $14,368,270.79 ($99,873.69) $14,268,397.10 Pending 0 0 0 0 $0.00 $0.00
Information Only 0 0 0 0 $0.00 $0.00
Unassigned 0 0 0 0 $0.00 $0.00
First Aid 0 36 36 0 $9,917.70 $9,917.70 $9,917.70 $0.00 $9,917.70 $0.00 $9,917.70 Rpt # O080
Report Run: 9/10/2020 6:26:01 AM
2 of 3
Claim Summary By Year - Program Name
Claim Loss Dates From 1/1/2015 Through 12/31/2019
Activity Dates From 1/1/2015 Through 12/31/2019
Period Ending 12/31
As Of 12/31/2019
#9..
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Program Name Period: 12/1/2019 To 12/31/2019
Claim No. Claimant Stat. Type Loss Date Knowl St Leg Paid Incurred Paid Reserves Incurred C Info Onl 12/3/2019 12/4/2019 CA N $0.00 $0.00 $0.00 $0.00 $0.00 O Medical 12/5/2019 12/5/2019 CA N $0.00 $0.00 $0.00 $0.00 $0.00 C Medical 12/6/2019 12/6/2019 CA N $0.00 $0.00 $0.00 $0.00 $0.00 O Medical 12/6/2019 12/6/2019 CA N $0.00 $1,150.00 $0.00 $1,150.00 $1,150.00 O Temporar 12/11/2019 12/11/2019 CA N $833.52 $4,156.00 $833.52 $3,322.48 $4,156.00 O Info Onl 12/17/2019 12/17/2019 CA N $0.00 $0.00 $0.00 $0.00 $0.00 O Info Onl 12/15/2019 12/15/2019 CA N $0.00 $0.00 $0.00 $0.00 $0.00 O Info Onl 12/31/2019 12/31/2019 CA N $0.00 $0.00 $0.00 $0.00 $0.00 O Info Onl 12/31/2019 12/31/2019 CA N $0.00 $0.00 $0.00 $0.00 $0.00 O Info Onl 12/27/2019 12/27/2019 CA N $0.00 $0.00 $0.00 $0.00 $0.00 O Info Onl 12/6/2019 12/6/2019 CA N $0.00 $0.00 $0.00 $0.00 $0.00 Totals For: Program Name
Ending Open: 9 Period 12/1/2019 - 12/31/2019 Financials As Of 12/31/2019 Ending Closed: 2 Paid Incurred Paid Reserves Incurred
Total: 11 $833.52 $5,306.00 $833.52 $4,472.48 $5,306.00 Recoveries: $0.00 Net Incurred: $5,306.00
Report Total:

Ending Open: 9 Period 12/1/2019 - 12/31/2019 Financials As Of 12/31/2019 Ending Closed: 2 Paid Incurred Paid Reserves Incurred
Total: 11 $833.52 $5,306.00 $833.52 $4,472.48 $5,306.00 Recoveries: $0.00 Net Incurred: $5,306.00
Report run: 9/10/2020 6:25:15 AM
Report Id:
1 of 1
Examiners: All
Status: Open
ClaimType: All
Incurred Range: ($1,000,000,000,000.00) - $1,000,000,000,000.00 Legal Activity: Both
Claims Cost Summary
As Of: 12/31/2019
Activity Period 12/1/2019 - 12/31/2019
Loss Dates between 12/1/2019 - 12/31/2019 #9..
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, INC.

Claimant Name
Description
Stat
Litg
Loss Age
Juris
Loss Date
Knowledge
Nature Of Injury
Body Part
Claim Type
Life Medical
Claim No. Close
d
55 12/3/2019 Strain Info Only Activity Paid 12/1/2019--12/31/2019 Totals Through 12/31/2019 N CA 12/4/2019 Shoulder N Paid Paid Reserve Incurred
Examiner: jthongdy Claim Total: $0.00 $0.00 $0.00 $0.00 Muscle Strain Left Shoulder
Claim No. Open 62 12/5/2019 Strain Medical Only Activity Paid 12/1/2019--12/31/2019 Totals Through 12/31/2019 N CA 12/5/2019 Head N Paid Paid Reserve Incurred
Examiner: jthongdy Claim Total: $0.00 $0.00 $0.00 $0.00 Hit the right side of temple. Bruising around the area.

Claim No. Open 37 12/6/2019 Strain Info Only Activity Paid 12/1/2019--12/31/2019 Totals Through 12/31/2019 N CA 12/6/2019 Multiple Body Parts N Paid Paid Reserve Incurred Examiner: jthongdy Claim Total: $0.00 $0.00 $0.00 $0.00 right heel and right knee
Claim No. Open 58 12/6/2019 Strain Medical Only Activity Paid 12/1/2019--12/31/2019 Totals Through 12/31/2019 N CA 12/6/2019 Rib(s) N Paid Paid Reserve Incurred
Medical $0.00 $0.00 $750.00 $750.00
Other $0.00 $0.00 $400.00 $400.00
Examiner: jthongdy Claim Total: $0.00 $0.00 $1,150.00 $1,150.00 hurt right ribs, have not received results from x rays
Claim No. Close
d
36 12/6/2019 Puncture Info Only Activity Paid 12/1/2019--12/31/2019 Totals Through 12/31/2019 N CA 12/6/2019 Hand, Right N Paid Paid Reserve Incurred Examiner: jthongdy Claim Total: $0.00 $0.00 $0.00 $0.00 Hand, Right middle and ring finger puncture
1 of 4
Detail Loss Run
Program Name
Loss Date Between 12/1/2019 and 12/31/2019 Financials As Of 12/31/2019 #9..
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Claimant Name
Description
Stat
Litg
Loss Age
Juris
Loss Date
Knowledge
Nature Of Injury
Body Part
Claim Type
Life Medical
Claim No. Open 33 12/11/2019 Strain Temporary
Disability
Activity Paid 12/1/2019--12/31/2019 Totals Through 12/31/2019 N CA 12/11/2019 Leg - Right N Paid Paid Reserve Incurred Medical $0.00 $0.00 $1,500.00 $1,500.00
Temporary Disability $815.52 $815.52 $1,340.48 $2,156.00 Other $18.00 $18.00 $482.00 $500.00
Examiner: mdelfin Claim Total: $833.52 $833.52 $3,322.48 $4,156.00 Right side of right lower leg, near the inner portion behind the kneecap.

Claim No. Open 62 12/15/2019 Contusion Info Only Activity Paid 12/1/2019--12/31/2019 Totals Through 12/31/2019 N CA 12/15/2019 Arm - Right N Paid Paid Reserve Incurred Examiner: jthongdy Claim Total: $0.00 $0.00 $0.00 $0.00 Ladder slipped from load beams and landed on him right arm.

Claim No. Open 52 12/17/2019 Contusion Info Only Activity Paid 12/1/2019--12/31/2019 Totals Through 12/31/2019 N CA 12/17/2019 Head N Paid Paid Reserve Incurred
Examiner: jthongdy Claim Total: $0.00 $0.00 $0.00 $0.00 Head Contusion
Claim No. Open 36 12/27/2019 Strain Info Only Activity Paid 12/1/2019--12/31/2019 Totals Through 12/31/2019 N CA 12/27/2019 Back N Paid Paid Reserve Incurred
Examiner: jthongdy Claim Total: $0.00 $0.00 $0.00 $0.00 Employee was bringing refrigerator down from liftgate of trailer when it began to fall. Employee strained his back while trying to keep refrigerator from falling.

Claim No. Open 29 12/31/2019 Strain Info Only Activity Paid 12/1/2019--12/31/2019 Totals Through 12/31/2019 N CA 12/31/2019 Back N Paid Paid Reserve Incurred
Examiner: jthongdy Claim Total: $0.00 $0.00 $0.00 $0.00 upper back between shoulder blades; light throbbing and muscle spasms. 2 of 4
Detail Loss Run
Program Name
Loss Date Between 12/1/2019 and 12/31/2019 Financials As Of 12/31/2019 #9..
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, INC.

Claimant Name
Description
Stat
Litg
Loss Age
Juris
Loss Date
Knowledge
Nature Of Injury
Body Part
Claim Type
Life Medical
Claim No. Open 48 12/31/2019 Strain Info Only Activity Paid 12/1/2019--12/31/2019 Totals Through 12/31/2019 N CA 12/31/2019 Back N Paid Paid Reserve Incurred
Examiner: jthongdy Claim Total: $0.00 $0.00 $0.00 $0.00 possible strained middle of back
89561 Ending Open: 9
Ending Closed: 2
Total: 11
Activity Paid 12/1/2019--12/31/2019 Totals Through 12/31/2019 Paid Paid Reserve Incurred
Medical $0.00 $0.00 $2,250.00 $2,250.00
Temporary Disabilty $815.52 $815.52 $1,340.48 $2,156.00 Other $18.00 $18.00 $882.00 $900.00
Total: $833.52 $833.52 $4,472.48 $5,306.00
Net Incurred: $5,306.00
Ending Open: 9
Ending Closed: 2
Total: 11
Grand Totals: Activity Paid 12/1/2019--12/31/2019 Totals Through 12/31/2019 Paid Paid Reserve Incurred
Medical $0.00 $0.00 $2,250.00 $2,250.00
Indemnity $0.00 $0.00 $0.00 $0.00
4850 $0.00 $0.00 $0.00 $0.00
Death $0.00 $0.00 $0.00 $0.00
Permanent Disability $0.00 $0.00 $0.00 $0.00
3 of 4
Detail Loss Run
Program Name
Loss Date Between 12/1/2019 and 12/31/2019 Financials As Of 12/31/2019 #9..
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Temporary Disabilty $815.52 $815.52 $1,340.48 $2,156.00 Rehab / Voucher $0.00 $0.00 $0.00 $0.00
Other $18.00 $18.00 $882.00 $900.00
Legal $0.00 $0.00 $0.00 $0.00
Investigation $0.00 $0.00 $0.00 $0.00
Recovery $0.00 $0.00 $0.00
Total: $833.52 $833.52 $4,472.48 $5,306.00
Net Incurred: $5,306.00
4 of 4
Report # 0070
4 of 4
Report Run: 9/10/2020 6:24:39 AM
Detail Loss Run
, INC.

Loss Date Between 12/1/2019 and 12/31/2019 Financials As Of 12/31/2019 #9..
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Check # Date Level 2 Level 3 Claim # Loss Date Claimant From Through Amount 12/3/2019 6/5/2019 06/05/2019 06/05/2019 $0.00
12/3/2019 7/16/2019 07/19/2019 07/19/2019 $0.00
12/3/2019 5/17/2019 05/24/2019 05/24/2019 $0.00
12/4/2019 10/3/2019 10/17/2019 10/18/2019 $0.00
12/4/2019 7/7/2014 04/05/2018 04/05/2018 $0.00
12/4/2019 3/5/2019 08/05/2019 08/05/2019 $0.00
12/5/2019 4/30/2018 07/23/2018 07/23/2018 $0.00
12/5/2019 4/30/2018 07/26/2018 07/26/2018 $0.00
12/5/2019 6/14/2018 11/17/2018 11/17/2018 $0.00
12/5/2019 6/8/2019 07/17/2019 07/19/2019 $0.00
12/6/2019 7/15/2019 07/15/2019 07/15/2019 $0.00
12/6/2019 6/11/2019 09/20/2019 09/20/2019 $0.00
12/6/2019 8/21/2017 04/18/2018 04/18/2018 $0.00
12/6/2019 7/25/2018 07/16/2019 07/16/2019 $0.00
12/6/2019 7/26/2019 09/16/2019 09/16/2019 $0.00
12/9/2019 6/8/2019 07/17/2019 07/19/2019 $0.00
12/10/2019 8/9/2013 06/13/2017 06/13/2017 $0.00
12/10/2019 10/3/2019 10/17/2019 10/18/2019 $0.00
12/10/2019 3/4/2019 09/17/2019 09/19/2019 $0.00
12/10/2019 3/4/2019 09/24/2019 09/27/2019 $0.00
12/10/2019 4/4/2019 04/10/2019 04/10/2019 $0.00
12/10/2019 9/13/2018 02/01/2019 02/07/2019 $0.00
12/13/2019 5/31/2012 11/04/2019 11/04/2019 $353.00
12/12/2019 8/3/1984 04/12/2019 04/12/2019 $0.00
12/17/2019 9/12/2017 09/18/2017 09/18/2017 $0.00
12/17/2019 7/13/2018 11/27/2018 11/27/2018 $0.00
12/17/2019 12/16/1999 09/03/2019 09/03/2019 $0.00
12/18/2019 7/26/2019 09/16/2019 09/16/2019 $0.00
12/18/2019 3/5/2019 04/15/2019 04/30/2019 $0.00
12/18/2019 3/5/2019 05/03/2019 05/07/2019 $0.00
12/18/2019 3/5/2019 05/09/2019 05/14/2019 $0.00
Pay Type Payee Name Method
Attending Physician Occupational Health
Centers of California, A
Paper
Transaction
Financial Reconciliation Ledger
Transactions between 12/1/2019 and 12/31/2019
Program Name
Surgeon COAST SURGERY
CENTER
Paper
Transaction Medical Copy Gemini Duplication, Inc Paper
Transaction
Physical Therapy Align Networks, Inc. Paper
Transaction Attending Physician Kenneth R. Sabbag, M.D. Paper Transaction
Attending Physician HealthFirst Medical Group Paper
Transaction Radiology Group Central Valley Imaging
Medical Associates Inc
Paper
Transaction
Medical Copy Gemini Duplication, Inc Paper
Transaction Attending Physician Ronald B. Perelman, MD Paper Transaction
Physical Therapy Align Networks, Inc. Paper
Transaction Attending Physician Occupational Health
Centers of California, A
Paper
Transaction
Medical Copy Gemini Duplication, Inc Paper
Transaction Surgeon US Healthworks Medical
Group PC
Paper
Transaction
Physical Therapy Align Networks, Inc. Paper
Transaction Physical Therapy Align Networks, Inc. Paper Transaction
Physical Therapy Align Networks, Inc. Paper
Transaction Pathology/Lab Cranford L Scott, MD Inc Paper Transaction
Physical Therapy Southern California
Permanente Medical
Paper
Transaction Physical Therapy Align Networks, Inc. Paper Transaction
DME Progressive Medical LLC
DBA Optum
Paper
Transaction Attending Physician Banning Med Services, A Med Corp
Paper
Transaction
DME CareWorks Paper
Transaction Utilization Review Athens Managed Care NonPrintable Physical Therapy Align Networks, Inc. Paper
Transaction Anesthesiolgst Souther California
Permanente Medical
Paper
Transaction
Physical Therapy Align Networks, Inc. Paper
Transaction Physical Therapy Align Networks, Inc. Paper Transaction
Physical Therapy Align Networks, Inc. Paper
Transaction Physical Therapy Align Networks, Inc. Paper Transaction
Physical Therapy MedRisk Inc. Paper
Transaction Attending Physician Alex Zand, M.D. A
Professional Corp.

Finance CommitteeMay 23, 2022

Finance Committee
May 23, 2022