Richmond City Council
June 28, 2022

CITY OF RICHMOND

STANDARD CONTRACT
Department: Human Resources Project Manager: Kim Greer
Project Manager E-mail: Project Manager Phone No:
kim [email protected] 620-6605
PR NO: Vendor No: 9209 P.O./Contract No:

Description of Services:

Workers' Compensation third party administration services The parties to this STANDARD CONTRACT do mutually agree and promise as follows:

1. Parties. The parties to this Contract are the City of Richmond (herein referred to as the "City") and the following named Contractor:

Acclamation Insurance Management Services, Inc.

Company Name:

Street Address: 10445 Old Placerville Road
City, State, Zip Code: Sacramento CA 95827
Contact Person: Dominic Russo
Telephone: (916) 563-1900 Email: [email protected] Business License No: 40047315: / Expiration Date:

A California V corporation, L limited liability corporation general partnership, C | limited partnership, ] individual, L non-profit corporation, ] individual dba as [specify: _
other [specify:]
Term. The effective date of this Contract is July 1, 2017 and it terminates June 30, 2020 unless terminated as provided herein.

3. Payment Limit. City's total payments to Contractor under this Contract shall not exceed $ 1,726,747 • City shall not pay for services that exceed the Contract Paymenf Limit unless a contract amendment has been approved by the City Council or City Manager.

Contractor's Obligations. Contractor shall provide those services and carry out that work described in the Service Plan (Exhibit A) which is attached hereto and is incorporated herein by reference, subject to all the terms and conditions contained or incorporated herein.

City's Obligations. City shall make to the Contractor those payments described. in the Payment Provisions (Exhibit B) which are attached hereto and are incorporated herein by reference, subject to all the terms and conditions contained or incorporated herein.

6. Authorized Representatives and Notices. This Contract is subject to the Authorized Representatives and Notices Provisions (Exhibit C) which are attached hereto and are incorporated herein by reference.

General Conditions. This Contract is subject to the General Conditions (Exhibit D) which are attached hereto and are incorporated herein by reference, subject to all the terms and conditions contained or incorporated herein.

8. Special Conditions. This Contract is subject to the Special Conditions (Exhibit E) (if any) which are attached hereto and are incorporated herein by reference, subject to all the terms and conditions contained or incorporated herein. (Note:
other than Public Works contracts, the City will agree to Special Conditions only in unusual circumstances.)

9. Insurance Provisions. This Contract is subject to the Insurance Provisions (Exhibit F) which are attached hereto and are incorporated herein by reference.

10. Signatures. These signatures attest the parties' Contract hereto:

CITY OF RICHMOND CONTRACTOR:
a municipal corporation
Acclamation Insurance Management Services, Inc.

By:
(* The Corporation Chairperson of the Board,
President or Vipe President should sign below)
Tite: MayoR By: - Віші вино
I hereby certify that this Contract Title: President + cEo has been approved by City Council.

Date Signed: 9/8/17
or Openel Chisti
(* The Corporation Chief Financial Officer,
Secretary or Assistant Secretary should sign below)
Approved as to form:

By:

By: Title:

Cy Atomy
Date Signed:

Bruce Reed Goodmiller (NOTE: Pursuant to California Corporations Code Section 313, if Contractor is a corporation
or nonprofit organization, this Contract (1) must
be signed by (a) the Chairperson of the Board,
President or Vice-President and (b) the
Secretary any Assistant Secretary, the Chief
Financial Officer or any Assistant Treasurer.

LIST OF ATTACHMENTS:

Service Plan Exhibit A
Payment Provisions Exhibit B
Authorized Representatives and Notices Exhibit C
General Conditions Exhibit D
Special Conditions Exhibit E
Insurance Provisions Exhibit F
Standard Contract/EJ/TE 9-26-07
For the Contract between the City of
Richmond and
Acclamation Insurance Management
Services, Inc.

EXHIBIT A

SERVICE PLAN
Contractor shall, to the satisfaction of the Project Manager , perform the following services and be compensated as outlined below:

For Scope of Services, please see attached Exhibit A-1
For Proposed Annual Fee for Services, please see attached Exhibit A-2 Annual Not-to-exceed amount:

FY2017/2018: $558,665
FY2018/2019: $574,415
FY2019/2020: $592,677
EXHIBIT A-1

AIMS E MANAGHD CARE
F00000
Acclamation Insurance Management Services (AIMS) answers to the City of Richmond ("City") Request for Proposal (RFP) questions are laid out to follow the guidelines specified in the City's RFP to provide "Third Party Workers' Compensation Claims Administration and Managed Care Services" ". The RFP text has been extracted verbatim and is in black font and AIMS responses are in a blue 12-point Arial font.

Also, we capitalize the word, "Client" in our answers to signify the integral role and respect we have for these relationships.

3. Minimum Qualifications
Each proposal received by the City will be evaluated to determine if the proposing firm meets the following minimum qualifications. Proposals that do not meet these minimum qualifications will not advance to the Selection Committee for further evaluation.

A. The firm, its principals, and its lead claims examiners servicing the City shall have at least five (5) years' experience in California as a third party workers' compensation administrator or providers of ancillary services such as bill or utilization review for public entițies.

AIMS was originally founded in 1973 and is the industry-leading preferred provider of third party claims administration in California and Hawaii. Allied Managed Care, Inc. (AMC), a sister company of AIMS, was established in 1995 and provides professional medical cost containment solutions that result in improved program costs. As the incumbent vendor partner with the City of Richmond, AIMS currently support the City's program with team comprised of Claims Examiners and Corporate Management/Principals that cumulatively has over one-hundred years of experience in handling California workers' compensation claims. This team has worked hard to establish a relationship and to partner with the City to create a responsive and successful program.

B. Proposed claims service office is located in close proximity to SF Bay Area or the Sacramento Valley area and provides assurance of reasonable staffing at that location for the term of the contract.

The City's account will continue to be serviced out of the AIMS office in Sacramento.

C. Present a certificate of insurance evidencing the Proposer meets the City's insurance requirements in accordance with "Type 2 Insurance Requirements, Professional Services" outlined in Attachment E of this RFP. The certificate of insurance must be included in your RFP response.

AIMS has reviewed the specified Insurance Requirements and can continue to comply as required. A copy of our insurance certificate has been provided in the noted exhibit.

Please see Exhibit 1 - Certificate of Liability Insurance Viay 30, 2017 2
AIMS Proposal Response to City of Richmond
Third Party Workers' Compensation Claims Administration and Managed Care Services EXHIBIT A-1
- INCOMPOSITIO

4. Scope of Work
AIMS senior operating management team is familiar with the "Scope of Work" and as the current vendor has been able to meet this criteria and if selected will continue to fully comply. with all requirements as presented in this "Scope of Work".

Claims Administration
A. Determine liability for claimed injuries and illnesses on a timely basis and in accordance with the California Labor Code;
AIMS utilizes industry best practice standards, in compliance and accordance. with the California Labor Code, for workers' compensation claims management. It is AlMS protocol for the Examiner to review and investigate the claim for compensability upon claim assignment. This includes the initiation of 3-point contact: within 24 hours of receipt of new workers' compensation indemnity claims. Examiners evaluate all claims for Arising out of Employment (AOE) / Course of Employment (COE), delay, denial, subrogation, or referral for investigation of issues surrounding injury. Examiners request all required documentation from Doctors, Client, and Injured Worker. All claims which are to be denied or delayed, pending a compensability decision, shall be done in keeping with all applicable statutory rules and regulations (and/or case law). All denials and delays are approved by the team Supervisor. Authority to delay or deny a claim is first obtained from the City, unless express written authority for this purpose is granted to AIMS.

All questionable claims are investigated in a prompt, thorough, and legal manner to determine compensability or to validate issues in question. The Examiner identifies the need for Investigation and will refer the case for same within three (3) days from receipt of claim, or knowledge of questionable issues which give rise to the need for investigation.

The City's authorization is first obtained before initiating any field investigation. This authorization is documented in the notepad section of the claims file.

AIMS protocol is for all payments to be made in a timely and comprehensive fashion in conformance with the Official Medical Fee Schedule (OMFS), Labor Code sec, 5307.1 and sections 9789.10 et seq. of Title 8, California Code of Regulations.

B. Determine eligibility for and authorize payment of medical and indemnity benefits or a timely basis;
Paying appropriate and timely benefits is critical in our business, AIMS has multiple levels of assurances in this regard. Before a payment is issued, it is verified for appropriateness, accuracy, and reserve adequacy. When applicable, minimum statutory requirements are adhered to or exceeded. All payments are listed in each file, and distinguished by the following basic categories: Indemnity, Medical, Legal/Allocated, and Vocational May 30, 2017 3
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Third Party Workers' Compensation Claims Administration and Managed Care Services EXHIBIT A-1•

CUMS E MANAGED CARE
Rehabilitation. AIMS policy is all payment documentation is contained within the claims file.

C. Review, compute, and, after approval by the City, pay all informal ratings, findings and awards, and settlements; arrange for informal disability ratings whenever possible to avoid unnecessary litigation;
Once a claim has reached the point of serious settlement negotiations, we collect all pertinent data and present it to authorized City personnel in a Settlement Authorization Request. Included in our Settlement Authorization Request is the reserve documentation Indicating the adequacy of the reserves for eventual settlement offers, a summary of paid- to-date amounts, any disability ratings, medical reports, and a synopsis written by the handling Claims Examiner. The synopsis includes a complete risk assessment with any available alternative options authored by defense counsel (if applicable). The Settlement Authorization Request is approved by the Claims Manager and/or Supervisor and presented to the City in a timely fashion and in a format customized to meet the needs of the City. AIMS does not enter into any settlement negotiations without prior approval from the authorized City representative.

Additional focus and coordination is provided for those claims within the City's ADR/Carve out Program; as the goal and objective of is to provide expedited claim resolution - up to and including claim settlement.

All awards are processed for payment within the statutory requirements or within fourteen (14) calendar days, whichever is less. All appropriate accrued interest is included in the award payment unless the approved award has had the interest waived by the parties and the court in the settlement document.

Please see Exhibit 2 - Settlement Authority Request Worksheet.

D. Pay any and all penalties due in accordance with the California Labor Code, Such penalties shall be paid by the claims administrator with liability for the action determined by the record unless such penalties were incurred as a result of the City's action or inaction;
AlMS has a robust Penalty Prevention Process, which is augmented by our ability to track incoming documents and scheduled benefit payments. While it is never our intent to incur penalties, in the rare instances when they happen, AIMS immediately corrects the issue and makes the penalty payment. At the same time the payment is made, the Claims Team produces a Penalty Prevention Form which is circulated inside the appropriate departments at Corporate for reimbursement to the Client. It is always our desire to take notice of any penalties. rather than being made aware of them through outside sources. AIMS understands and takes very seriously the fact that these payments are not the fault of the Client and quickly works with our Accounting Department to refund these to the Client Trust Fund. Careful reconciliation of these payments occurs within the Accounting Department and the Claims Management System so all parties are aware of the occurrence and reimbursement schedule:

May 30, 2017
AIMS Proposal Response to City of Richmond
Third Party Workers' Compensatlon Claims Administration and Managed Care Services EXHIBIT A-1
"UNS SE MANAGRD CARE
E. Establish files containing medical and factual information on each reported claim; together with complete accounting records and maintain in accordance with statufory time requirements;
Captured Claim File Data: A file is established for each reported claim and all claims- related documents are stored electronically, retrievable by claim number. The electronic file can be sorted and filtered by all of the index fields including date ranges and types of documents.

All files include pertinent information (such as litigated court case number, cross- referencing, future medical award, "closed" and date closed, etc.).

All electronic files are include the following documents:
• Correspondence (all non-medical, non-rehabilitation, nori-payment documents including the Employer's First Report, letters file memos, reserve analysis, legal correspondence, data input sheets, index returns; etc.). • Legal Information (all information relating to the litigation of the claim). • Medical (all medical reports, notes, disability notes signed by medical personnel, except subpoenaed records, photo-copied records).
• Payment documentation (such as approved bills, invoices, etc.).

Paperless Solution: AIMS has partnered with a global leader in IT solutions, to provide a paperless solution that includes document-based business process management (BPM) with ease of usage and accessibility. The AIMS paperless system (AX) is directly integrated with the claims system. AIMS Clients have appropriate access to the paperless documents through the claim system. When a claim is open in the claims system the City staff select a hotkey that opens all associated files for the requested claim. Our paperless environment also has the ability to provide documents to the City by searching by date, physician name and/or medical report type, pulling the data across all claims and mail received. This eliminates the need to access each individual claim file to review reports,
All claims related documents are centrally captured, indexed, and stored in the paperless The paperless system has customized key index values to simplify file organization and search ability. A customized global workflow process has been created to eliminate the possible loss of documents, the duplication of documents, and the accuracy of filing. Customized business workflow processes are attached to each document type (medical, legal, bills, etc.) to streamline activities required by Claims Examiners during the claims process. Documents requiring time sensitive processing have built-in triggers and management oversight flagging to ensure expedited handling of those documents.

The paperless system is separate and distinct from the claim system. AlMS' paperless solution is built on a separate database and storage platform that is virtualized for May 30, 2017 5
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Third. Party Workers' Compensalion Claims Administralion and Managed Care Services EXHIBIT A-1

GUYS SHANAGED CARE
ДОЛОВАТО
redundancy and high availability. All documents are accessible through a separate interface from AIMS' claim system and can be opened simultaneously.

F. Prepare, file, and maintain all information and reports as required by the State of California, Department of Self-Insurance;
Claims are entered into the claim management system within one (1) day from receipt of the first notice of claim and all files are maintained on a 30-day diary by the assigned Examiner to ensure the claim is progressing as expected and that all required information has been received and or the request for the information is documented in the claim file.

The standing plan of action is reviewed at each diary date and updated accordingly.

The City is kept appraised of the status of their claims via a claims status report created and sent every 90-days when the Plan of Action Review has been completed.

All statutory State and Federal reporting requirements are prepared in a timely manner, in accordance with the required specifications of the regulating agency. Annual reports to the State regarding claims and financial experience are prepared on behalf of the Client in accordance with the rules and regulations of the jurisdiction.

G. Provide the City with information and recommendations for implementation strategies for changes or proposed changes in statutes, rules and regulations affecting the City under the California Labor Code for workers' compensation; AIMS prides itself on providing the kind of pro-active Client service seldorn seen in our industry. From in-person meetings with the City to year-end performance reporting on the program development, we are always available to go the extra step.

AIMS has developed a variety of training programs for employers that can be customized and incorporated into the Client's own training programs. These programs are overseen by our Vice President Workers' Compensation, Cheryl Agee, and. our Senior Vice President Operations, Lynn Cavalcanti. Cheryl manages a team of staff who provide training on a wide range of topics including; California Education Code Benefits, "Workers' Comp 101", legislative changes, fraud prevention, return-to-work (RTW), and State laws, etc. When requested, training sessions on proper reporting, new case law or changes in the methodology set by the State of California on the delivery of workers' compensation services training is provided as an integral part of our value-added partnership. Training sessions are held at our offices, Client locations or other specific areas designed to accommodate a number of our Clients. This service comes at no additional charge.

AIMS team is currently training on the new Drug Formulary and changes to the Utilization Review Process for the initial 30-days of a claim. These trainings focus on how the new regulations will apply within the scope of the examiners duties and what processes need to be changed to implement them. These trainings are being conducted by AlMS' Medical Director, Dr. Alan Randle.

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AIMS Proposal Response to City of Richmond
Third Party Workers' Compensallon Claims Administration and Managed Care Services EXHIBIT A-1

HITNAGED CARE
Please see Exhibit 3 - Sample Legislative Report
H. Review with the City the program's progress, including identification of problem areas and recommended solutions and attend monthly meetings required by the City relative to the workers' compensation program;
As a true partner with the City, AIMS attends monthly department meetings and litigation meetings where all high profile and claims on disability are reviewed and discussed. It is important for the department heads of the City to know and understand their current inventory of employees receiving disability and/or nearing finalization of their claims where permanent restrictions are likely. Key claims are discussed at these meetings to insure that all parties (Risk Management, Department & AIMS) are in agreement with how the claim should proceed and what the ultimate claim resolution goal is. These meetings are key to the success of this program and AIMS respects and admires the City for. continuously conducting them.

Typically, monthly meetings include a discussion of:
• Current case status, reserves, and resolution plan
• Functioning of the workers' compensation program
• Develop coordinated plans for specific claims handling • Cost savings plans
• Coordinate plans for returning employees to work
In addition, AIMS advises the City of individual claim developments) in multiple formats (written notifications are customized on an individual Client basis) which include but not limited to:
• Claim Status Report Forms
• Electronic Mail Updates
• Letter - Narrative
• Customized Reports
The program analysis we provide presents hard data to benchmark results and determine strategies to improve and optimize the program created specifically for the City. Also planned is reports on the outcomes of the ADR/Carve-Out Program implemented early this year. AIMS captures key events, which are directly related to the ADR Program so that analysis and benchmarking can be done of the outcomes and cost savings. Samples of previous benchmarking reports have been included in the noted exhibit.

Please see Exhibit 4 - AIMS Sample Claims Reports
I. Arrange for and supervise all necessary investigations to determine eligibility for compensation benefits and liability of negligent third parties; As indicated previously, it is AIMS protocol for the Examiner to review and investigate the claim for compensability upon claim assignment. This includes the initiation of 3-point contact within 24 hours of receipt of new workers' compensation indemnity May 30, 2017
AIMS Proposal Response to City of Richmond
Third Party Workers' Compensation Claims Administrafion and Managed Care Services EXHIBIT A-1

EUMS GED CARE

IXCOLTOLITED
claims. Examiners evaluate all claims for Arising out of Employment (AOE) / Course of Employment (COE), delay, denial, subrogation, or referral for investigation of issues surrounding injury. Examiners request all required documentation from Doctors, Client, and Injured Worker. All claims which are to be denied or delayed, pending a compensability decision, shall be done in keeping with all applicable statutory rules and regulations (and/or case law). All denials and delays are approved by the team Supervisor. Authority to delay or deny a claim is first obtained from the City, unless express written authority for this purpose is granted to AIMS.

All questionable claíms are investigated in a prompt, thorough, and legal manner to determine compensability or to validate issues in question. The. Examiner identifies the need for investigation and will refer the case for same within three (3) days from receipt of claim, or knowledge of questionable issues which give rise to the need for investigation.

The City's authorization is first obtained before initiating any field investigation, This authorization is documented in the notepad section of the claims file.

In addition, AIMS Claims Examiners understand they have the responsibility to review each claim for possible subrogation potential. Any file which indicates the possibility of subrogation is forwarded to a Claims Supervisor for review to determine if. further investigation is required, When authorized by our Client, consultation with AIMS liability specialists to evaluate the strengths and weaknesses of the subrogation will take place.

AIMS will review and identify the cause of the accident for each new claim received and AIMS assigned Claims Examiner will serve as the main subrogation "adjuster". Notice of third party credit recovery is sent out once the relevant party is identified. A notice letter is also sent out to the injured worker. A diary for the statute of limitation is set as a backup and the file is reviewed online in the maintained diary for subsequent follow up.

Upon receipt of the recovery, the adjuster will forward the check with a cover letter indicating the amount of the recovery to be returned to each department.

Some of the points considered may include, but not be limited to injured worker was injured as a result of:
• Injuries away from employer's premises
A motor vehicle accident
An assault
Malfunction of a tool or piece of equipment
Use of a type of machinery
Negligence of any other person
Animal bite
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Third Party Workers' Compensalion Claims Administration and Managed. Care Services EXHIBIT A-1

CUMS AGED CARE
In addition:
* It shall be the responsibility of the Claims Examiner to periodically request a status report from the attorney who is protecting the third party interests, or from the attorney who has filed a lien or intervening petition on behalf of our Client. • Our Clients will be advised at least semi-annually regarding our efforts to recover moneys which have previously been paid.
• Determination shall be made if Client has other damages to recover. Prior to entering into a recovery agreement, approval of the agreement should be given by our Client: This will protect our Client's interest in recovery of all expenses, including damage to company automobiles, etc., as opposed to simple recovery of workers' compensation costs.
• Upon receipt of the check or checks from the responsible third party or parties, these moneys should be made payable to our Client and credited to the workers' compensation file in the appropriate category.
• In the event where a Police Officer is assaulted by a suspect who is later convicted of the crime and is incarcerated, the Claims Examiner will attempt to pursue recovery as a condition of the suspect's probation. This arrangement will be made with the local District Attorney's office.

Outside Investigation:

1. All claims requiring an investigation shall be documented as such in the claim file, with an explanation of the issues, the reasons for the investigation, and the objective of the investigation.

2. All investigative assignments (either oral or written) shall be documented by completion of the approved Investigation Assignment Sheet. The assignment will be documented in the claims system.

3. Unless contractually specified otherwise, all investigative assignments shall have the prior approval of the Client.

4. The Examiner or his/her designee(s) shall monitor the results produced by the investigator(s) with the following criteria:

Quality of the report
=* Turnaround time
Cost
..

The ability to testify or support the findings in court Sub-rosa:
• Sub-rosa is designed to develop evidence to verify unsubstantiated facts or activities of claimants. Initial report from investigator is to be received within 15 days of assignment. Subsequent Reports should be received from the investigator no less than every 30 days.
9 AIMS Proposal Response to City of Richmond
Third Party Workers' Compensalion Claims Adininistration and Managed Care Services EXHIBIT A-1

CENARAGED CARE
• All surveillance assignments should include the precise type of surveillance required with a specific time limitation for the assignment (a maximum of 2-3 days is recommended for the initial authorization).

Subrogation:
• AIMS will pursue recovery on behalf of our Clients from any responsible third party causing a workers' compensation claim. Examiners and Supervisors have the responsibility to review each claim for possible subrogation potential.

Our attempts to recover will be based on the merits of successful recovery versus the hazards and delays of litigation.
• Any responsible third party will be notified in a general form letter within 30 days following a decision to pursue recovery. Particular attention will be paid to any applicable Statutes of Limitation which might affect the abllity to recover. • As long as there is subrogation potential, the file shall be kept in an active status with appropriate diary dates.
• The Examiner will pursue recovery. If it is determined that a Subrogation Attorney is needed, the Examiner will discuss and request authorization for the referral with the City.
• It is the responsibility of the Examiner to periodically request a status report from the attorney who is protecting the third party interests, or from the attorney who has filed a lien or intervening petition on behalf of our Client. • The City will be advised at least semi-annually regarding our efforts to recover money which has previously been paid.
• Determination will be made if Client has other damages to recover. Prior to entering into a recovery agreement, approval of the agreement should be given by the Cilent. This will protect the Client's interest in recovery of all expenses, including damage to company automobiles, etc., as opposed to simple recovery of workers' compensation costs.
• In a situation where a Police Officer is assaulted by a suspect who is later convicted of the crime and is incarcerated, the Examiner will attempt to pursue recovery as a condition of the suspect's probation. This arrangement will be made with the local District Attorney's office.

In addition, monthly statistics are maintained to determine the number of assignments made and to whom they were assigned.

J. Establish procedures to support the payment of all benefits and allocated expenses together with appropriate documentation necessary to reconcile a trust fund checking account provided by the City;
AIMS has extensive expertise establishing Workers' Compensation Trust Fund accounts for our Clients. AIMS Claims. Manager will work with the Client to coordinate Client trust funds/checking accounts to ensure accuracy and appropriate funding levels. The Claims Manager function includes providing weekly/monthly check registers directly to Clients.

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Third Party Workere' Compensatlon Claims Administration and Managed Care Services EXHIBIT A-1
O CARE
AIMS established procedures support the payment of all benefits and allocated expenses together with appropriate documentation necessary to reconcile a trust fund checking account provided by the City: All payment requests shall be made with the necessary documentation to allow for an audit trail.

Banking is managed from a separate and distinct division at our headquarters; thus facilitating additional fund management oversight, security, and monitoring.

A monthly reconciliation report is provided to the City detailing trust account activity. The detailed accounting includes the date and check number of all benefits and allocated loss payments. All payment requests are made with the necessary documentation to allow for an audit trail.

The cost for this service is included in our fees.

Please see Exhibit 5 - Proposed Annual Fee for Services K. Sponsor and pay for a membership in the nationwide Index System on the City's behalf; submit all claims to the Index System as regular practice; All indemnity claims are indexed. AIMS and other organizations submit tens of millions ofreports on individual insurance claims to the Insurance Service Office (ISO). ISO stores those reports in a single database that helps insurers, self-insurers, law enforcement agencies, and state fraud bureaus detect and prevent fraud, evaluate risk, and process meritorious claims. The system furnishes essential data for researching prior-loss histories, identifying claims patterns, and detecting suspeot claims.

AIMS will re-index as frequently as the City requires and when claim facts indicate that other claims may exist for which more information is needed.

L. Provide (at no cost to the City) informational pamphlets in appropriate languages to employees as required by the State of California relative to their workers' compensation benefits;
AIMS provides the City with Claim Reporting Kits, which include the following forms and information:
• Welcome Letter
• Employers Report of Work Injury or Iliness (5020)
• Employee's Claim Form (DWC1)
• Work Injury posters
* Informational pamphlets about AIMS and the claims team • Instructions for reporting claims
M. Refer litigated cases to attorneys approved by the City for the purpose of defending the City's interest before the Workers' Compensation Appeals Board and courts of law;
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Third Paity Workers! Compensation Claims Administratlon and Managed Care Services EXHIBIT A-1

E MANAGED CARE
AIMS works with the City's approved panel of defense firms/attorneys and establishes the agreed upon legal defense panel for the City, which includes referrals to a defense attorney when approved by the City.

When a decision to refer to defense counsel has been made, the Claims Examiner sends a narrative letter to the attorney with an outline of the case, along with the issues and clear directions for further handling by the attorney. The Claims Examiner remains actively involved in the claim and performs as much of the routing handling as possible on these cases. Once a claim has been referred to defense counsel, the Claims Examiner will continue to oversee all activity on the claim, direct all legal activity and monitor performance in accordance with the Client's criteria. This method of active involvement helps mitigate legal costs associated with unnecessary discovery proceedings, helps to gather all required evidence and witnesses as well as arranges expert testimony from the medical community.

N. Attend, where indicated, trials, hearings, arbitrations, rehabilitation hearings and any and all legal proceedings;
Yes, within their capabilities and as statutes allow, the AIMS Claims Examiner and/or Supervisor may represent a Client before the Appeals Board of California or judicial body.

If the case has a defense attorney assigned, it may not be recessary for the AIMS Claims Examiner to attend the hearing, unless issues call for their attendance.

O. Produce computer generated reports as specified by the City; AIMS provides various standard monthly reports and custom reports upon request for each department and division requested by the city. Our system is an extremely powerful data management claims system for both standard and ad hoc report generation. Our web based 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.

Please see Exhibit 4 - AIMS Sample Claims Reports
P. Coordinate Medicare and Medicaid set aside agreements in compliance with Section 111 of the MMSEA including required reporting.

AIMS has a formal plan in place to comply with the mandatory reporting requirements of Section 111 ("Medicare Secondary Payer") of the Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA). AIMS' strategic partner provides Mandatory Insurer Reporting (MIR) Services to our Clients, including State Children's Health Insurance • Program (SCHIP) reporting and ensures MSP compliance. Our strategic partner is used for all Qualified Referrals (claim settlements determined to require a Medicare Set Aside (MSA), Claim Settlement Allocation (CSA) and other services related to MSP compliance identified in their fee schedule).

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Third Parly Workers' Compensatlon Claims Administration and Managed Care Services EXHIBIT A-1

E MANAGED CARE
AIMS has selected ExamWorks Clinical Solutions, the nation's most respected Medical • Secondary Payer (MSP) compliance leader, to provide MIR Services to our Clients, including SCHIP. reporting, and to ensure MSP compliance. ExamWorks Clinical Solutions is AIMS' sole vendor for all Qualified Referrals (claim settlements determined to require a Medicare Set Aside (MSA), Claim Settlement Allocation (CA) and other services related to Medicare Secondary Payer (MSP) compliance identified in their fee schedule). Also, AIMS continuously evaluates the use of strategic partner services to ensure performance-levels and continued value-added to our Clients.

There are no additional fees to the City for this reporting service.

Q. Comply with the SAC-EIA claims adjusting requirements dated 7/1/2011, (Available as a separate document from this RFP).

AIMS has over one-hundred (100) Clients of which approximately 80% are public entities in the State of California. Several of these Clients are contracted with SAC-EIA. AIMS has worked with CAC-EIA for many, many years and AlMS is familiar with their guidelines. AIMS' own protocols mirror those of SAC-EIA and AIMS applies these guidelines to the management of the City's claims.

Bill Review
The AIMS senior operating management team has reviewed the Bill Review Scope of Work outlined detail. Our team fully complies with all requirements as presented in the Scope of Work. • Please see the Bill Review response under the Specific submittal Requirements section for complete details,
A. Review all bills in a timely manner for compliance with applicable fee. schedules and reduce accordingly, including those that fall outside of a fee schedule or PPO network;
B. Identify and reduce all duplicate billings;
C. Deny charges for all items not required for injury described; D. Identify all unauthorized charges to insure billing does not exceed parameters of injured workers' treatment plan;
E. Maintain contracts with effective PPO organizations (including pharmacies), that include providers in the City of Richmond area; F. Provide reports on a monthly and annual basis outlining bill review activity, savings and costs. Provide ad hoc reports as requested; G. Provide a computer system that interfaces with both the City's workers' compensation TPA and utilization review provider;
H. Handle all provider inquiries regarding bill reductions.

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Third Parly Workers' Compensation Claims Administration and Managed Care Services EXHIBIT A-1

VIGTO CARE
Utilization Review
The AIMS senior operating management team has reviewed the Utilization Review Scope of Work outlined below. As the incumbent, our team fully complies with all requirements as presented in the Scope of Work. Please see the Utilization Review response under the Specific submittal Requirements section for complete details. AIMS is also fully aware and participating in the coordination of medical treatment inside of the City's ADR Program, whose goal is to expedite treatment to impact return to work status and claim resolution. AIMS is working closely with the City to monitor those industrial clinics participating in the ADR Program and provide feedback and suggestions on areas of improvement for delivering medical treatment.

A. Approve or disallow service requests within the applicable time standards and provide medical advice as warranted;
B. Provide timely reports to the City outlining utilization review requests, approvals, denials and costs/savings;
C. Recommend, for City approval, panels of medical professionals, specialists, and treatment facilities to which injured employees should be referred for long-term or specialized treatment;
D. Provide medical management of all cases to assure cost-effective and appropriate treatment, including assurance that treatment is related to the compensable injury or illness;
E. Arrange for medical/legal opinions in disputed cases, conferring with medical examiners, professional personnel, the City and legal counsel where indicated.

F. Provide a computer system that interfaces with the selected TPA and bill review service provider.

Nurse Case Management
The AIMS senior operating management team has reviewed the Nurse Case Management Scope of Work outlined below. As the incumbent, our team fully complies with all requirements as presented in the Scope of Work. Please see the Nurse Case Management response under the Specific submittal Requirements section for complete details.

A. Provide telephonic and field case management nurses; B: Maintain close liaison with selected doctors and ensure maximum efficiency in the management of claims by practicing proactive case management and aggressive return-to-duty when clinically feasible;
-..

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C. Coordinate all medical management services with the selected TPA and ancillary service providers as hecessary.

D. Narcotic medication requests received from the Pharmacy Benefit Program are automatically and electronically referred to the nurse to review. This process is a proactive step to prevent injured workers from becoming addicted to narcotic medication.

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5. Proposal Requirements
General Submittal Requirèments
Bidders submitting proposals must include (1) a written response to proposed service(s), and (2) cost proposal for service(s). The proposal shall be submitted in a sealed package with tabbed sections clearly identifying sections of the proposal. The written proposal must conform to an 8 1/2 x 11 format with foldouts utilized as necessary. Cost proposal(s) must be submitted in accordance with Section 6 - Cost Proposal.

As noted at the beginning of our proposal, AIMS responses to the City of Richmond ("'City") Request for Proposal (RFP) questions follow the guidelines specified in the City's RFP to provide "Third Party Workers' Compensation Claims Administration and Managed Care Services". . The RFP text has been extracted verbatim and is in black font and AIMS responses are in a blue 12-point Arial font.

The AIMS management team has reviewed the conditions identified in this section and implicitly agrees to them. We believe our proposal is complete and none of our responses are conditional. If there is a question about the interpretation of one our responses, AIMS would welcome the opportunity to address and provide clarification for the City.

Also, we capitalize the word, "Client" in our answers to signify the integral role and respect we have for these relationships.

Regardless if the bidder is responding to this entire RFP or parts of it, the following elements are required for ALL proposals:

A. Cover Letter
To include the title of the RFP, name and mailing address of the firm, contact person, telephone number and email address, a statement explaining whether the proposal is submitted for claims administration services, bill review services, utilization review services, nurse case management services, or all. Acknowledgement that your proposal is public information and may be released to any person who requests it. If any information is considered proprietary not to be released to the public, you must specifically designate such information. The cover letter must be signed by an officer authorized to sign on behalf of the firm and enter into contracts.

Our Cover Letter precedes this content and includes the name of Lynn Cavalcanti, Sr.

VP Operations, who may be contacted during the evaluation period. The requested information is provided below.
• NAME / TITLE: Lynn Cavalcanti, Sr. VP Operations
• ADDRESS: 10445 Old Placerville Road, Sacramento, CA 95827 • EMAIL: |[email protected]
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• PHONE: Direct (707) 685-1138 or Corporate Office (916) 563-1900 x259 Also, our Cover Letter is signed by Dominic Russo, President & CEO of AIMS/Allied Managed Care, Inc. (AMC). As an officer of the Company, Dominic is authorized to bind the offering of services and cost terms provided in our proposal. His contact information is provided in the cover letter as requested.

B. Cost Proposal
Each bidder must include a cost proposal for the proposed services in accordance with Section 6 - Cost Proposal: Complete only those cost proposal worksheets located in the Attachment section of this RFP for which you are proposing services to the City:

Do not make any reference to cost, fees, rates, estimated savings, or other financial details in your written proposal response. The cost proposal(s) shall be included in a separate section of your proposal and clearly identified.

A cost proposal identifying the fees for each service identified within our proposal and the requested cost proposal worksheets have been included in the exhibit noted below.

Please see Exhibit 5 - Proposed Annual Fee for Services C. Tabbed Sections
If you are bidding on more than one Scope of Services as outlined in Section 4 - Scope of Work, you must clearly separate and tab each scope of work section.

AIMS is bidding for these services: Claim Administration, Bill Review, Utilization Review and Nurse Case Management Services. As requested each scope of work section is separated by a tab.

D. Proposal Exceptions
Each bidder must complete and submit Attachment B - Proposal Exceptions when submitting proposals, regardless if an exception is taken to the proposed scope of work, performance expectations, insurance requirements or any other information contained in this RFP.

AIMS does not take any exceptions or request any amendments to the proposed scope of work, performance standards, insurance requirements or other information contained within the City's RFP. We have completed the form as required and provided in the exhibit noted below.

Please see Exhibit 6 - Attachment B: Proposal Exceptions May 30, 2017 17
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6. Cost Proposal
For all services offered in your written proposal, complete the appropriate cost proposal worksheet in Attachment sections A-1 - A-4 of this RFP and include them in a separate section of your written proposal. In addition, indicate on this cost proposal a schedule of rates for additional related services, if any, which the City may consider, at its sole option.

AIMS has reviewed the requested pricing information and has provided a cost proposal detalling ourfees, as well as completing identified Attachments sections: A-1 - A-4 and included in the exhibit noted below.

Please see Exhibit 5 - Proposed Annual Fee for Services 18 AIMS Proposal Response to City of Richmond
Third Party Workers' Compensation Claims Administration and Managed Care Services EXHIBIT A-1
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Claims Administration
A. Firm's Qualifications: Describe the firm and provide a statement of qualifications for performing the requested scope of work as outlined in Section 4 - Scope of Work - Claims Administration Services. Identify the firm's primary service office for the City's account. Provide a company-wide organizational chart with reference to the proposed service office and proposed service team.

Background: LJR Holdings, Inc. (LJRH) was incorporated in July 1996 in Califomia to act as a holding company for its wholly owned operating subsidiaries: Acclamation Insurance Management Services, Inc. (AIMS) and Allied Managed Care, Inc. (AMC), collectively the "Compahy". As the parent organization to AIMS and AMG, JRH provides all corporate services to its subsidiaries such as Finance, Human Resources, Information Technology/Support, Marketing and Sales, and Client Information Services: LJRH does not generate revenues and is supported by allocation methodology from its subsidiary companies.

The Company was originally founded in 1973 as Leonard J. Russo Insurance Services, Inc. In January of 1990 there was a name change to Acclamation Insurance Management Services, Inc. (AIMS) to better reflect the diverse nature of our product offering, AIMS was incorporated in California in March 1990 in conjunction with and just after the name change.

The Company is a diversified service firm, which provides claims services, cost containment, and risk-management information services to insurance companies, self- insured corporations, and government entities throughout the continental United States and Hawaii.

The Company is a family-owned business and primary ownership is divided amongst the immediate family members. Leonard Russo, Chairman of the Board and Dominic Russo, President & CEO are the majority shareholders.

AIMS is a Third Party Administrator (TPA) and the industry-leading preferred provider of Loss Portfolio Management® services, including claims administration (both workers" compensation and liability) and full service medical cost containment management through our sister company, AMC. AIMS is incorporated in the State of California and as a corporation, has a board of directors and corporate officers.

AIMS has built a reputation as being one of California's most progressive, Client-centric third party claims administrators in managing employer workers' compensation loss portfolios. AIMS currently has over 100 Clients throughout California ranging ih size from small utility districts to a Joint Powers Authority (JPA) consisting of 53 cities to the large City of Los Angeles sworn Fire personnel claims and all sizes in between. AIMS has 19 May 30, 2017
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been providing claims administration services for two-thirds of these Clients for greater than 10 years.

Managed Care: After having worked with other medical management firms, AIMS found that none had a thorough understanding of the needs of a workers' compensation claims administrator and encouraged its parent company, LJRH, to form a managed care company. So, in 1995, Allied Managed Care, Inc. (AMC) was formed. AMC was first established and incorporated in California in July 1995 to provide professional medical cost containment. Having at its finger on the pulse of the workers' compensation administration issues has put AMC management in a uniquely informed and unique position when it comes to designing programs that improve clalms administration workflows and reduce costs while improving injured employee outcomes.

AMC offers Medical Bill Review, Preferred Provider Organization (PPO) networks, Utilization Review (UR), Nurse Case Management (including telephonic and on-site or fleld nurse case management), customized Medical Provider Networks (MPN), AlliedR (Prescription Management), AlliedCare Complete (Early Intervention), and CallConnect (Call Center Services),
Qualifications: AIMS currently administers over 12,000 open indemnity claims for our Clients that are based in California. AIMS focus is to provide a program that reinforces the strategic goals of workforce excellence, organizational effectiveness, and fiscal responsibility.
• As a California based business, we specialize in the management of California workers' compensation claims; we focus on identifying, addressing, and managing all areas of the workers' compensation program and focused on Issues that are more relevant to Clients based in California. • As a privately held company, we bring a transparent approach to establishing TPA programs; a unique skill set, and a different perspective versus national and publicly held third party administrators.
• All AIMS offices are certified by the State of California to administer workers' compensation claims by Self Insurance Plans.

AIMS distinguishes itself from other TPA/Managed Care organizations not only by its dedication to providing superior Client service but by its "Loss Portfolio Management®" approach to managing claims programs, which is an overall "management of assets" approach as opposed to merely processing one claim at a time. A true partnership between the Client and the administrator is imperative to the successful management of a workers' compensation program. Our "Loss Portfolio Management®" approach ensures that we are always focused on identifying key issues that have a large financial impact on overall claim costs and to proactively utilize all available internal and extemal cost containment resources to resolve these issues in an expedient fashion. As a Client- driven organization, we deliver measurable financial results to our Clients through intelligent use of innovative technology and a flexible, yet disciplined approach to service delivery with fiscal accountability.

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Quality Control (QC) Program: AIMS asserts a strong Quality Control Program, in which we consistently monitor, measure performance, and review the quality of the services being provided to ensure superior Client service and cost saving results for our Clients.

In addition to the standard supervisory audit, our Internal Audit Unit, headed by Cheryl Agee (Vice President of Workers' Compensation) will conduct audits against our best practice standards as well as the Client's Special Handling Instructions. The Audit Unit's process involves notification that an audit is to be conducted in the Branch or local office.

The Manager will make available all requested information, claim files, logs, contracts, etc. In addition, the Manager shall participate in the actual audit itself. All files with deficiencies and/or recommendations are immediately returned to the Claims Examiner for corrective action. The Claims Managers review the file for compliance at each diary date. The Supervisors carry independent diaries for this purpose. Audit scores are incorporated into Performance Evaluations conducted annually for each employee. The audit conducted by our internal audit unit is comprehensive and takes into consideration all facets of claim file handing,
• AIMS will continue to meet with the City periodically to discuss specific file issues and all claim denials will be approved by the Claims Supervisor prior to the denial being made.
* Rules and Regulation Updates: AIMS takes its commitment and responsibility to ensure its management of claims is in adherence with Workers Compensation Laws of California, Governing Statutes and Rules and Regulations of the Department of Industrial Relations, and Client Contract Service agreements while ensuring the appropriate delivery of benefits for injured workers.
* To keep up on all legislative and regulatory updates that would affect our business, AIMS employs an independent Legislative Lobbyist/Advocate. AIMS' legislative advocate is based in Sacramento and their sole function is to serve as the eyes and ears for AIMS and our Clients. We lobby on behalf of our Clients. Having famillarity with numerous legislators as well as access to the Executive Branch of California State Government, the AIMS Legislative/Lobbyist Advocate has been instrumental in helping to shape policy in the workers' compensation arena on behalf of our Clients, both in the public and private sectors of industry. Their year-end report on passed and pending legislation is provided to our Clients at no additional cost and has been a valuable primer in keeping our Clients aware of the potential rules and regulations that affect workers' compensation in the State.
• Medicare Second Payer: AIMS has a formal plan in place to comply with the mandatory reporting requirements of Section 111 ("Medicare Secondary Payer") of the Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA). AIMS' strategic partner provides Mandatory Insurer Reporting (MIR) Services to our Clients, including State Children's Health Insurance Program (SCHIP) reporting, and ensures MSP compliance. Our strategic partner is used for all Qualified Referrals (claim seltlements May 30, 2017 21
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determined to require a Medicare Set Aside (MSA), Claim Settlement Allocation (CSA) and other services related to MSP compliance identified in their fee schedule). • Audit Results: AIMS administers all claims for workers' compensation benefits in accordance with the requirements of the workers' compensation laws of the State of California. All AIMS offices are certified by the State of California to administer workers' compensation claims by Self Insurance Plans. Over the last 40 years, AIMS successfully passes audits conducted by Division of Workers' Compensation's Audit Unit, Self-Insurance Plans, California State Association of Counties/Excess Insurance Authority (CSAC-EIA), Local Agency Workers' Compensation Excess Joint Powers Authority (LAWCX), other excess carriers, and Client specific auditors, This demonstrates AIMS qualifications to administer claims in full accordance of applicable rules, regulations, laws, and the City's Scope of Work to be performed and standards to be followed.
• Vendor Panel: AIMS can provide the City with the flexibility to customize a vendor panel or we can recommend vendors that have historically provided the best outcome for our Clients. This approach to claims administration has yielded a significant reduction in program costs and overall better results for our Clients. AIMS does not have any limitation in working with outside vendors. Our objective is to help our Client obtain the best value for the needed service.

Garve-Outs: AIMS has expertise and experience in working with our Clients in developing Carve-Outs programs (Alternative Dispute Resolution or ADR). By working with our Clients, Unions and employees there is the opportunity to alter the adversarial culture of the worker's compensation claims process which could result in reducing cost to our Clients as well as speed up the process and improve the experience for the employees. Alternative Dispute Resolution (ADR) carve-outs have proven to significantly decrease the time-lines associated with the statutory workers' compensation system by: providing better care to injured workers; reduce time involved to resolve disputes over freating physicians; utilization review; and can all but eliminate lawyers in the system. Carve-outs allow employers and labor to create a separate track for resolving disputes through mandatory mediation and arbitration before claims can go to the Workers' Compensation Appeals Board. The parties are free to negotiate other terms of the program, such as agreed-upon panels of doctors and independent medical Examiners (IME) to prevent disputes before they start, as well as benefit enhancements that go beyond State-mandated minimums. AIMS encourages our qualified Clients to consider this cost saving program. • AIMS Rapid Referral Portal: AIMS has developed and utilizes a web-based communication platform that connects our claims staff with all recommended/allowable service providers. Through this process, we have the ability to monitor assignments to preferred providers that are identified and selected for our individual Clients. AIMS has researched and vetted service providers for quality and May 30, 2017 22
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- сОкРовіТО
best-value for our Client and will make our recommendations known to the City. The service provider "panel" is pre-approved by our individual Clients. Any exceptions to appropriate assignments are managed on a case-by-case basis. Through this platform, we have the ability to track, manage, and run reports on service provider usage.
• Maximum number of indemnity files: The targeted average indemnity caseload for a senior Claims Examiner is based on the requirements of our Client. If no specific caseload is specified, we target 150 indemnity claims per Claims Examiner, but acknowledge that the City has an indemnity cap of 125. On a monthly basis, we review Claims Examiner activity reports that capture all new claims and closing ratios. The Claim Supervisors consistently manage the Claims Examiner's caseloads to ensure caseload levels are managed based on our Client specific requirements. AlMS, as matter of practice, assigns Claims Examiners in one of two ways:

1. By claims frequency and Client request warrant, the account is assigned on a fully dedicated basis. In those instances the Claims Examiner(s), work on a single account only. Ihe City currently has two dedicated Claims Examiners handling their open active indemnity files.

2. It volume does not warrant, Claims Examiners are assigned on a designated basis. * Focus on Service: We work in partnership with our Clients to achieve optimal results, consistent with fair compensation for material loss and humane, competent, compassionate care for injured employees. We have built our business, and a stellar. reputation, on communication and partnership with our Clients. AIMS senior management takes an active role in supervision of our dedicated account teams fo assure timely response, proactive claims management and consistent quality control.

Our goal is to customize our products and services to serve you best and to help you spend your money wisely.
• Client Service: 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 on promptly providing these employees the benefits due to them and maintaining open and on-going communication with them during the course of their claims. Programs that provide this positive approach produce lower overall workers' compensation costs, including significantly reduced litigation expenditures.

Primary Service Office: The Company has extensive professional management, technical and support staff in multiple offices located throughout California and Hawaii.

AIMS California offices are located in Santa Clarita, Sacramento, Pomona, Modesto, Fresno, Bakersfield, Tulare, and Concord.

We propose to continue to provide Claims Administration services to the City from our office in Sacramento.

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INCOBTORLTEO
AIMS Corporate Headquarters will continue to serve as the location providing loss data functions other than claims adjusting. The AIMS corporate headquarters is located at 10445 Old Placerville Road in Sacramento, CA 95827.

Please see Exhibit 7 - Organization Charts and Exhibit X - Legislative Advocate Report
B. Service Team Qualifications: Provide an organizational chart outlining your proposed service team including names, titles, and length of service in your organization. For each proposed team member, provide a summary of qualifications including claims handling experience, indemnity case load, experience working with public entity self- insured entities, education, and any professional designations and awards. Include full resumes for each member of your proposed service team. If you have not designated staff to service the City's account, provide the selection qualifications for any staff necessary to service the City's account.

Kim Silas, Claims Manager; Kim. will continue to serve as the City's primary representative. Kim has worked in the California Workers' Compensation Industry since 1990 and prior to that she worked within the Insurance Industry. Kim has her Workers' Compensation Claims Professional (WCCP) and Workers' Compensation Claims Administration (WCCA) designations from the Insurance Education Association (lEA) and the Self-Insurance Plans Certificate to Administer Workers' Compensation Claims. Kim has been a Claims Supervisor since 2005 and Claim Manager since 2011.

AIMS Corporate Management Team
The AIMS corporate management team of professionals identified below has extensive claims management tenure. They understand the importance of monitoring each claim to see that every event that affects the outcome is recognized and appropriately managed.

These individuals are involved from the onset at the proposal stage, through contracting, implementation, and for the life of the program. Their objective will be to facilitate a successful program for the City.

Dominic Russo, President & CEO: Dominic has served as President of AIMS since 1994. Under his leadership, AIMS has consistently met its corporate strategy to nurture long term relationships by providing our Clients with technically competent, experienced, and dedicated staff acting with integrity in all that we do. Prior to Mr. Russo's position as President & CEO, he has served in various industry positions of management from supervisor to Vice President in Southern California, Northern California, and Hawaii.

Dominic achieved his Owner President Management Certification from the Harvard Business School.

Lynn Cavalcanti, Sr. Vice President Operations: Lynn has over 25 years of claims experience, all with public entities. Her role serves AIMS Clients by establishing critical service, program operations, and productivity criteria; benchmarking leading-edge May 30, 2017 24
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Dominic achieved his Owner President Management Certification from the Harvard Business School.

Lynn Cavalcanti, Sr. Vice President Operations: Lynn has over 25 years of claims experience, all with public entities. Her role serves AIMS Clients by establishing critical service, program operations, and productivity criteria; benchmarking leading-edge practices; developing marketing channels; leading commitment to quality service; evaluating service results, and representing the company to major customers (making periodic visits, exploring specific needs, and resolving problems). She has a Master of Arts as well as a Juris Doctorate degree. Lynn joined the AIMS team in 2010.

Tricia Baker, Assistant Vice President, Operations: Tricia has over 27 years of workers' compensation claims experience with public entities and insurance. Tricia assists the Senior Vice president of Operations with Client relations issues, managing new Client implementations and transitions, identifying and coordinating training, maintaining appropriate controls, and ensuring AIMS delivers as promised. Tricia serves as the Transition Coordinator for new. program implementations. Tricia joined the AIMS team in 2013.

Cheryl Agee, Vice President Workers' Compensation: Cheryl has thirty-plus years in the Workers' Compensation sector as an Examiner, Supervisor and twenty-one years as a Claims Manager. She is responsible for the analysis of work performance against best practices, which includes compliance oversight, internal audits, and quality control. This includes the development and delivery of Workers' Compensation training programs such as ongoing technical training, standardized work flow processes. Cheryl is responsible for best practice implementation and revision, work measurement, management oversight practices and the development of performance standards at various levels.

Cheryl also leads the company in interpreting and implementing new work flow processes following legislative enactment. Cheryl joined the AIMS team in 2005.

Rendell ("Ren") Johnson, Vice President Information Technology: Ren has held various positions in the information technology industry over the last 18 years, 15 years in leadership positions, including the last 8 years as Director of Information Technology in the workers' compensation industry. Ren has been making strategic technology decisions and providing state of the art solutions for pre-PO, government, healthcare, workers' compensation, and enterprise environments. Ren will be overseeing the implementation from an IT perspective. He has studied in Business Administration with training and certifications in networking, security, and Microsoft technologies. Ren joined the AIMS team in 2010.

Kristina ("Tina") Patterson, Manager of Data Delivery Services: Tina has over 10 years workers' compensation claims experience. She is a state-certified self-insurance administrator, as well as Workers' Compensation Claims Administration. Tina oversees the ongoing claims system of the AIMS/AMC Data. and how it interacts with various systems. Tina joined the AIMS team in 2016.

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As the current incumbent, AIMS has established a staffing model that is responsive to the requirements of the City. This team consists of the following individuals:
• Experienced Manager: Kim Silas
• Dedicated Senior Claims Examiner: Jackie Dawson
• Dedicated Claims Examiner: Tamara Nolasco
• Future Medical Examiner: Lorraine Maull
• Claims Assistant: Marilou Abrio
Having an experienced team in place ensures consistency and continuity for the City of not only the conflict/overflow claims program, but most importantly the care for City's injured employees. This established team will maintain the program efficiencies without any disruption of a transferring of existing open claims.

As a matter of practice, AIMS designates and/or dedicates key personnel to an account and strives to maintain consistency of the assigned team for each of our valued Clients.

If claims frequency and Client request warrant, the account is assigned on a fully dedicated basis. In those instances the Examiner(s), work on a single account only. If volume does not warrant, Examiners are assigned on a designated basis. Generally, the number of accounts handled by a designated single Claims Examiner will not exceed three.

Please see Exhibit X - Staff Organization Chart and Exhibit 10 - AIMS Team Resumes
C. Claims Administrative Services: Describe your firm's claims administration policies, procedures, and best practices that ensure superior service to City employees while maintaining economic and administrative. control over claims costs. Discuss your claims reserving philosophy and indicate the maximum number of indemnity files handled by your proposed claims examiners.

Policies and Practices: AIMS has customized all procedures to meet the Scope of Work requirements of the City. AIMS administers our California Clients' self-insurance plans in full compliance with all laws, rules and regulations governing the administration of self- insurance pursuant to Sections 3700 et seq. of the Labor Code and the California Administrative Procedure Act as set forth in Government Code, Title 2, Div. 3. Part I, Chapter 4 and 5 in effect at the time of submission of our response to this RFP as amended during the period that any contract with the Client is in effect and any other laws, rules, and regulations that govern the handling of California Workers' Compensation claims.

A true partnership between the Client 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 has involved partnering May 30, 2017 26
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with the City to assess specific needs and then developing a customized claims management program designed to combat claim exposures and costs for the City. 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 Superior Client Service to City employees: As a Client-driven organization, AIMS delivers measurable financial results to our Clients through our intelligent use of innovative technology and a flexible, yet disciplined, approach to service delivery with fiscal accountability. We nurture long-term relationships by providing our Clients with technically competent, experienced, and dedicated staff, acting with integrity in all that we do.

Our commitment to great Client service is the same at every level of our organization - from our front line employees to our senior managers. Clients evaluate our performance based on the responsiveness of our employees. When we consistently meet our commitments with enthusiasm and timeliness, the entire organization benefits, and our Clients becomes our advocates:

It is every employee's responsibility to:
• Listen for understanding
Show empathy
• Find solutions
• Anticipate needs
Follow through on commitments
"Serving Clients is our purpose: Client service is our passion." Client Service Initiative: Seven years ago we launched a Client Service initiative directed at improving and providing a higher level of Client service for our current and future Clients. In the initial phase of the program we focused specifically on training and investing in our managers and staff bringing them on board with our goals and initiatives.

Our training efforts have continued regularly since that time with an ultimate objective: to better understand, from our Client's perspective, how we at AIMS interact with you on a day to day basis.

Client Relations Director: AIMS has implemented the second phase of our Client service program by establishing a Client Relations role within AIMS. We felt it was vitally important to have a position solely focused on maintaining and improving client satisfaction. Therefore, we have established and assigned the position of Director of Client Relations. This individual is in charge of developing a better understanding of how we work together and how we at AIMS can provide even better service. Our Director of May 30, 2017 27
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Client Relations contacts Client staff that interacts with us on day to day basis and asks questions concerning Client experiences with AIMS, both good and bad. This information is then provided to AIMS senior management for review and issue resolution responsibility.

Meetings, Training, Stewardship Reporting: AIMS prides itself on providing the kind of pro-active Client service seldom seen in our industry. From in-person Client meetings to completing specialized data reports on the program development, we will always go the extra step. Our management staff is responsible for our in-service training:
requested, training sessions on proper reporting, new case law or changes in the methodology the State expects the delivery of workers' compensation services to be accomplished is an integral part of our value-added partnership. These training sessions may be held at our offices, Client locations or other specific areas designed to accommodate a number of our local Clients who share the same need for up-to-date status on the ever changing climate of workers' compensation in California.

As part of our philosophy with regard to continual and seamless communication with the City, we expect there will be times when agency or department heads will inquire about . specific cases and the strategy for disposition. On those occasions and with the City's permission, we will schedule file reviews or in-person meetings to inform the department of progress on a specific claims). AIMS provides the City regular face-to-face meetings with the Examiner(s) at the City's desired location. Pre-meeting status reports are developed and any issue that is allowed to be discussed will be placed on an agenda.

Privacy issues will be protected from those employees who are not authorized to discuss those topics.

Economic and Administrative Control Over Claims Costs: 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 Loss Portfolio Management® approach. 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 them and maintaining open and on-going communication with them during the course of their claims. Programs that provide this positive approach will produce lower overall workers' compensation costs, including significantly reduced litigation rates.

Loss Portfolio Management®: Our "Loss Portfolio Management®" approach ensures that we are always focused on identifying key issues that have a large financial impact on the overall claim and to proactively utilize all available internal and external cost containment resources to address and resolve these issues in an expedient fashion.

AIMS management and staff have a singular objective: assist the City to be productive and profitable while providing compassionate care of its injured employees. We work in partnership with our Clients to achieve optimal results from their self-insured workers' compensation program. AIMS goes beyond ordinary third party May 30, 2017 28
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CUMS GBD CARR
1AC08r01*TD
administration services, to offer our Clients a customized, flexible loss management program and services designed to generate lower claims costs and better outcomes.

Quality Assurance: AIMS asserts a strong Quality Control Program, in which we consistently monitor, measure performance, and review the quality of the services being provided to ensure superior customer service and cost saving results for our Clients. In addition to the standard supervisory audit, our Internal Audif Unit, headed by Chery! Agee (Vice President Workers' Compensation), conducts audits against our best practice standards as well as the Client's Special Handling Instructions. The Audit Unit's process involves notification that an audit is to be conducted in the Branch or local office. The Manager makes available all requested information, claim files, logs, contracts, etc: In addition, the Manager participates in the actual audit itself. All files with deficiencies and/or recommendations are immediately returned to the Claims Examiner for corrective action. The Claims Managers review the file for compliance at each diary date. The Supervisors carry independent diaries for this purpose. Audit scores are incorporated into Performance Evaluations conducted annually for each employee. The audit conducted by our internal audit unit is comprehensive and takes into consideration all facets of claim file handling.

Diary System: The key to good claims management, avoiding penalties and keeping deadlines, is an effective diary system that enables the Claims Examiner to properly manage each claim in an expedient manner. Claims Examiners are required to review open Indemnity claims at least every 45 days. Our computer system has an automated diary system that is utilized by all of our staff. A detailed list of diaries is displayed each time a user logs onto the computer. At a minimum the claims unit supervisors are required to review open Indemnity claims within 10 days of a new claim filing and thereafter every 120 days. Our knowledgeable, dedicated managers and supervisors provide strong supervisory oversight. AIMS internal audit team reviews claims to assure legal and regulatory compliance, as well as conformity to best practices and Client-specific performance standards.

We employ a "supervisor's overview" of the daily diary to monitor when a file is due to be reviewed and whether or not the Examiner has conducted the diary. This is one of the key components of our internal audit process.

In addition to the standard supervisory audit, our own Internal Audit Unit (headed by the Vice President of Workers' Compensation), conducts audits against our established procedures as well as the Client's Special Handling Instructions. The Audit Unit's process involves notification that an audit is to be conducted in the Branch or local office. The Manager shall make available all requested information, claim files, logs, contracts, etc.

In addition, the Manager shall participate in the actual audit itself. All files with deficiencies/recommendations are immediately returned to the Claims Examiner for corrective action. The Claims Managers review the file for compliance at each diary date:

The Supervisors carry independént diaries for this purpose. Audit scores are incorporated into Performance Evaluations conducted annually for each employee. The audit May 30, 2017 29
AIMS Proposal Response to City of Richmond
Third Party Workers' Compensation Cläims Administration and Managed Care Services EXHIBIT A-1

E MANAGED CARE
conducted by our internal audit unit is comprehensive and takes into consideration all facets of claim file handling.

The following Time Performance Standards are part of our Best Practices audit standards, which are used to help keep claims on track for prompt resolution.

TASK TIMEFRAME
Claim set up in Computer Within one (1) working day of date of receipt Initial Claimant Contact Within one (1) working day of date of receipt Subsequent Claimant Contact Every 14-days of continued disability - or every thirty (30) days if on modified duty
Initial Client Contact Within one (1) working day of date of receipt Initial Medical Provider Contact Within one (1) working day of date of receipf Initial Payment of Disability Within fourleen (14) days of first day of disability Investigation Within five (5) days of knowledge of condition requiring investigation & approval by Client
Investigation Reports Within fifteen (15) days of assignment - subsequent reports maximum of every thirty (30) days
DWC Benefit Nolices Within fourteen (14) days of the event causing the need for notice Penalty Report Form To be completed within 72 hours of notice of penalty-Form to home office within 5 working days
Penalty Payments Self-imposed penalty to accompany delayed benefit Auto Pay Schedules Not to be authorized for more than seven (7) perlodic payments (84) days
Advance Travel Expense At least ten (10) days before examination date Transportation Reimbursement Approval for payment within fifteen (15) working days of request for reimbursement
Medical Treatment Billings •Approval for payment within ten (10) calendar days of receipt of bill
Payment of electronic bills Within fifteen (15) days of electronic receipt May 30, 2017 30
MS Proposal Response to City of Richmor
hird Party Workers' Compensation Clalms Adminstration and Managed Care Servic EXHIBIT A-1

KUMS EMANAGED CARE
БОДОВОТО

TASK TIMEFRAME
Contested medical bills Notice to provider within twenty (30) calendar days that bill is contested; denied or incomplete
Payment of Awards, _ & R's, Approval for payment within fourteen (14) calendar days of receipt stipulations or Statutory Requirements.

Litigation Referral to defense council no more than ten (10) days from date of decision to refer (sooner if impending court date or other deadline)
inittal status reporl from defense Maximum of fifteen (15) days from date of referral counsel
Subsequent reports Maximum of thirly (30) days from last report Subrogation Notification/Contact with negligent third party within thirty (30) days of determination of existence of subrogation
Balancing of Claim File Every 180 days or end of benefit, whichever occurs first Excess Initial reporting-within ten (10) working days of date of Reporting/Reimbursement knowledge that any reporting Criterion has been met Requests for reimbursement Maximum of every ninety (90) days Case Closure Within thirty (30) days of the final payment, notice, or as provided by law
Telephohe Inquires Return Calls-within one (1) working day of original telephone Inquiry
Plan of Action Review Every ninety (90) days a full plan of action update is noted in the system
Return Correspondence Written answer compleled and retired within five (5) working days of receipt
Supplemental Job Displacement Within 10 days of last payment of temporary disability Vouchers (Potential Notice)
Converslon of Medical Only to Within one (1) day of knowledge that file needs to be converted Indemnity and reviewed/approved by Supervisor
Reserves At initial file setup
31 EXHIBIT A-1
- moronto

TASK TIMEFRAME
Within seven (7) days for any event that triggers the need for a reserve change
Reserve reviews required at.a maximum of every ninety (90) days Status Reports Every ninety (90) days created and provided to Client Examiner File Review No less than every forty-five (45) days - documented by notepad activity under "Examiner review"
Supervisory File Reviews At a maximum of every one-hundred and twenty (120) days AIMS will customize these response times if the Client has specific requests and these will also be reflected in the Client Special Handling Instructions. These instructions will incorporate AIMS Best Practices (AIMS4Excellence), Case Review Details, and assertive quality control measures that include all Client specified timelines.

All of these standards and procedures, along with our hands-on proactive involvement in the claims, ensure cases continually move toward a timely and cost effective closure without jeopardizing necessary high quality of care for the injured worker.

AIMS Supervisors are focused on providing continuous oversight of the claims and Client programs. A monthly review is conducted on a percentage (minimum 10%) of each Examiner's files to ascertain that the Claims Examiner is performing up to our standard as well as the agreed upon standards of the Client. The Supervisor subsequently reviews claims at regularly timed intervals (not less than every 120 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.

AIMS Supervisor has numerous duties including frequent reviews of Clalm Examiner's claims. Supeivisors do not carry caseloads as they are focused on providing continuous oversight of the claims and Client programs. The following are examples of Supervisor duties:
• The Supervisor will review all new losses received daily to confirm contact was made timely and make an entry in the computer's supervisor notepad. • The Claims Management Information System will set an automatic supervisor diary . for 10 days following claim entry to confirm that all issues on the claim have been addressed. (i.e,, subrogation, notices, benefit provision, eto.) • By the ft business day of the following month the Supervisor will provide a report to the Branch Manager and corporate office outlining the total lost time claíms received, the total timely contacts and the percentage of timely contacts.

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AIMS Proposal Response to City of Richmond
Third Parly Workers' Compensation Claims Administration and Managed Care Services EXHIBIT A-1
LIMS
-СОВГОКАТЕВ
*1337
• Each Supervisor is to monitor the payment diary of their staff for timeliness and accuracy.
• The Supervisor is to monitor the review diary of their staff for timeliness and accuracy no less than once a month.
• All denials and delays shall be approved by the team supervisor. Authority to delay or deny a claim shall first be obtained from the Client. • Aș soon as suspect issues arise, they must be written up by the Claims Examiner and given to the immediate Supervisor with the file to be reviewed and consideration for fraud investigation will be made,
• Any file which indicates the possibility of subrogation should be forwarded to a Supervisor for review to determine if further investigation is required • Upon receipt of a Decision or Order, the Supervisor shall make a prompt analysis regarding an appeal. If the Supervisor feels the decision should be appealed, the file should be documented as to the reasons and referred to the Branch Manager. • Upon receipt of the "Reinsurance Report" each Unit Supervisor or Branch Manager shall verify that all cases listed on the report have been reported to the Excess/Reinsurance carrier.
* All non-senior level Team member closures shall be approved by the Team Supervisor or Manager.
• In addition to the above duties, the Supervisor, as a part of his/her performance evaluation has to review a select percentage (minimum 10%) of each Claim Examiner's files on a monthly basis. This review is conducted to ascertain that the Claim Examiner is performing up to our standard as well as the agreed upon standards of the Client. For sensitive or high exposure cases, the supervisor utilizes a personal oversight diary, identifying those cases that warrant periodic management review. The Supervisor Review is clearly noted in the notepad; • Appropriate action is taken to ensure completions of all tasks are met. Our Supervisors provide technical oversight of the individual claims and of the employers' workers' compensation programs, ensuring quality, service, results as well as compliance with regulatory and Client-specific program performance standards. Supervisors do not carry a caseload. All Senior Claim Examiners and above are State certified to administer self-insured workers' compensation claims unless waived by the Client.

Monitor and Manage Case Loads: Ona continual basis, we review the Claim Examiner activity dashboards that capture all new claims and closing ratlos and pending open files.

The Supervisors consistently manage the Claim Examiner's caseloads to ensure caseload levels are managed based on Client specific requirements. All files with deficiencies/recommendations are immediately conveyed to the Claim Examiner for corrective action.

AIMS is committed to fully comply with the regulations for Workers' Compensation Examiner Certification regulations (CCR, Title 10, Sections 2592 to 2592.14) that were developed to implement Insurance Code Section 11761 effective February 22, 2006.

May 30, 2017 33
AIMS Proposal Response to City of Richmond
Third Party Workers' Compensation Clalms Administration and Managed Care Servioes EXHIBIT A-1

WINGED CORE
Education and Training: Our management staff is responsible for conducting and/or coordinating all in-service training and our Vice President of Workers' Compensation (VP), responsibility includes monitoring for compliance with the Insurance Code 11761, training and continuing education, on a bi-annual basis. The VP currently publishes a schedule for each branch manager indicating who in the respective office is subject to the CEU requirement annually. It becomes the responsibility of the Manager to then arrange for outside CEU opportunities or arrange to schedule in-service seminars by inviting industry professionals into our offices to conduct DWC approved courses. All professional staff is invited as well as interested Clients.

AIMS pays for our Claim Examiners and Assistants to complete their Insurance Educational Association (IEA) certificate. We also pay for the Self-Insured Administrators test if the current position requires certification. We pay for outside seminars and conferences and provide the staff with frequent in-house educational presentations. AIMS recognizes the only way to ensure compliance with workers' compensation laws, regulations and statutes is to maintain a high level of continuing education and training in order to keep up with legislative, legal, and regulatory changes in our 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. At AIMS, we require all staff to attend and complete training sessions regarding legislative, legal and regulatory changes in the workers' compensation industry.

Partial List of Recent Mandatory Training Sessions: EDI Training, Utilization Review, Medicare Set-Aside Trusts, AMA Guides & PD Rating, Fraud Training, Medical Provider Networks, Security Awareness, 4850 & Public Safety Presumptions, Supplemental Job Displacement Benefits, Ergonomics, and Medical Roundtable.

Reserving: AIMS Claims Examiners are well versed in the tangible and intangible rationale affecting reserves and establish accurate reserves given the state of the claim facts at any point in time. Reserves are constantly reviewed at each scheduled diary.

Reserve worksheets are prepared to support any changes made in reserving amounts and can be provided to the Client in support of a reserve increase or other change. This information is made available to the Client through online viewing. of the Examiner's electronic file notepad. If the Client desires, prior to any reserve change of a pre-agreed amount or level, the Claims Examiner will confer with appropriate Client personnel to discuss the merits of the proposed change.

AIMS Examiner will review and evaluate the reserve adequacy and possible closure at 45 day intervals or as designated by the City.

The criteria that mandates review of reserves is based on the level of authority by position.

Provided below are the corporate guidelines applied to reserving as well as the task performance timeframes:

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AIMS Proposal Response to City of Richmond
Third Party Workers' Compensation Claims Administratlon and Managed Care Services EXHIBIT A-1
cUMS CART
Examiner - $250,000
Senior Examiner $0 - $500,000
Supervisor $0 - $750,000
Branch Manager $0 $1,000,000
Performance Time Frame Standards - Reserves

TASK PERFORMED TIMEFRAME
Reserves. At initial file setup, Within seven (7) days for any event that triggers the need for a reserve change. Reserve reviews required at a maximum of every ninety (90) days.

Status Reports/ Plans of Action Every ninety (90) days.

Supervisory File Reviews At a maximum of every one-hundred & twenty (120) days.

Please see Exhibit 2 - Settlement Authority Request Worksheet and Exhibit 8- AIMS4Excellence TOC
D. Ancillary Services: Identify any company-owned and affiliated ancillary services to include, but not limited to, bill review, utilization review, and nurse case management.

Provide a description of each ancillary service including an organizational chart, physical location, description of where the work is being conducted, management structure, and number of employees. List all outside vendors you currently work with including the services they provide. If such services were awarded to one or more vendors not owned by or affiliated with your company, describe how your firm would work with such outside providers to ensure effective and efficient service to the City.

Include any limitations you may have in working with outside vendors.

AIMS strives to provide its Clients with a thoroughly customized program. We provide assistance to our Clients in formulating customized claim report generation, customized stewardship reporting, a customized transition plan, customized Medical Provider Networks (MPN), customized Preferred Provider Organization (PPO) Networks, customized Carve-Out Programs to address cost drivers, customized utilization review (UR) and medical case management referral criteria, customized vendor panel, and in- house customized training on workers' compensation topics and trends to name a few.

For medical cost containment services, AIMS recommends its sister company, Allied Managed Care, Inc. (AMC). AMC has been providing these services to California public agencies, self-insured's and insurance carriers since 1995. AMG offers Medical Bill May 30, 2017 35
AIMS Proposal Response to City of Richmond
Third Parfy Workers Compensation Claims Administration and Managed Care Services EXHIBIT A-1

GUYS AGED CARE
Review, Utilization Review, Nurse Case Management (including telephonic and on-site or field nurse case management), Customized Medical Provider Networks (MPN), AlliedR (Prescription Management), AlliedCare Complete (Early Intervention), and CalConnect (Call Center Services).

AIMS researches and will vet service providers for quality and best-value for our Client and will make our recommendations known to the City. If the City has preferences for various service providers, AIMS will use the City's preferred vendors. The service provider "panel" is pre-approved by our individual Clients. Any exceptions to appropriate assignments are managed on a case-by-case basis. Through this platform, we have the ability to streamline the Claims Examiner workflow as well as track, manage and run reports on service provider usage.

AIMS coordinates Clients' vendor panels and approvals in advance and all referrals to vendors in accordance with the Clients' requirements as part of an integrated cost containment solution, which entails managing ancillary services and coordinating programs such as:
• Medical Bill Review
• Utilization Review
• Nurse Case Management
• Return to Work (includes on-site programs),
• Loss Control
• Workplace Safety
• Occupational Health Clinics
* Job Task Banks
• Employee Training and Medical Provider Networks (MPN) Also, AIMS continuously evaluates our strategic partner service providers to ensure performance-levels and continued value-add to our Clients.

AIMS has created an integrated referral platform called AIMS Rapid Referral Program (ARRP) to expedite this process of referral coordination between vendors and AIMS Examiners. The process integrates information directly from the David NavRisk System and uploads to the ARRP System. The ARRP System documents the referral and uploads the forms into the AX Document Storage System. The uploading and documentation of the referral eliminates the Examiners need to do these steps and instead completes these tasks upon creating the referral in the ARRP System. Reports are generated to track lag times and effectiveness of both the AIMS teams and the Vendors.

E. Claims Management System: Describe in detail how your computer system is utilized to provide workers' compensation services. Discuss the capabilities of the system including whether the system tracks lost time, temporary modified duty and temporary partial disability. Provide samples of standard and customized computer- generated reports you prepare for your clients (Note: limit 1 - 2 pages per sample).

May 30, 2017 36
AIMS Proposal Response to City of Richmond
Third Parly Workers' Compensation Claims Administration and Managed Care Services EXHIBIT A-1

CUMS AGHD CARS
AlMS utilizes David Corporation, NavRisk System, which is an Internet-based claims management system built on MicrosoftNet technology, designed for anytime, anywhere access. The system access is web-based and runs on an SQL database platform, NavRisk is based on David Corporation's Renaissance system which has been in operation since 1999. This system is upgraded on a continuous basis.

Our claim management system provides a wide array of information so, the City can immediately evaluate the current condition of its customized program. Access to this information allows the City to effectively manage its workers' compensation program and to confidently make high impact risk management decisions, Our system provides the City with extensive on-line capabilities for reporting claims, customized report generation, and immediate real time access to key information from any location.

Claim System Features of benefit to the City:
• Direct viewing of Claims System with description and details • Key data at fingertips: financial data, claims diaries, notes, lost time, temporary partial disability, and RIW
• Self-Generated ad-hoc reporting when you need it
• User defined report queries
• Web-based entry of (Employers' First Report of Industrial Injury or illness) • 1099 reporting to the Internal Revenue Service
• Self-Insurers Annual Report generation
• Occupational Safety and Health Administration. (OSHA) reports - Lost Work Days • Electronic interface with the Index Bureau and Workers" Compensation Insurance System
• Production of all required reports and data exports (real time and viewed archived reports)
• Electronic Data Interface compliant
• Access all performance metrics (dashboard view)
AIMS claims management system accepts unlimited levels of location coding, allowing Client data to be sorted by location or cost center for loss control and financial purposes.

The department names and organizational coding is customized to fit the needs of each Client. Similarly, custor code sets allow each Client to define their own tables, such as notepads, pay types, class codes, and job descriptions.

By customizing our coding tables, we are able to extract accurate and relevant data that satisfies the needs of each Client. The primary categories for reserves have been expanded to allow us to more effectively track benefit payment, reserve, and incurred data. The system tracks lost time, temporary modified duty, and temporary partial disability. Listed below are some of the reserve categories:
• Temporary Disability
• Permanent Disability
• Labor Code 4850
May 30, 2017 37
AIMS Proposal Response to City of Richmond
Third Parly Workers' Compensation Claims Administratlon and Managed Care Services EXHIBIT A-1

CUMS CURIED CRE

DORATED
• Death Benefits
• Medical
• Legal Expenses
* Other Expenses (includes investigations)
• Vocational Rehabilitation Benefits
• Maintenance Benefit
• "Capped" Vendor Costs
• Miscellaneous Program Costs (Training, etc.)
As mentioned above, the RMIS is upgraded on a continuous basis. Our claims information system utilizes state-of-the-art technology including access security, nightly back-ups • with off-site storage, an uninterrupted power source to ensure continued use in the event of a power shortage, and a formal business interruption plan.

Access to our system is only gained through user specific security codes; therefore, only select personnel who have been given clearance have access to data and monetary functions. Various security levels are granted to users, which preclude change of data and generation of payment or reserve changes unless pre-authorized. Also, the system allows password security at the location code level so user can access only their location information.

Standard & Monthly Reports: In addition to extensive reporting, the following information is a sample of what type of reports and data AlMS Clients can view within the claims system: Claims Summary, Claims Examiner Notes, Detailed Payment Information, Detail Transaction, Managed Care (UR, Fee Schedule), Billing Information, and Prior TPA Information. In addition, correspondence such as medical legal reports, depositions, denial letters, and attorney correspondence information is also captured.

AIMS electronic database is capable of producing specialized and ad hoc reports in addition to those required by the State of California. AIMS can provide various standard monthly reports and custom reports upon request. AIMS supports its Clients with a robust report library. Our system is an extremely powerful data management claims system for both standard and ad hoc report generation. Our web based system also 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 Portable Document Format (PDF) or Microsoft Excel. Types of data available which will electronically be available to the County range from Claims Summary, Adjuster Notes/Diaries, Detailed Payment Information, Detail Transaction, Managed Care (UR, Fee Schedule), billing details to prior TPA information.

Please see Exhibit 4 - AIMS Sample Claims Reports
May 30, 2017 38
AIMS Proposal Response to City of Richmond
Third Parly Workers' Compensation Claims Administration and Managed Care Services EXHIBIT A-1
F. SAS 70 Audit Compliance: Indicate your firm's compliance with SAS70 annual audit compliance reporting and indicate the date of the most recent completed audit report.

Yes, AIMS is SSAE 16 (replaced SAS 70) certifled. In today's global economy, service organizations, and providers must demonstrate they have adequate security controls and safeguards when they host or process data belonging to their Clients. AIMS undergoes SSAE 16 audits annually to ensure our controls are effective because we are very earnest about our business and the security of our Client's information.

AIMS successfully completes its SSAE 16 audit annually. The SsAr. 16 audits eftectively report on the relevant internal controls established by AIMS, especially the financial and confidential data controls, in performing our services for our Clients. First, controls are established that describe the service organization's description of security controls at a specific point in time, Second, the audit includes the service organization's description of controls and also includes detailed testing results of the service organization's controls over a minimum six-month period. A complete audit report was conducted on July 1, 2015 to December 1, 2015. The most current audit for the 2016-2017 period took place and the completed audit in 2015 was validated with no changes made to controls.

Please see Exhibit 9 - SSAE 16 and URAC Reports
G. Client References: Provide a list of five (5) clients (including full contact information) from which similar types of claims-related services are provided by your proposed service team office. Include the length of your contract with each client including the approximate number of indemnity claims annually. The City will contact these references to discuss the bidder's performance.

The longevity of our Client relationships is based in part on the types of programs AIMS establishes, which reinforce the strategic goals of workforce excellence, organizational effectiveness, and fiscal responsibility. Provided below are references for Clients with programs similar to the City of Richmond.

REFERENCE — Claims. Related Services
Agency Name
Central San Joaquin Valley Risk Management Authority (52 Member Cities JPA) Contact Name
Kevin Werner; City of Ripon, City Administrator
Contact Phone Number Contact Email Address
(209) 599-2108 [email protected]
Length of Contract / Number of Indemnity Claims
Client since 1995 / 1000
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MS Proposal Response to City of Richmon
hird Party Workers' Corpensation Claims Administration and Mariaged Care Service EXHIBIT A-1

E MANAGHD CARE
Everane
REFERENCE - Ciaims Related Services
Agency Name
City of Bakersfield
Contact Name
Jena Covey, Risk Manager
Contact Phone Number Contact Email Addréss
661-326-3090 [email protected]
Length of Contract / Number of indemnity Claims
Client since 2007 / 500
REFERENCE - Claims Related Services
Agency Name
City of Huntington Beach
Contact Name
Patti Williams, Risk Manager
Contact Phone Number Contact Emall Address
714-536-5290 [email protected]
Length of Contract / Number of Indemnity Claims
Client since 2010 / 500
REFERENCE - Claims Related Services
Agency Name
City of Clovis
Contact Name
Lori Shively, Personnel/Risk Manager
Contact Phone Number Contact Emall Address
559-324-2726 [email protected]
Length of Contract / Number of Indemnity Claims
Client since 2007 / 175
REFERENCE - Claims Related Services
Agency Name
City of Hayward
Contact Name
Nina Collins, Director of Human Resources
Contact Phone Number | Contact Email Address
510-583-4534 Nina. [email protected]
I Proposal Response to Clify of Richmond 40
hird Party Workers' Compensatlon Claims Administration and Managed Care Service EXHIBIT A-1
(GED CARE
НА ХОРОВАТИ!
REFERENCE - Claims Related Services
Length of Contract / Number of Indemnity Claims
Client since 2016 / 350
May 30, 2017 •41
AIMS Proposal Response to City of Richmond
Third Party Workers' Compensation Claims Admihistration and Managed Care Service:

EXHIBIT A-1

LUVS SHANAGED CARE
ПОВТОВАТЕ
Bill Review
A. Firm's Qualifications: Describe the firm and provide a brief statement of qualifications in providing bill review services. Describe your experience doing business with self- insured public entities in California. Discuss what distinguishes your company from other bill review providers. Provide a company-wide organizational chart with reference to the proposed service office and proposed service team.

AIMS recommends its sister company, AMC for bill review (BR) services, AMC has one central goal - provide professional medical cost containment solutions that result in improved program costs. AMC has over 100 Clients consisting of approximately 80% self-insured public entities and 20% private entities throughout the continental United States and Hawaii. AMC audits approximately 230,000 bills per year.

AMC's philosophy is, in part, that the greatest net savings and not just the lowest fee bill review company should be any employers' decision point. Our goal is to ensure our Clients only pay what they are legally obligated to pay, no more or no less. Some competitors offer an extremely low fee and, to do so, they also automate nearly all of the bill review process. Fully automating BR leads to an increase of inquiry and dispute calls from the provider to the TPA/Employer, an increase in provider litigation (liens), and ultimately an increase in claims cost because of inaccurate and unjustifiable bill reviews.

Qualifications: As a full-service medical BR company, AMC adjusts medical, hospital, surgical and pharmacy bills using the Official Medical Fee Schedule (OMFS), the Official Inpalient and Outpatient Fee Schedules, and we apply discounts generated by MPN, Preferred Provider Organization (PPO) and pharmacy networks.

AMC does not simply "process" medical bills by pushing them through scanning and OCR technology for repricing, rather our certified bill reviewers manually review each and every bill in order to ensure we are recommending the most appropriate fee for the services provided. We strive to obtain the highest net savings for our Clients.

AMC Distinguishing Features: Our approach to the management of our Clients' Medical Bill Review programs center on quality, service, and results, AMC is committed to a constant focus on these key elements and provides these services in accordance with the California Labor Code and California Code of Regulations. • A paperless single source solution for BR processing
• Director of Client Services (single point of contact) • Over 20 years of expertise in California public entities including but not limited to having over 65 Clients that have safety officer employees and over 30 school districts. We have firsthand knowledge of the claim exposures, which allow us to effectively utilize all cost containment measures. • Offer a variety of PPO's with the ability to geographically assess the best PPO May 30, 2017 42
AIMS Proposal Response to City of Richmond
Third Party Workers' Compensation Clalms Administration and Managed Care Services EXHIBIT A-1
GUMS

FLORALATED
Enforcement of UR determinations/interfaced with BR
• Health Insurance Portability and Accountability Act (HIPPA) Compliant • Electronic document storage and retrieval
• Claims Examiner ToolBox (Web-based portal) - Electronic Claims Examiner Approvals/Objections
AMC maintains a partially manual process to ensure the ability of the BR analyst to verify via reading the corresponding medical reports the services billed were actually the services provided.
• Higher savings
• Improved accuracy
• Less provider disputes
• Less lien litigation
Enhanced Value for our Clients:
• Experience/Stability
• California focus and expertise
• Over 21 years' experience providing bill review/utilization review services - Californla public and private entities
• Mandatory ongoing continuing education - effective solutions and increased. cost containment savings
• Fully licensed/dedicated technical staff
• Managed care professionals collectively has over 100 years of experience • Management structure
• Proven savings results
Consistent superior audit results
Client specific customization of programs
o Customized Special Account Instructions based on the Client's requirements for desired results
• Special Handling Instructions Allied Customer Expectations (ACE) • Customized protocols based oh Client's requirements
Innovative programs for cost effective handling of medical cost containment programs
Dedicated Client Services Director - single point of contact Paperless Process - increased productivity, security/management Excellent references
AMC BR Service Office and Org Chart: 10360 Old. Placerville Road, Sacramento, GA, 95827.

A company-wide organizational chart has been included in the exhibit noted below.

Please see Exhibit X - Corporate Organizational Charts (Company-wide) May 30, 2017 43
AIMS: Proposal Response to City of Richmond
Third Pady Workers' Compensation Claims Administration and Managed Care Services EXHIBIT A-1

CUMS E HANGED CERE
B. Service Team Qualifications: Provide a brief summary of the qualifications and experience of each proposed team member, including their length of service with your firm and their resume. Provide an organization chart representing your staff and identify any sub-consultants you plan to utilize to supplement your proposed staff.

The AMC BR team identified below is supplemented by an extensive management, technical, and support staff in multiple offices located throughout the continental United States and Hawail. Listed below are key personnel and members of the AMC Corporate Team. We do not use sub-consultants for the identified BR services.

Mark Denison, Senior Vice President of Operations: Mark oversees the entire customized Bill Review/Utilization Review/Nurse Case Management Program. Mark's role is to monitor all contract compliance with performance standards, audit compliance to individualized Special Account Instructions; legal and regulatory compliance; and provide ongoing communication with our Clients. Mark provides unparalleled leadership and direction to all AMC staff. He oversees all operational and administrative components of Allied Managed Care's services, including Medical Bill Review, Utilization Review, and Case Management. He has over 21 years of experience in workers' compensation cost containment, strong multi-jurisdictional managed care knowledge and practical application. His involvement ensures that our Client's performance standards are met and communication is ongoing. Mark is always available to meet with our Client's staff to discuss issues and performance when requested to do so. Mark is a state board certified licensed Chiropractor, Certified Disability Evaluator and past Division of Workers Compensation (DWG) appointed Qualified Medical Evaluator (QME). Mark joined the AMC team in 2008.

Lea Morales-Mendez, Director of Client Services: Lea has over 26 years of workers' compensation experience in roles of operations and management as well as Client Services. Lea has received training in Disability Management, Health Insurance Portability and Accountability Act (HIPAA) and Utilization Review Accreditation Commission (URAC). Lea's role is to assist the management team in addressing all issues related to the contract as well as serving as a resource for workers' compensation decisions that may affect our Client. As well, as interacting with AMC's management team to resolve all issues that may arise in UR and Bill Review; provide timely communication to the management staff of any critical developments that may affect the product delivery; meet regularly with the management team to assess AM's performance; discuss business decisions, and address concerns. Lea is a resource for our Clients. Lea joined AMC in 2006.

Melissa Miller, Bill Review Manager: Melissa has over 20 years of experience in the industry including working for large national bill review companies. Melissa is a California Designated Bill Reviewer. She provides supervisory oversight and quality control of the entire medical bill review process for our Clients to ensure timely processing of payments.

Melissa is responsible for all administrative and operational components of the bill review unit, including staffing, training, quality, timeliness and accuracy of work performed in the May 30, 2017 44
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Huarano
unit, ensuring efficient and optimum workflows. She has a working knowledge of the entire bill review process, from bill entry, tracking of bills in and out of the office, review of all bill types, check-offs, invoicing, export file generation and sending, report generation according to the Special Account Instructions, the re-evaluation process and the lien process. Melissa joined AMC in 2009.

Darcy Olivares, Bill Review Supervisor: Darcy is a California Designated Bill Reviewer with over 16 years in the workers' compensation industry. She reports to Melissa and is responsible for all administrative and operational components of the bill review unit; including staffing, training, quality, timeliness and accuracy of work performed in the unit, efficient and optimum worktlows, and maintaining the positive and professional attitudes of unit members. Darcy also has a working knowledge of the entire bill review process, from bill entry, tracking of bills in and out of the office, review of all bill types, check-offs, invoicing, exporting files, report generation according to Special Account Instructions, the re-evaluation process, and the lien process. Darcy joined AMC in 2007.

Please see Exhibit X - Corporate Organizational Charts (AMC Org Chart) and Exhibit 11 - AMC Team Resumes
C. Services: Describe your bill review services, features of your system, unique capabilities, and ability to customize the delivery of your services. Provide an organizational chart, physical location, description of where the work is being conducted, management structure, and number of employees. Discuss your ability to work with TPAs in delivering bill review services and provide a list of three (3) you currently work with. Include your average monthly bill volume processed by your office.

AMC brings innovative medical cost containment programs for cost effective management at the onset of all olaims. These programs include approprlate medical case management, formal customized utilization review programs, medical bill review, Medical Provider Networks, Preferred Provider Networks, and all necessary ancillary services to maximize all areas of medical cost containment to bring real savings back to the Client.

We bring paperless single source solutions for utilization review treatment planning and bill review processing.

Average monthly bill volume processed by your office: AMC processes approximately 16,350 (/1/16 - 4/30/17) bills on average per month in California. As the current Bill Review services provider, AMC has reviewed 6,611 Bills between 5/1/16 - 4/30/17 for the City of Richmond.

Third Party Administrators: AMC provides BR services through the following TPA's:

Acclamation Insurance Management Services (AIMS), TRISTAR, and several self- insured/self-administered programs.

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Third Parly Workers' Compensation Clalins Administration and Managed Care Services EXHIBIT A-1
AMC's Bill Review Services
Client specific customization of programs: AMC develops a customized Allied Customer Expectations (ACE) for each Client and for each cost containment service. The ACE document outlines all expectations and any special requests of the Client that is required of AMC in order to comply with contract requirements. • Customized Special Account Instructions based on the Client's requirements • Special handling instructions detailed in the ACE service document • Customized protocols based on Client's requirements
AMC Clients benefit by having a single point of contact, our Director of Client Services who is available to our Client to develop and maintain specific strategies ensuring proactive program management and compliance with all Client's requirements. We understand medical cost containment programs for public agencies. We have firsthand knowledge of the claim exposures, which allow us to effectively utilize all cost containment measures.

Innovation: These innovative programs include services to maximize all areas of cost containment and bring real savings to the City.
• Single Source Solution: AMC will provide paperless single source solutions. for BR processing and UR treatment planning.
•• Director of Client Services: AMC will provide a Director of Client Services (single-point-of contact) for the City to develop and maintain strategies to ensure proactive program management and compliance with the City's requirements.
• TPA Insight: We understand medical cost containment programs for public agencies. We understand the requirements, specific procedures and overall goals of the City. Having AIMS, a workers' compensation claims administration firm, as our sister organization, AMC management is uniquely informed and experienced in designing programs that improve claims administration workflows and reducing costs while improving injured employee outcomes. • Best Suited PPO: AMC does not own its own PPO, therefore, AMC can provide an objective analysis as to the best suited PPO. • Interface between BR and UR: AMC has an established interface between BR and UR. We have had this in place for over 8 years, many years before it was recognized by the industry that it is a critical component to cost containment.
• Education: A key aspect of our services has been educating the Claims.

Examiners of the importance of timely submissions, appropriate UR referrals and full documentation. Educating the Claims Examiners on SB863, ensuring they understand their responsibilitles and the penalties that apply as well as the proper workflow. Training is provided to the TPA by our Medical Director, Alan May 30, 2017 46
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Randle.
• Medical Director: AIMS/AM's Medical Director, Dr: Randle provides oversight, leadership, and medical expertise to all Managed Care Services provided by AMC, Dr. Randle has served as our Medical Director since 2008.

AM's BR services include but are not limited to:
• Fee Schedule and/or Usual & Customary Review
• Duplicate bill detection
• Offer a variety of PPO's with the ability to geographically assess the best PPO • PPO re-pricing and administration
• Code review and re-bundling of services
• Inpatient line-item audit reviews
Outpatient line-item audit reviews
Complex, specialty, and rush processing
• Enforcement of UR determinations/interfaced with UR
National Bill Review Service
Pharmacy review/PBM.services
Explanation of Benefits with appropriate State language Hearing Representation at no cost
• Negotiated Discount Services
Guaranteed turnaround time
Interface with claim systems or overnight pick up
Health Insurance Portability and Accountability Act (HIPPA) Compliant 100% audit of reviews
Electronic document storage and retrieval
• Examiner ToolBox (Web-based portal)
Flexible account structure, customized work flows
Provider inquiry explanation and resolution
• Extensive management/savings analysis reports (choose from a wide range of reports to gain instant access to important data):
• Data reporting to State regulatory agencies (AMC is State reporting and electronic billing compliant)
AMC's Software Platform: AMC can provide a state of the art BR program that utilizes a highly sophisticated software platform enhanced by the expertise of the dedicated AMC Client team trained to review bills in accordance with the specific requirements of the Client. The features of our system can be customized for each of our Client's unique needs and specific reporting requirements.

Our analysts use a web-based, automated system to generate accurate revlews and maximize savings. AMC identifies treatment that is not appropriate under American Medical Association (AMA) guidelines, monitor and identify duplicate bills and adjust Mav 30, 2017
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Third Party Workers' Compensation Claims Administration and Managed Care Services EXHIBIT A-1

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medical, hospital, surgical and pharmacy bills using the updated and accurate Official Medical Fee Schedule (OMFS), the Official Inpatient Hospital Fee Schedule, and apply discounts generated by the MPN and PPO providers. Our BR software is updated on a regular basis to reflect current fee schedules and PPO networks. Our qualified trained staff reviews each bill to determine appropriateness of treatment and to ensure provider compliance with fee schedule ground rules. AMC Will provide a paperless single source solution for the processing of all medical bills through scanning technology hardware.

In addition to the distinguishing BR features previously described in this proposal provided below are capabilities unique to AMC.

Integration of Bill Review and Utilization Review: The electronic interface between AMC's BR and UR/Nurse Case Management is already established. When BR and UR share data, greater savings and better medical control result. Additionally, the electronic interface between AMC's managed care services to the AIMS Claims System is already established. Because these interfaces are already established, there is no delay in taking control of the medical cost containment aspect of a Client's program. The Client can be confident that this aspect of their program is not only in place, which often never happens on unbundled programs, but has been in place for many years with workflows streamlined and perfected over time.

AMC's system ensures integration of real time current information and communication on all claims is available to all cost containment practices/specialists through shared screen access. All UR and case management decisions regarding treatment limits and authority are placed directly into the BR software for retrieval and review during the audit process of all incoming bills. The Claims Examiner and/or telephonic nurse case manager can easily determine if retrospective UR is potentially needed based on AMC's advanced ability to electronically return medical bill review information sorted by prior prospective or concurrent UR involvement. In other words, integrated platform ensures, on an automated basis, that services approved are the services paid.

If treatment that was never requested or authorized is billed, the BR system will flag the treatment and allow the Claims Examiner and/or telephonic nurse case manager to send the treatment through UR for a retrospective look at whether the treatment is authorized or denied.

Reports: AMC is able to track trends for Clients by providing numerous BR reports including savings reports, PPO savings, and penetration reports, provider savings, duplicate billing, claim charges, top billers, hospital reviews, and many more. The City can also request ad-hoc reporting to meet specific needs. A wide variety of reports are available to the City and can be run on any schedule required. These reports can be generated in multiple formats including: PDF, Excel, RTF, HTML, eto. The reports include information such as claim number, provider, dates of service, billed charges, recommended allowances, etc.

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GIVE EMANAGED CARE
Quality Assurance: AMC provides quality assurance in medical bill review on several levels as follows:

1. An override report is run at the end of each business day, to determine that all overridden bills were checked for duplicates:

2. A retrospective Quality Assurance ("QA") is performed using reports that identify all bills reviewed by each analyst. QA is performed during the daily functions while researching bill history and processing of Addrees. The QA is performed by the senior analysts and supervisors on a daily basis. The following is an abbreviated list of the QA points that are stringently looked at:
• Keying - ensure bill data and demographics has been correctly added into the system.
• Claim - ensure the bill has been processed against the correct claim. • Reductions - whether correctly taken or calculated.
• Reports - ensure all required reports are attached
• Negotiated Discounts - ensure negotiated discounts have been applied. • Treatment Plans - confirm the treatment plan has been followed. • Vendor/Provider - confirm the correct vendor/provider has been selected for payment purposes.
• Billed Charges - confirm all attached billing documents and charges are for the same patient and from the same vendor/provider while ensuring no charges are missed.
• Coding - ensure correct diagnosis, service codes and DOS are entered, • EOR Message Codes - ensure the message codes applied are applicable to the services being reviewed.

3. Results are addressed with each individual analyst, noted as part of their production standards, and are logged for monthly reporting as well as performance review,

4. Results are further utilized for individual and group training sessions.

5. While conducting a QA audit, should an AMC error be discovered, our Client will not be charged for the correction and a new EOR will be sent to our Client.

6. All found issues are provided to the Manager of BR who maintains spread sheets of production counts and errors: This data is used for the monthly reviews of the analysts and to determine where additional training is required.

AMO's turnaround time averages four (4) days: AMC's average company turnaround time is four (4) days. It is important to define and explain AMC's turnaround time guarantee. Sometimes, a bill cannot be properly reviewed without additional information. Approximately 8 - 12% of bills received fall into this category for any number of reasons beyond AMC's control. The AMC guarantee speaks direcfly to the timeframe once a bill arrives in the AMC office which has no issues relating to the accuracy of the information on the bill or the completeness of the bill.

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Third Party Workers Compensation Claims Administrallon and Managed Care Services.

EXHIBIT A-1

TANAGED CARE
AMC adjusts medical, hospital, surgical and pharmacy bills using the Official Medical Fee Schedule, the Official Inpatient and Outpatient Fee Schedules, and applies discounts generated by PPO and pharmacy networks. At AMC we don't just don't run the CPT codes as billed by the provider. In our process each bill is looked at to ensure that documentation supports the level of service being billed.

Negotiated Bills: AMC's pro-active approach to maximizing potential savings is demonstrated in AMC's practice that dictates we send fee schedule exempt bills as well as non-PPO bills to the negotiation unit within the AMC BR department. This unit is able to negotiate additional savings beyond PPO discounts and/or in place of when no PPO reduction is applied by the specific PPOs. The Negotiation Unit has been building relationships with providers who are now submitting requests directly for additional savings and prompt payments. Savings are obtained by way of LOAs (letters of agreement) that apply when a 7-10 day turnaround on payments are made.

Additionally, all bills, regardless of status, that are in excess of $2,000.00 (after reductions) are reviewed for potential referral to the negotiation unit. It should be noted that our Clients pay only a percent of these additional savings, if we achieve savings above and beyond the fee schedule. Simply put, if no additional savings are achieved, our Client pays nothing for our review. Currently, our Negotiation Unit is averaging a 10% savings for our Clients.

AMC routinely negotiates fee reductions on bills meeting standard criteria (including in- patient hospital bills, surgical procedures, and other high dollar exposures) that fall outside our contracted PPO Network. Our negotiation approach, which includes signed negotiation letters by both AMC and the medical provider, serves two purposes:

1. Acceptance of payment as full and final payment (eliminating lien potentials).

2. Additional savings below Fee Schedule allowances (or in place of) for expanded Bill Review savings for our Clients.

Automated Recalculation of Savings and Fees of Duplicate Bills: When AMC displays data that is for additional allowance recommendations on previously reviewed bills, the billed charges are shown as zero (which is accurate) and the "savings" is shown as a negative number. In this way, we do not artificially inflate the billed charges and our total savings is actually reduced, so that at the end of each month our Client sees a true "net" savings. If our Clients BR fee was based on a percent of savings, then AMC recalculates the full BR fee and refunds the appropriate amount based on the updated savings on the bill. Any reconsideration with a credit to our Client is done automatically in the system. Our Client does not have to rely on the manual intervention on an individual which may be subject to error.

Unbundling is a significant cost driver that is virtually overlooked by many BR systems.

Embedded in our software platform are bundling criteria from multiple sources, including Correct Coding Initiative (CCI), AMA, and American Academy of Orthopedic Surgeons May 30, 2017 50
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(AAOS). The system is able to identify inappropriate billing patters through logging vendor ID numbers associated with bills that are up-coded, bundled, fall outside medical treatment guidelines, and/or exhibit excessive fees. A report is then generated to reflect these providers so action can be taken if indicated. AMC's system reviews all CPT ranges but we pay special attention to CPT codes in the range of 97010-98778 and 98940-98943 because of the mandated limits on physical therapy and chiropractor treatments, AMC's system generates an automatic alert indicating the 24-limit visit rule has been exceeded.

Provider Networks: AMC can provide both MPN and PPO, to be used exclusively by our individual Clients. These workers' compensation specific networks incorporate the medical providers with extensive, specialized experience in dealing with injuries incurred at the work place or job site. AMC does not own its own PPO, therefore, AMC can provide an objective analysis as to what PPO is best suited for the Client.

Allied Managed Care Service Entity Medical Provider Network (MPN): The Division of Workers' Compensation Medical Unit for the Allied Managed Care MPN, MPN Identification Number 2360. The approval is for a period of four (4) years. Allied Managed Care Network is filed as a "Network Service Entity" which means that we can add the City without having to refile with the state, saving many months for implementation.

On March 11, 2015 AMC received approval (#2360) from the Department of Industrial Relations, Division of Workers' Compensation Medical Unit. This approval is valid for a period of four (4) years.

As a "Network Service Entity" AMC offers Clients:
• Only one filing
• Less customization
• Only one website
• Only one audit
• Better control of Network
Preferred Provider Organization (PPO): AMC has an ever-growing list of PPO's to offer and will work with the City to determine the best PPO's for the City's program. Our broad menu of network relationships is designed to offer our Clients the ability to match their own experience with the PPO option that would maximize cost effectiveness, By not being tied to or owning any PPO network we avoid the potential for a conflict of interest when selecting the best PPO for our Client.

Additionally, the system allows several ways in which we can maintain and support Client specific contractual discounts. AMC can load virtually any PPO or negotiated fee arrangement by individual provider, into the BR software engine for automated application of discounts.

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eUMS

INDORATED
We work with the Client to determine the best PPO. During the transition phase, we discuss the PPO options. We are able to use the provider zip codes from our Client's . most recent BR data to let our Client know which PPO offers the most coverage in its area. Ultimately, the Client will choose which PPO provider we use. The Client may select access to one, two or three PPO's. If more than one is selected, the PPO's are then categorized in our BR system as primary, secondary and tertiary.

Provided below is a partial list of some of the available PPO networks:
• Blue Cross - CA
• First Health / Coventry
Procura
• PRIME
• InterPlan
• ClarisPointe
• ASI Flex
Lesser of Language: In order for a PPO Network to be utilized by AMC for its BR services, the contract must contain the "Lesser of Language", ", which allows the reviewer to apply the lesser of fees between Fee schedule and the PPO contract.

Pharmacy Program: AMC can track narcotic prescription drug usage and recommend UR and/or Medical Case Management to work with the prescribing physician and injured worker to establish an alternative treatment course to avoid the potential for addiction and abuse.

Integration with PPO, MPN, UR, and PBM Programs:
• AMC's BR System has a variety of PPO's a Client can choose from and AMC can also cascade up to three PPO's to assure maximum savings for our Clients. • AMC will load the Client's specified MPN providers and discounts into the Bill Review System so MPN providers are assured appropriate payment. • AMC BR System can accept UR determinations from UR companies to assure only treatment approved will be paid. AMC can provide the City's UR Company a layout of needed information in order to accept the determination in the BR System.

AMC has an Approved Ancillary Networks Panel: AMC has gone through an extensive process of researching and interviewing numerous ancillary network vendors in order to establish a complete ancillary network vendor panel which will give our Clients the best possible service. AMC does not receive any fees for referrals to the AMC Ançillary Network Panel vendors. Any discounts received are based upon AMC's collective buying power and passed through to our Clients. Our Clients can use the AMC networks, or AMC will work with any network preferred by the Client.

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Third Party Workers' Compensalion Clalms Administration and Managed Care Services EXHIBIT A-1
EUMS
Provider Inquiries Bill Review: Provider/vendor inquiries or appeals are received via phone, mail and fax regarding underpayments and/or denial of reviewed bills. Phone calls are returned within 24 hours. Inquiries that come through the mail are distributed within 24 hours of receipt. If the inquiry is an appeal, that appeal will be completed within 30 days. Each appealed bill is reviewed against the claim history to determine if the bill was paid correlly on the initial review, processed under a different document control number (DCN) or processed if the missing information/documentation is attached for further review. Upon completing an additional or follow-up review, the results are sent back to the provider via an EOR or letter.

Independent Bill Review (IBR): We work with each Client in determining the best process by which to manage the Second Requests as well as the IBR determinations, As each Client has a different workflow process, we have a questionnaire that we will complete with our Client in order to determine the best way to manage the process.

A testament of Quality Bill Review is demonstrated by AMC's Bill Review error of less than 1% and the fact that AMC has only received a total of four (4) IBR's from the inception of the IBR process.

AMC Implementation of Request for Second Review

1. AMC can create either pend or denial rules based on proposed time frames. Determination of which type of rule will be upon Client request.

2. AMC has created specific message codes to be utilized in conjunction with the legislation.

3. Tracking of the 14 day response timeframe to the provider can be managed by the Client in a variety of ways including the creation of specific Bill Review queues, assignments to work specific pend queues, and use of reports,

4. Any current Penalty and Interest reports will be updated to include the time frames for Request for Second Review.

Lien Resolution: AMC works together, at no additional cost, with any representative appointed by the Client to resolve a lien. The Bill Review Re-Evaluation Specialist advises the Claims Examiner as to the process by which the bill was reduced (OMFS or which specific PPO was applied) so this information can be passed along to the lien claimant and defense counsel if the claim is litigated. In the event of a lien trial, if paper documentation of our process does not suffice, the Bill Review Re-Evaluation Specialist is available to attend the trial to testify and will appear as needed for expert testimony at no additional cost. We try to prevent billing disputes through a thorough re-evaluation process:

Physical location and number of employees: AMC provides all of its managed care services out of its office located at 10360 Old Placerville Road, Sacramento, California 95827.

As of April 2017, AMC has approximately 67 employees.

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CUME E MANAGRO CARE
Org Chart: As requested a company-wide organizational chart with reference to the proposed service office and proposed service team has been provided in the noted exhibit.

Please see Exhibit X - Corporate Organizational Charts (AMC Org Chart) D. Client References: Provide three (3) client references for your firm for which you provide bill review services including full contact information. / REFERENCE #1 - Bill Review
Agency Name
County of Los Angeles
Contact Name
Alex Rossi, MBA, ARM, Workers' Compensation Contract Administrator Contact Phone Number Contact Email Address
(213) 738-2154 [email protected]
Brief Description of Scope of Services
All Managed Care Services / Client since 2006
REFERENCE #2 - Bill Review
Agençy Name
Central San Joaquin Valley Risk Management Authority:

Contact Name
Kevin Werner, City of Ripon, City Administrator
Contact Phone Number Contact Email Address
(209) 599-2108 [email protected]
Brief Description of Scope of Services
All Managed Care Services / Client since 2012
REFERENCE #3 - Bill Review
Agency Name -
City of Huntington Beach
Contact Name
Patti Williams, Risk Manager
Contact Phone Number Contact Email Address
(714) 536-5290 [email protected]
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Ird Party Workers' Compensation Claims Administration and Managed Care Servlc EXHIBIT A-1

MANAGED CARE
REFERENCE #3 - Bill Review
Brief Description of Scope of Services
Workers' Compensation Claims Administration and Managed Care / Client since 2010 REFERENCE #4 - Bill Review:

Agency Name
Schools Insurance Group
Contact Name
Jaxine Anderson, Return to Work Coordinator
Contact Phone Number Contact Email Address
(530) 823-9582 x205 [email protected]
Brief Description of Scope of Services
Workers' Compensation Claims Administration and Managed Care / Client since 2013 May 30, 2017 55
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Third Party Workers' Compensation Clalms Administration and Managed Care Services EXHIBIT A-1
GuMS ETIME CRE
Utilization Review
A. Firm's Qualifications: Describe the firm and provide a brief statement of qualifications in providing utilization revlew services. Describe your experience doing business with self-insured public entities in California. Discuss what distinguishes your company from other utilization review providers. Provide a company-wide organizational chart with reference to the proposed service office and proposed service team.

AIMS recommends its sister company, AMC who has been providing expert Utilization Review (UR) Services since 2005. AMC conducts over 30,000 utilization reviews per year. AMC has over 100 Clients consisting of approximately 80% self-insured public entities and 20% private entities throughout the State of California.

AMC's Utilization Review Service Qualifications
AMC has developed a customized efficient method to handle UR referrals, meet mandated timelines for decisions, handle Peer Review and appeals, and communicate with all parties. This information is captured in a responsive and results oriented. Policy oration is capit and Procedures Manual. This manual outlines the metrics AMC uses to ensure a high standard of quality for products and services provided to our Clients.

Accompanying the Policy and Procedures Manual is a proprietary document called, Allied Customer Expectations (ACE). AMC develops a customized ACE for each Client and for each cost containment service. The ACE document outlines all expectations and any special requests of our Client that is required of AMC in order to comply with contract requirements.

Superior Audit Scores: AMC is very proud of our exceptional services being verified by the State, which is reflected in AMC's State Audit scores. In 2007 AMC received a score of 96%. In 2009 we received a score of 99% and in 2010, 2011, 2012, and 2013; we received scores of 100% in all of our UR audits. In 2015, AMC received scores of 99.4% and 100%. In 2016, AMC received a score of 100%.

Independent audits have been performed by the California Department of Workers Compensation; Statement on Standards for Attestation Engagement No. 16 (SSAE 16); and Utilization Review Accreditation Commission (URAC). AMC consistently performs well above the standard level of acceptability; as shown in our recent DWC audits. We also perform extensive in-house quality assurance audits on our employees' work product and processes.

URAG Accreditation: In 2010, 2013, and again in 2016, AMC was awarded Workers' Compensation Utilization Management Accreditation from Utilization Review Accreditation Commission (URAC), a Washington, DC-based health care accrediting organization that establishes quality standards for the health care industry. Accreditation -
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EUMS HANAGRD CARE
is valid for a three (3) year period and renewable. AMO's accreditation is valid through 2019.

In 2016 with the passing of SB 1160, URO's will be required to be accredited in Utilization Review: "The bill would, commencing July 1, 2018, require each utilization review process to be accredited by an independent; nonprofit organization to certify that the utilization review process meets specified criteria, including, but not limited to, timeliness in issuing a utilization review decision, the scope of medical material used in issuing a utilization review decision, and requiring a policy preventing financial incentives to doctors and other providers based on the utilization review decision." Beginning nearly ten years before this legal requirement, AMC invests time, resources and money year after year to be URAC accredited in order to protect the interests of our Clients and their employees.

URAG, an independent, nonprofit organization is a leader in promoting health care quality through accreditation and certification programs. The URAC standards keep pace with the rapid changes in the health care system, and
provide a mark of distinction for health care "By receiving URAC accreditation, AME has demonstrated a commitment to quallty health
organizations such as AMC to demonstrate their
care." sald URAC President and CEO Kylanne
commitment to quality and accountability. This Green. "Quality health care Is crucial to. our certification and URAC audits of AMC is a benefit to nation's welfare, and it is important to have our Clients by providing third party assurance that örganizatioris that are willing to measure we are in full compliance with data integrity, Health themselves against national standards and Insurance Portability and Accountability Act undergo rigorous evaluation by an independent accrediting body."
(HIPAA) requirements, proper credentialing.

Through its broad-based governance structure and
an inclusive standards development process, URAC ensures that all stakeholders are represented in setting meaningful standards for the health care industry.

AMC is driven toward continual improvement of services by applying quality metrics and benchmarking to ensure we achieve top-quality performance consistent with the URAC Workers' Compensation Utilization Management Accreditation. Obtaining URAC accreditation demonstrates Allied Managed Care's commitment to providing quality services for our Clients to help ensure that injured workers receive the best and most appropriate care.

Client Module - AlliedConnect: An Important Part of the UR lifecycle is the Claims Examiner approval process. AMC has developed our own UR platform, AlliedConnect with the understanding that it must be user friendly for Claims Examiners. Having a TPA. such as AIMS as our sister company, provides AMC with a strong understanding of the "pain points" a Claims Examiner can experience when processing Utilization Review requests. AMC's AlliedConnect - Client Module is a fully integrated software, automated to help the Claims Exariner approve and distribute appropriate UR requeșts when needed. Our proprietary system includes an easy referral process 1o AM's UR when appropriate. All Claims Examiner UR approvals and AMC Utilization Review May. 30, 2017 57
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E MANAGED CARE
determinations are captured, tracked, and electronically delivered to our BR platform for enforcement and payment.

Training: We hire and train the best people and streamline all systems and processes to support that goal. We provide our Client's Claims Examiners with the training necessary to authorize treatment requests that fall within pre-approved screening criteria. We also insist that our UR managers and directors attend all Department of Workers' Compensation (DWC) seminars and conferences to stay current on the constantly changing UR process.

AMC offers assistance to Claims Examiners in making first level UR decisions by providing utilization "Trigger Lists" "and on-going training. Our in-house staff of nurses is trained to review additional medical information and make decisions, within accepted guidelines, regarding treatment specific to each individual employee. For those decisions which are more advanced or when treatment may not be medically necessary, AMC escalates the referral to one of our many peer panels for a physician's decision.

Licensed Nurses and Physicians: AMC has only licensed nurses and physicians performing all Utilization Review services that go beyond the Claims Examiner: No non- professional staff authorizes treatment or requests referral to Peer Review. The AMC UR Program operates under the direction of the Medical Program Director who is a California- licensed physician. Physicians that serve to evaluate treatment plans are licensed and board-certified with experience both as. practicing physicians and in managed care/medical management. Specialty appropriate physicians are assigned to evaluate and make recommendations on plans of care.

First level reviewers (nurses) must be health professionals with a current, valid and unrestricted license, and have their credentials verified on an annual basis. Our Utilization Review Nurses must be licensed as either a Licensed Practical (Vocational) Nurse (LPN, LVN), or a Registered Nurse (RN).

Our UR team evaluates planned and provided medical care for necessity, frequency, and duration through services that include:
• Pre-Certification/Pre-Authorization reviews
• Reviews performed by our medical director and specialty peer review network • Reviews based on national evidence-based treatment guidelines Utilization Review process are compliant with 8 CCR §9792.9 (I) wherein treatment requests will not be denied on the basis of a lack of information without documentation reflecting an attempt to obtain the necessary information from the physician or from the provider of goods or services identified in the request.

Training: A key aspect of our services has been educating the Claims Examiners of the importance of timely submissions, appropriate UR referrals, and full documentation.

Educating the Claims Examiners on current legislation, ensuring they understand their responsibilties' and the penalties that apply as well as the proper workflow. AMC's UR -
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workflow is outlined in a diagram and has been included as an exhibit. Training is provided to the TPA by our Medical Director, Alan Randle on a yearly basis or as needed with legislative updates.

Satisfaction Surveys: Client satisfaction surveys are conducted annually by the Director of Client Services using a survey instrument that encompasses issues of access, satisfaction with UR decision-making, turnaround time, and AMC's Client service. The survey data is collected and analyzed by the Client Services staff and is shared with all departments. The survey results and action plan are presented to the Quality Management Committee and the Vice Chairman of the Board, who may modify or add to the plan. The results of the corrective action plan are monitored by the Quality Management Committee and Vice Chairman of the Board.

Medical Director: AIMS/AMC Medical Director, Dr. Alan Randle, who is a California- licensed physician is actively involved with not only AIMS/AMC, but also with our Clients.

Dr. Randle will work with the City to develop a mutually agreeable process for oversight of the Claims Examiner approvals and will be actively involved in the appropriate training or the claims staff in the authorization process to recognize the most appropriate claims for medical case management services.

Dr. Randle received his medical degree from the University of San Francisco in 1973. He completed his residency in Seattle, Los Angeles, and Cincinnati with a focus on general surgery and occupational medicine. Dr. Randle became certified by the American Board of Preventive Medicine in Occupational Medicine in 1989. Dr. Randle practiced Occupational Medicine while Vice President of RediCare Industrial Medical Clinic through June of 1991. Dr. Randle is board certified in Occupational Medicine and has ultimate oversight of all UR department decisions; education of nurses and Examiners regarding UR rules and regulations. He stays abreast of current changes in legislation and trains staff on new regulation. Dr. Randle is also the Chairperson of our Quality Management Committee and is accountable to the corporate President & CEO and Senior Vice President.

Dr. Randle has over twenty (20) years of experience with the practice of occupational medicine. This experience encompasses the clinical practice of medicine, medical evaluation, management, and academia. Dr. Randle is a noted industry expert in California Utilization Review. He is a presenter and instructor to physicians, claims personnel and employers, both in private and public, on the Califomia Utilization Review process.

Dr. Randle conducts training sessions to ensure our Claims Examiners are aware of various modalities as well as conducting training for our Clients on topics such as best practices to use for UR. He is always available via a phone call or e-mail to immediately address any questions or concerns.

As AMC's Medical Director, Dr. Randle provides oversight, leadership, and medical expertise to all Managed Care Services provided by AMC. Dr. Randle has served as May 30, 2017 59
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AMC's Medical Director since 2008. Additional information about Dr. Randle's expertise is further detailed in his resume, which has been included in the noted exhibit.

Physical location and number of employees: The City's Utilization Review program is conducted out of AM's Sacramento office located at 10360 Old Placerville Road, Sacramento, California 95827.

As of April 2017, AMC has approximately 67 employees.

Org Chart: As requested a company-wide organizational chart with reference to the proposed service office and proposed service team has been provided in the noted exhibit.

Please see Exhibit X - Corporate Organizational Charts (AMC Org Chart), Exhibit 9 - SSAE 16 and URAC Reports, Exhibit 11 - AMG Team Resumes, and Exhibit 12 - UR Life Cycle
B. Service Team Qualifications: Provide a brief summary of the qualifications and experience of each proposed team member, including their length of service with your firm and their resume. Provide an organization chart representing your staff and identify and sub-consultants you plan to utilize to supplement your proposed staff.

AMC's Dedicated, Experienced Medical Management Team: AMC's UR team is a dedicated group of medical case management professionals with tremendous tenure and collectively over 100 years of experience.

Licensed Nurses and Physicians: AMC has only licensed nurses and physicians performing all UR services that go beyond the Claims Examiner. No non-professional staff authorizes treatment or requests referral to Peer Review.

Peer Review: Allied Managed Care utilizes the physician peer review panels of P&S, National Medical Review (NMR), Dane Street, and ClaimsEval; which are all URAC accredited organizations. In addition, physician peer review may be conducted by the Medical Director. The credentialing process for physician peer reviewers is delegated to the respective panels to ensure each physician reviewer meets URAC standards. Also, AMC is not sub-consulting any of the proposed staff.

Listed below are the key members of AMC's UR team.

Karen Mazza, RN, CCM - Director of Nursing Services: Karen has been a Registered Nurse since 1982 and has worked in the Workers' Compensation arena since 1998. She developed an entire UR department in 2004 as the new reforms came into effect. She is responsible for all administrative and operational components of the UR department which includes staffing, training, quality, timeliness, accuracy of work performed in the unit, creating efficient and optimum workflows, application of consistent Best Practices and adherence to URAC standards. She has serviced a wide variety of Clients with May 30, 2017 GD
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individualized requirements (i.e., MPNs, unionized labor, UR for offices/claims in other states and jurisdictions). Her involvement ensures State compliance and accountability as well as immediate and detailed attention to Client service requests. Karen joined the AMC team in 2010.

Mark Denison, Senior Vice President of Operations: Mark oversees the entire customized Bill Review/Utilization Review/Nurse Case Management Program. Mark's role is to monitor all contract compliance with performance standards, audit compliance to individualized Special Account Instructions; legal and regulatory compliance; and provide ongoing communication with our Clients. Mark provides unparalleled leadership and direction to all AMC staff. He oversees all operational and administrative components of Allied Managed Care's services, including Medical Bill Review, Utilization Review, and Case Management. He has over 21 years of experience in workers' compensation cost containment, strong multi-jurisdictional managed care knowledge and practical application. His involvement ensures that our Client's performance standards are met and communication is ongoing. Mark will always be available to meet with our Client's staff to discuss issues and performance when requested to do so. Mark is a state board certified licensed Chiropractor, Certified Disability Evaluator and past Division of Workers Compensation (DWC) appointed Qualified Medical Evaluator (QME). Mark joined the AMC team in 2008.

Lea Morales-Mendez, Director of Client Services: Lea has over 26 years of workers' compensation experience in roles of operations, management as well as Client Services, Lea has received training in Disability Management, Health Insurance Portability and Accountability Act (HIPAA) and Utilization Review Accreditation Commission (URAC).

Lea's role is to assist the management team in addressing all issues related to the contract as well as serving as a resource for workers' compensation decisions that may affect our Client. Interact with AMC's management team to resolve all issues that may arise in UR and Bill Review; provide timely communication to the management staff of any critical developments that may affect the product delivery; meet regularly with the management team to assess AMC's performance; discuss business decisions; address concerns; Lea is a resource for our Clients such as the City. Lea joined AMC in 2006.

Alan Randle, M.D., Medical Director: Dr. Randle received his medical degree from the University of San Francisco in 1973. He completed his residency in Seattle, Los Angeles and Cincinnati with a focus on general surgery and occupational medicine. Dr. Randle became certified by the American Board of Preventive Medicine in Occupational Medicine in 1989. Dr. Randle practiced Occupational Medicine while Vice President of RediCare Industrial Medical Clinic through June of 1991. Since that time Dr. Randle has served as Medical Director for several of the largest insurance companies and managed care companies in the country. As Medical Director, Dr. Randle provides oversight, leadership, and medical expertise to all Managed Care Services provided by AMC. Dr. Randle has served as AMC's Medical Director since 2008.

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Caroline Iverson, DC, Peer Review Manager: Caroline has 20 years of UR experience with 9 years in workers' compensation UR; eight of which were with public entities.

Caroline provides an added level of auditing of the referrals and documents sent from UR nurses to Peer Review physicians and also auditing every completed Peer Review for quality and timeliness. Caroline works closely with the UR Manager and Medical Director to ensure the quality and timeliness of all peer reviews. She coordinates our extensive Utilization Review Quality Management Program and has been a licensed Chiropractor since 1993. Caroline joined AMC in 2008.

Shannon Buelna, Nurse, Utilization Review Manager: Shannon has over 6 years of Workers' Compensation Utilization Review experience which includes public entities. Her responsibilities include oversight of AMC performance of UR in accordance to the State protocols, guidelines, and regulations. Collaboration with the Claims Examiners to ensure proper handling of each referral, understanding of claim status and med/legal implications, and attention to Client specific instructions. Assist the Director in the oversight of the UR program; supervise and audit the dedicated UR staff; ensure State and regulatory compliance; ensure URAC compliance; assist in the implementation of Client specific instructions and any new processes which might arise out of DWC revisions. Collaborate with Claims Examiners to ensure proper handling of each referral, understanding of claim status and medical/legal implications, and attention to Client specific instructions, Licensed Vocational Nurse for over 9 years with licenses in the State . of California and the State of Texas, Shannon joined the AMC team in 2014.

Please see Exhibit X - Corporate Organizational Charts (AMC Org Chart) and Exhibit 11 - AMC Team Resumes
C. Services: Describe your utilization revlew services including standards and guidelines you use to review treatment requests. Describe any unique capabilities or approaches your firm has for reviewing medical treatment requests. Discuss any methods you employ to help clients reduce utilization review costs. Provide an organizational chart, physical location, description of where the work Is being conducted, management structure, and number of employees. Discuss your ability to work with TPAs in delivering utilization review services and provide a list of three (3) you currently work with.

Capabilities and Approach: As the City's current UR vendor, AMC provides the City with UR services developed to assess the frequency, duration, intensity and appropriateness of all modalities and procedures common to workers' compensation.

This includes concurrent management of hospitalizations and retrospective review of medical treatment not previously reviewed. Reviews are performed by licensed nurses and physicians. The AMC UR program operates under the direction of our Medical Program Director, Dr. Randle, The UR program is compliant with all California-specific regulatory requirements. Reviewers use medical care guidelines such as the Medical Treatment Utilization Schedule (MTUS). Other nationally recognized and publicly available medical necessity criteria sets developed by practicing physicians, such as May 30, 2017 62
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* last:.

Work Loss Data Institute/Official Disability Guidelines and Presley Reed/Medical Disability Advisor serve to augment MTUS guidelines. Guideline sets are evaluated annually by the Program Medical Director and updated annually.

AMC integrates all cost containment products electronically for maximum efficiency and centralization of data. We realize cost containment programs are a collection point of critical data to measure program costs. AMC can report virtually any data field captured in our system, and provide valuable reports to our Client. This innovative approach provides our Client's managed care program with improved worktiow, security/management of documents and increased productivity/turnaround time.

At AMC we have a single-minded UR goal - to help our Client employees return to work by providing the best, most appropriate treatment as quickly as possible and denying those services that are incongruous or unreasonable cost alternatives to nationally recognized treatment standards. By implementing a customized utilization review trigger list, the Claims Examiner can quickly approve a significant amount of first level treatment which allows treatment to be provided quickly as well as saving UR dollars. At AMG, we do not believe everything must be reviewed by the UR unit. We know that our Clients are not all the same so AMO empowers the claims staff with the safe tools to authorize treatment which falls within the guidelines and is deemed appropriate.

Intake: The request for a UR is received by the Intake Coordinators at AMC. A confirmation email verifying receipt of the referral is sent to the Claims Examiner (and any other personnel designated by the Client) within three hours. intake staff confirms receipt of all medicals, demographic data, and that the medicals correspond with the referral from the Claims Examiner. The referral documents are sent to the mailroom where they are indexed individually and uploaded into a queue within AlliedConnect. The UR Manager assigns the referral to the UR nurse who will open the referral, confirm the data fields, identify if valid/invalid/incomplete/duplicate. The nurse also confirms the receipt date of the request for authorization to ensure AMC is operating under the correct due date. The nurse will indicate. the claim designation (prospective, concurrent, retrospective, appeal) and process the review according to the statutory regulations and timelines.

Timeframes: All UR referrals are entered by AMC intake staff into AlliedConnect as a prospective review, at which time AlliedConnect automatically calculates the fifth business day due date. As part of the nurse's daily triage of the new referrals, the nurses will identify the designation of prospective, concurrent, expedited, appeals, and retrospective. A new due date will be calculated in AlliedConnect which corresponds to the service type. If the nurses determine additional information is required, again a new due date will be calculated once the nurse submits the formal request in writing for the additional records, AlliedConnect has the ability to calculate the due dates by incorporating weekends and State holidays. The most critical component, though, is to verify the date of receipt which is verified by Intake and again by the nurses. This first critical step will ensure the calculated due dates are correct.

The Supervisor and/or Manager monitor the nurses queues daily to ensure timelines are May 30, 2017 63
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being met consistently.

The Peer review referrals are submitted to AMC's internal Peer unit no later than business day three, or two business days prior to calendar day fourteen if additional information has been requested. As such, the UR nurses monitor their inventory as well throughout the day to ensure that referrals requiring physician revlew are sent to the Peer unit promptly and with sufficient time for the physician reviewer to make the decision.

If referred to AMC's internal Peer unit for physician review assignment, the due dates are monitored not only by the UR nurse, but also by the Peer unit via AlliedConnect.

Peer reviews are assigned for physician review with the applicable due date clearly marked on the referral. The Peer unit then monitors timeframes by first observing the online "pie chart" widget throughout the day in the AlliedConnect Peer module dashboard which reflects the number of reviews due each day, and second by sorting the Peer module's AlliedConnect in-box by due date and status to ensure that all referrals are completed by their due date. AlliedConnect reports are run by the Peer unit on a daily basis reflecting all pending physician reviews by due date to verify that the reviews are timely. The Peer unit further manages the timeliness of physician reviews by controlling the volume of referrals assigned to each of the Peer review panels so as not to exceed the capacity of any given panel.

Expedited Reviews: Prospective or concurrent decisions related to an expedited review shall be made in a timely fashion appropriate to the injured worker's condition, not to exceed 72 hours after the receipt of the written information reasonably necessary to make the determination. The requesting physician must indicate the need for an expedited review upon submission of the request.

Peer Review Turnaround Times:
• Prospective - 2.8 business days
• Retrospective - 9.6 calendar days
• Appeals - 3.5 business days
Over-prescribing Opioid Medications: Protocols and triggers have been set up with the City's pharmacy benefit manager to help identify trends and assist the City with flagging those providers who may be over-prescribing opioid medications. All new narcotic medication requests and any other identified class of medication can be submitted directly to the pharmacy nurse through an electronic link with the Pharmacy Benefit Management (PBM) or to the Claims Examiner who can forward the request to the AMC nurse who will review for medical appropriateness and certification. If not meeting guldeline criteria, the nurse will submit this request to the Peer unit for review. If a formal utilization review has not been received when the narcotic medication is requested, and the request is not within the formulary, the nurse will contact the doctor's office to provide the required documentation for a formal UR review.

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AMC has the ability to run UR reports showing what has been requested along with the determination. AMC can identify trends through analysis of this data to identify medications being requested which have been denied or modified and by what prescribing physicians. This data can also be gathered from the PBM. By utilizing both reporting tools, AMC and the City can easily identify the over-prescribers of opioid medications.

A daily report is provided to the PBM that includes all information needed to ensure for the proper dispensing of prescriptions for the Client. The data exported has information that includes but is not limited to demographics for injured workers, claims coding, Examiner information, and claim status information.

Request for Authorization: Whenever an AMC physician reviewer issues a decision to deny a request for authorization (RA) based on the lack of medical information necessary to make a determination, the claims administrator's file shall document the attempt by the claims administrator or reviewer to obtain the necessary medical information from the physician either by facsimile, mail, or e-mail. If AMC is in receipt of a RFA as part of a UR referral sent by the Claims Examiner after 5 business days from the documented date of receipt (or after 30 days from receipt of the information necessary to perform a retrospective review) and it is therefore determined that the referral has exceeded the timeframe for prospective or concurrent (or retrospective) decisions, the following procedure will be followed:

1. The Claims Examiner will be notified that the UR referral has exceeded the 5 business day timeframe for a prospective determination and 30 days for a retrospective review within the UR Standards.

2. If the Claims Examiner can document that there has been a request for additional information issued on or before the fifth business day after the date of receipt that would appropriately allow an extension of the due date to 14 calendar days, the REA will be managed in the normal manner as outlined above.

3. If there is no documentation of a prior written request for additional information, the Claims Examiner will have the option of either
• Authorizing the treatment request and provide appropriate written notification consistent with the UR Standards.
• Proceeding with the normal UR process for an RFA.

Written decisions approving a request for treatment authorization shall specify the specific medical treatment service approved and the date of the determination.

Written decisions modifying, delaying or denying treatment authorizations will be provided to the requesting physician, the injured worker, and if the injured worker is represented by counsel, the injured worker's attorney and shall only contain the following information specifio to the request;
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1. The date on which the DWC Form RFA was first received.

2. The date on which the decision is made (The date of the UR report is the date on which the decision was made unless otherwise specified).

3. A description of the specific course of proposed medical treatment for which authorization was requested.

4. A list of all medical records reviewed.

5. A specific description of the medical treatment service approved, if any.

6. A clear, concise, and appropriate explanation of the reasons for the reviewing physician's decision, including the clinical reasons regarding medical necessity and a description of the relevant medical criteria or guidelines used to reach the decision pursuant to section §9792.8. If a UR decision to modify, deny or delay a medical service is due to incomplete or insufficient information, the decision shall specify the reason for the decision and specify the information that is needed.

7. The Application for Independent Medical Review, DWC Form IMR-1, with all fields completed, except for the signature of the employee and date. The application, set forth at section 9792.10.1, shall include an addressed envelope, which may be postage-pald for mailing to the Administrative Director or his or her designee.

8. A clear statement advising the injured employee that any dispute shall be resolved in accordance with the independent medical review provisions of Labor Code section 4610.5 and 4610.6, and that an objection to the UR decision must be communicated by the injured worker, the injured worker's representative, or the injured worker's attorney on behalf of the injured worker on the enclosed Application for Independent Medical Review, DWC Form IMR-1, within 30 calendar days of receipt of the decision.

If the request for authorization of medical treatment is not approved, or if the request for authorization for medical treatment is approved in part, any dispute shall be resolved in accordance with Labor Code sections 4610.5 and 4610.6. Neither the employee nor the claims administrator shall have any liability for medical treatment furnished without the authorization of the Claims Administrator if the treatment is delayed, modified, or denied by a UR decision unless the UR decision is overturned by independent medical review or the Workers' Compensation Appeals Board under this Article, A request for independent medical review must be communicated by the employee, the employee's representafive, or the employee's attorney by mail, facsimile, or electronic transmission to the Administrative Director, or the Administrative Director's designee, within 30 days of service of the Utilization Review decision. The request must be made on the Application for Independent Medical Review, DWC Form IMR-1, and submitted with a copy of the written decision delaying, denying, or modifying the request for authorization of medical treatment.

If expedited review is requested for a decision eligible for independent medical review, the Application for. Independent Medical Revlew, DWC Form IMR-1, shall include, unless the initial UR decision was made on an expedited basis, a certification from the May 30, 2017 66
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employee's treating physician indicating that the employee faces an imminent and serious threat to his or her health as described in section 9792.10.1(a)(3).

AMC's Unique Capabilities:
• URAC (Utilization Review Accreditation Commission) Accredited since 2010 • Renowned Medical Director
• Nurse and Physician Determinations - No Determinations completed by non- medical personnel
• Proprietary Software - AlliedConnect Database Access Services (AlliedConnect)
• Client Access to AlliedConnect Database of Determinations • Claims Examiner Approval Tracking
• Auto-populates claim information
• Tracking of Request for Authorizations (RFA) from submittal through determination
• Referral status/determination "Look up"
• Peer Review
• Three Medical Specialists Panels - All URAC Accredited • Quality Assurance Profocols
• Detailed Reporting
• Integrated with BR
• Independent Medical Review (IMR) Process
AMC's Proven Medical Cost Containment Savings
• No duplicate charges
• No charge for reconsiderations within the first thirty (30) days • Single charge for UR referral regardless of the number of procedures on the request
• Streamlined Claims Examiner approval process
• Direct certified services to Client specifio verdors for contracted rates • Utilize the prior authorization process
Integration of Bill Review and Utilization Review: At AMC we work within our own proprietary platform called, AlliedConnect database access services (AlliedConnect).

AlliedConnect is a paperless single source solution for UR and integrates the UR and BR systems on the same proprietary platform. In this module, treatment planning or UR parameters can be entered in a highly normalized fashion into the BR system and is associated with a workers' compensation claim. Due to the highly normalized nature of AlliedConnect treatment plans, they can be automatically applied by the BR engine during the BR process and require no BR analyst intervention to be applied. This allows UR to communicate directly with BR to ensure the appropriate payment for certified versus modified certified versus non-certified treatment. In other words, this integrated platform May 30, 2017 67
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ensures, on an automated basis, services approved are the services paid.

AMC has developed a Client Application called, "AlliedConnect Client Module", in which the Client can view in real time the status of past, current, and pending reviews. A copy of each determination along with fax confirmations may be printed from the Client Module.

The AlliedConnect Client Module can also be provided to the Claims Examiner. From within AlliedConnect Client Module, the Claims Examiner can authorize treatment or submit referrals along with attached medicals to AMC. The Claims Examiner can review past, , current or pending referrals in real time. The Claims Examiner can print a determination along with the fax confirmation. This information is also seen by the AMO UR nurses so, they will always know what treatment has been authorized by the Claims Examiner which decreases calls to the Claims Examiner for verification, prevents duplication of services, and thus additional UR fees.

Further benefits include:
• Protect documents against unexpected loss or damage
• Improve workflow by eliminating the need to manually move documents • Increase security by maintaining better control of documents and regulating document access
• Improve records management and storage
• Portability of documents and information
AMC customizes the workflow to fit the individual needs of the Client. As an example, some Clients have requested adding specific service vendors to the certification letters to assist them in utilizing these providers in which they have special rates or contract relationships. AMC will then send a copy of this certification letter to the specified vendor which will then trigger the referral and assignment process for that service request.

AMC Value Added Services to Reduce Costs:
* AMC's policy related to bundling/unbundling the receipt of the RFA: AMC does not unbundle RA's. AMC keeps all RA's that are made by a provider within in one medical report for authorization together, we keep them "bundled". One medical report, which contains more than one treatment request will be reviewed as a whole and the Nurse or Peer Reviewer will make a determination on each treatment request. This is considered one referral with multiple treatment requests. AMG charges one review fee for multiple treatment requests within one referral.
* AMC offers a Claims Advice Nurse (CAN-Do) program as value added service to Clients at no additional cost. If the Claims Examiner receives a medical report and requires additional clinical expertise to assist them in understanding the medical condition and treatment requested, the Claims Advise Nurse is available to offer May 30, 2017 68
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assistance. Many of these discussions result in the Claims Examiner being able to authorize treatment without going through the UR process which expedites the treatment and saves UR fees,
* AMC will identify, monitor and coordinate the medication safety awareness program with the Pharmacy Benefit Management (PBM) program for narcotics and opioid use.

Protocols and triggers set up with the City's pharmacy benefit manager to help identify trends and assist the City with flagging those providers who may be over- prescribing opioid medications. All new narcotic medication requests and any other identified class of medication can be directed to the Claims Examiner by the bill review company who can forward the request to the AMC nurse who will review for medical appropriateness and certification. If the prescribing physician is not meeting guideline criteria, the nurse will submit this request to the Peer unit for review: If a formal utilization review has not been received when the narcotic medication is requested, and the request is not within the formulary, the nurse will contact the doctor's office to provide the required documentation for a formal UR review.

AMC has the ability to run reports showing what has been requested along with the determination. AMC can identify trends through analysis of this data to identify medications being requested which have been denied or modified and by what prescribing physicians. This data can also be gathered from the PBM. By utilizing both reporting tools, AMC and the City can easily identify the over-prescribers of opioid medications.

A daily report is provided to the PBM that includes all information needed to ensure for the proper dispensing of prescriptions for our Client. The data exported has information that includes but is not limited to demographics for injured workers, claims coding, Claims Examiner information, and claim status information. * AMC's High Emplovee Retention Rate (Low Turnover)
Over the past three (3) years AMC has brought on board a manager to oversee case management for ten (10) nurse case managers. We have also added two (2) utilization review nurses, and additional administrative support - one (1) for Case Management and two (2) for Utilization Review. These are the benefits of a. solid/cohesive team for our Clients:
• Innovative long term consistent managed care program administration • Detailed knowledge and understanding of our Client's program and needs • Satisfied, motivated employees who work hard for our Client to provide cost savings and appropriate outcomes and results
• No temporary personnel
* AMC currently has a 94% upheld rate with Maximus/IMRs.

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* AMC provides documentation required to respond to requests for Independent Medical Review (IMR) at no additional cost to the City. To minimize the disruption of claims operations, AMC retains all records provided by claim staff. We use a paperless system/document storage that catalogues historical medical records so they only need to be submitted once. Claims staff submitting a second referral on a particular claim only need to submit updated medical records, thus avoiding a large volume of medicals. When a modified or non-certification determination is made, a PDF file of all the medical records reviewed by the Peer Provider, along with the determination will be sent to the Claims Examiner. Therefore, If an IMR is requested the Claims: Administrator can request these documents from the UR staff or AMC can ensure they are provided to the Claims Examiner at the time of the determination distribution so they have the necessary information to provide to Maximus and then only needs to include any medicals within that 6 month period which are not part of the Peer packet.

Third Party Administrators: AMC provides UR services through the following TPA's:

Acclamation Insurance Management Services (AIMS), TRISTAR, City of Sacramento and other self insured/self-administered programs.

Physical location and number of employees: AMC provides all of its managed care services out of its office located at 10360 Old Placerville Road, Sacramento, California 95827.

As of April 2017, AMC has approximately 67 employees.

Org Chart: As requested a company-wide organizational chart with reference to the proposed service office and proposed service team has been provided in the noted Please see Exhibit X - Corporate Organizational Charts (AMC Org Chart) and Exhibit 11 - AMC Team Resumes
D. Client References: Provide three (3) references for your firm for which you provide utilization review services including full contact information.

REFERENCE #1 - Utilization Review
Agency Name
County of Los Angeles
Contact Name
Alex Rossi, MBA, ARM, Workers' Compensation Contract Administrator Contact Phone Number Contact Email Address
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REFERENCE #1 - Utilization Review
(213) 738-2154 [email protected]
Brief Description of Scope of Services
All Managed Care Services / Client since 2006
REFERENCE #2 - Utilization Review
Agency Name
City of Huntington Beach
Contact Name
Patti Wlliams, Risk Manager
Contact Phone Number: / Contact Email Address
(714) 536-5290 [email protected]
Brief Description of Scope of Services
Workers' Compensation Claims Administration and Managed Care / Client since 2010 REFERENCE #3 - Utilization Review
Agency Name
Central San Joaquin. Valley Risk Management Authority
Contact Name
Kevin Werner, City of Ripon, City Administrator
Contact Phone Number Contact Email Address
(209) 599-2108 [email protected]
Brief Description of Scope of Services
All Managed Care Services / Client sinoe 2012
REFERENCE #4 - Utilization Review
Agency Name
Schools Insurance Group
Contact Name
Jaxine Anderson, Return to Work Coordinator
Confact Phone Number Contact Email Address
(530) 823-9582 x205 [email protected]
Brief Description of Scope of Services
Workers' Compensation Claims Administration and Managed Care / Client since 2013 7 71
May 30, 2017
Thia Party Workers Compensation Claims Administralion and Managed Care Services EXHIBIT A-1

CUMS EMARAGED CARE
Nurse Case Management Services
A. Firm's Qualifications: Describe the firm and provide a brief statement of qualifications in providing nurse case management services. Describe your experience providing telephonic and field case management in California. Indicate the office location nurses would be working from. Discuss what distinguishes your company from other nurse case management providers. Provide a company-wide organizational chart with reference to the proposed service office and proposed service team.

AIMS sister company, AMG has been providing Nurse Case Management (NCM) services since 1995 and is the current NCM provider for the City. We believe our qualifications such as all of our Case Managers are Registered Nurses and many have their Bachelor of Science degree in nursing including maintaining their Certified Case Manager credential make AMC's NCM services a solid choice for Clients. All of our nurses have unlimited access to AMC's Medical Director, Dr. Alan Randle. AMC's NCM program has detailed guidelines and expectations. Listed below are the NCM-related services provided by AMC.

AlliedCare Complete (New claim Nurse Medical Review)
• Nurse reviews all newly reported claims 5020 (1st Report of Injury) • Nurse makes three-point contacts (Injured Worker, Treating Provider, and Employer)
• Nurse evaluated Medical Treatment needs
• Nurse Provides medical report outlining possible treatment outcomes • Nurse makes recommendation regarding Nurse Case Management follow-up to Claims Examiners.
• Upon approval from Claims Examiner Nurse refers to AMC Telephonic or Field Nurse Case Management
AMC Telephonic Nurse Case Management
: AMC Nurse provides Case Management Services by phone
. AMC Nurse follow Client Specific guidelines regarding contacts, reporting, and directing injured worker to medical providers etc.
• Reporting is provided in a format approved by Client
AMC Field or on-site and Catastrophic Nurse Case Management • AMC Nurse provides on-site Nurse Case Management.
• On-Site with Medical Providers, Hospitals, Skill Nursing Facilities, and Employers
• AMC Nurse follows Client Specific guidelines regarding contacts, reporting, directing injured worker to medical providers
• Reporting is provided in a format approved by the Client AMC NCM Differentiators
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May 30, 2017
AIMS Proposal Response to City of Richmond
Third Party Workers' Compensation Claims Administration and Managed Care Services EXHIBIT A-1

E MAHAGED CARE
• Over 21 years of experience providing Nurse Case Management • Over 70% of our services are provided to public agencies • AMC provides innovative specialized program addressing Schedule Il narcotics and addiction
• AMC provides accuracy using National guidelines to address Return-to-Work (RTW) with treating doctor and injured worker
• AMC provides cost savings using Official. Disability Guidelines • Early identification of costly claims and professional management of medical care
• Assertive and Experienced nurses with Case Management experience • Customized trigger list for referral to Case Management • Annual report cards on RTW stats and cost savings - hard dollar savings • Annual surveys to Client to assure we are meeting their needs Our paperless platform is not only accessible to Claims Examiners, but also to AMC nurses so that all medical records are available for review when making every medical determination including prior Claims Examiner treatment authorizations (from AlliedConnect Client Module) to help make the appropriate medical assessments.

Access to all this information by the assigned nurse allows for a more comprehensive analysis resulting in fewer delays, faster, and more appropriate determinations, and fewer appeals when conducting UR. AMC is the only UR company that can offer the City this level of integration: true team and document integration among claims administration, UR, and medical case management services:

Nurse Early Intervention: Shifting a large portion of your costs from a standalone UR Organization towards your own tailored Nurse Early Intervention and Utilization Management program provides the following benefits;
• Nurse Triage and assessment of each First Report of Injury for Medical issues • Three-point-contact with Providers, Employee, and Employer to identify Medical Needs
• Triage Report provided to an Employer's Claims representatives within 24 hours. Workability assessment and temporary bridge-assignments identified and provided to the treating physicians and return to work coordinators, where appropriate
• Authorization of appropriate evidence based treatment Referral to Medical Peer Review Panel, where appropriate Medical Director oversight
• Confirm and direct treatment within qualified medical providers and facilities • Referral for further Nurse Field Case Management services, where appropriate Physical location and number of employees: AMC provides all of its managed care services out of its office located at 10360 Old Placerville Road, Sacramento, California 95827.

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Third Party Workers: Compehsallon Claims Administration and Managed Care Services EXHIBIT A-1

AIMS E MANAGED CRE
As of April 2017, AMC has approximately 67 employees.

Org Chart: As requested a company-wide organizational chart with reference to the proposed service office and proposed service team has been provided in the noted exhibit.

Please see Exhibit X - Corporate Organizational Charts (AMC Org Chart) and Exhibit 11 - AMC Team Resumes
B. Service Team Qualifications: Provide a brief summary of the qualifications and experience of each proposed team member, including their length of service with your firm, whether they are licensed RNs, and their resume.

AMC has a staff of experienced nurses led by Karen J. Mazza, RN, CCM. As the Director of AMC's Nursing Services. Karen has oversight of the UR and Nurse Case Management (NCM) programs, manages dedicated UR and NCM staff; ensures State and regulatory compliance; ensures URAC compliance; implements Client specific instructions and any new processes which might arise out of the Department of Workers' Compensation revisions and updates.

The members of AMC's team are listed below, along with a description of their role and expertise. Detailed resumes for these individuals has been included in the noted exhibit.

AMC's Team Qualifications
Mark Denison - Senior Vice President of Operations: Mark oversees the entire customized Bill Review/Utilization Review/Nurse Case Management Program for the City.

Mark's role is to monitor all contract compliance with performance standards, audit compliance • to individualized Special Account Instructions; legal and regulatory compliance; and provide ongoing communication with our Clients. Mark provides unparalleled leadership and direction to all AMC staff. He oversees all operational and administrative components of Allied Managed Care's services, including Medical Bill Review, Utilization Review, and Case Management. He has over 21 years of experience in workers' compensation cost containment, strong multi-jurisdictional managed care knowledge and practical application. His involvement ensures our Clients' performance standards are met and communication is ongoing. Mark is always available to meet with our Client's staff to discuss issues and performance when requested to do so. Mark is a • state board certified licensed Chiropractor, Certified Disability Evaluator and past Division of Workers Compensation (DWC) appointed Qualified Medical Evaluator (QME). Mark joined the AMC team in 2008.

Lea Morales-Mendez, Director of Client Services: Lea has over 26 years of workers' compensation experience in roles of operations, management as well as Client Services.

Lea has received training in Disability Management, Health Insurance Portability and Accountability Act (HIPAA) and Utilization Review Accreditation Commission (URAC).

Lea's role is to assist the management team in addressing all issues related to the May 30, 2017 74
AIMS Proposal Response to Clty of Richmond
Third Party Workers' Compensallon Clalms Administration and Managed Care Services EXHIBIT A-1

MANAGED CARE
contract as well as serving as a resource for workers' compensation decisions that may affect our Client. Interact with AMC's management team to resolve all issues that may arise in UR and Bill Review; provide timely communication to the management staff of any critical developments that may affect the product delivery; meet regularly with the management team to assess AMC's performance; discuss business decisions, and address Client concerns. Lea joined AMC in 2006.

Karen Mazza, RN, CCM, Director of Nursing Services: Karen has been a Registered Nurse (RN) since 1982. In addition to being an RN, Karen is a Certified Case Manager (CCM). Karen has worked in the workers' compensation arena since 1998 beginning as a Telephonic Case Manager doing embedded UR for a variety of operational management levels. As the new reforms came into effect in 2004, Karen developed an entire UR department of a national managed care firm. She has serviced a wide variety of Clients with customized requirements (i.e., Medical Provider Networks (MPN), unionized labor, UR for offices/claims in other states and jurisdictions). Her involvement ensures State compliance. Karen joined the AMC team in 2010.

Susan Lowe, RN BS CCM CPDM, Manager Case Management Services: Susan is a registered nurse, Her role is to oversee all of the administrative and operational components of the Case Management (CM) unit, including i staffing, training, quality, timeliness, and accuracy of work performed in the unit. Susan joined AMC in 2014.

Shelly Ann Jones; RN, Telephonic Nurse Case Manager: Shelley has worked in the workers' compensation case management field since 2008 and prior to this in a hospital environment. Shelley possess superior communication skills enabling her ability to work effectively with all levels of employees and physicians. She is an outstanding telephonic case manager and a dedicated nurse case manager, She has been with AMC since 2010, Please see Exhibit X - AMC Team Resumes
C. Services: Describe your nurse case management services including guidelines and expectations regarding your nurse case management program. Describe any unique capabilites or approaches your firm has in providing nurse case management services. Provide an organizational chart, physical location, description of where the work is being conducted, management structure, and number of employees. Discuss your ability to work with TPAs in delivering nurse case management services and provide a list of three (3) you currently work with.

Description of AMC's Services: AMC has been providing Nurse Case Management (NCM) services in California since its inception in 1995. Over the years, telephonic and field case management services have grown to include customized pharmacy intervention programs, customized early return to work programs, nurse file reviews to assist claims with settlement issues, life care planning, anticipated treatment requirements on high exposure cases, catastrophic case management, and instructional programs for injured workers.

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Third Party Workers' Compensation Claims Administration and Managed Care Services EXHIBIT A-1

CUMS E MAHAGED CARE
1400810KATE D
All of our Case Managers are Registered Nurses and many have their Bachelor of Science degree in Nursing and maintain their Certified Case Manager credential. All of our nurses have unlimited access to our Medical Director, Alan Randle, MD..

Guidelines: AMC's case management nurses have access to the same guidelines as our utilization review team, but they rely mostly on the Official. Disability Guideline and Medical Disability Advisor Guideline for length of recovery and return to work. The Predictive Model can factor in co-morbidities which may impact recovery. The case management nurse will review these guidelines whenever there is a change in condition and update the Claims Examiner within 24 hours of this change along with any changes in the expected recovery period and complicating factors. Disability management includes all of those activities required to return the injured worker to usual and customary job duties.

Coordination of establishing maximum medical improvement (MMI) and return to work includes incorporating assessments and information from the employee, employer, physician restrictions, and disability management guideline recommendations.

Nurse Case Manager also includes a detailed assessment of the employee's functional capabilities as well as a description of the employee's current job duties and availability of transitional or modified duty from the employer. Once an injured worker retums to either modified or usual and customary duties, the Nurse Case Manager follows-up with the employee and employer to ensure there are no complications with the return to work duty.

AMC's Unique Capabilities and Approaches:
* Customized NCM workflow to meet the needs of each specific Client. One example is that some Clients want the telephonic case management (TCM) nurses to perform embedded UR. The benefit is a quicker review and referral to the providing vendor since the nurse is already aware of the medical condition of the injured worker, lower cost of that UR review, and faster turn-around time so •the treatment can be provided sooner which overall saves Temporary Total Disability (TTD) dollars. Another example is to customize triggers for case management intervention such as lost time, modified restrictions not changing, multiple providers, multiple diagnoses, high narcotic use, and other complex issues.
* Claims Advice Nurses (CAN-do program) is a program designed to help our Clients understand the current laws and how to manage a specific situation. With this program, we are available to answer questions directly from Claims Examiners and Clients without having to send something through UR. This helps in educating the Claims Examiner and saving our Client's money if something does not have to go through the UR process. The theory behind this program is that many times a Claims Examiner comes across a scenario that they are not sure how to manage.

The Claims Examiner can pick up the phone and discuss it with a registered nurse.

Sometimes the answer will be "Send it through UR." however; many times the answer will be advice about the meaning of the request, how the scenario fits with the rest of the claim, or that the Claims Examiner may authorize the request.

May 30, 2017
AIMS Proposal Response ta City of Richmond
Third Party Workers' Compensation Clalms Administration and Managed Care Services EXHIBIT A-1

MANAGBD CARE
100720 CORONATIO
* AlliedCare Complete - Nurse Early Intervention provides a comprehensive Nurse Early Intervention triage model that not only impacts the critical beginning stages of medical care but provides ongoing Utilization Management to facilitate and expedite medical treatment within the employer's network of providers.

AMC recommends having a licensed Nurse perform triage and initial review of medical issues in coordination with the Claims Examiner. The Nurse will provide medical expertise in evaluating and estimating the medical needs of claims. In addition, the Nurse will provide prospective evaluation of any ongoing UR requests for the same file.

Shifting a large portion of our Client costs from a standalone UR Organization towards the Clients' own tailored Nurse Early Intervention and Utilization Management program provides the following benefits:
• Nurse Triage and assessment of each First Report of Injury for Medical issues • Three-point contact with Providers, Employee, and Employer to identify.

Medical Needs
• Triage Report within 24 hrs. provided to Employers Claims representatives • Workability assessment and temporary bridge-assignments identified along with providing these to treating physicians and return to work coordinators, where appropriate
• Authorization of appropriate evidence based treatment • Referral to Medical Peer Review Panel, where appropriate • Medical Director Oversight
• Confirm and direct treatment within qualified medical providers and facilities • Referral for further Nurse Field Case Management services, where appropriate Through a successful Nurse Early Intervention program AMC is able to generate significant cost savings in the following key areas for Clients:
• Reduction of lost time
* Reduction in medical costs
• Reduction in litigation
The case manager will review the nature of the injury, direct treatment if determined to be part of the program, interview the injured worker, obtain the Doctor's First Report of Injury, identify barriers to recovery and red flags, obtain work restrictions and capabilities, identify if the work status can be accommodated, and if not accommodated will open to case management intervention. The job description is submitted to the provider and the case management nurse will continually work with that provider to move the injured worker back to work. The file can be closed to case management before full duty release if things are moving in the right direction and the Claims Examiner is in agreement with this plan.

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Third Party Workers' Compensation Claims Administration and Managed Care Services EXHIBIT A-1

KIMO SE MANAGED CARE
2 -УСОДРОЛТВ
AMC does not believe in long term case management involvement of a file. We will work with the Claims Examiner to identify the rationale for the referral with specific achievable goals. These goals will be re-evaluated at 90 days with the Claims Examiner if not already accomplished to determine if further intervention would be warranted. If the goals have been met, case management will close their file but will reopen as new goals are identified. This model is extremely effective with efficient use of nursing capabilities and cost savings for the Client.
• CallConnect (Call Genter Services) - 24/7 Triage Claim Reporting:
- Immediate Advice - Your employees get the medical advice they need, at the time they need it, within minutes of the incident * Immediate Reporting - Streamline the injury/illness reporting process and receive accurate information for all incidents immediately after the call • Immediate Results - Decrease the number of unnecessary r Emergency Room visits
/ Direct Care to Preferred Providers
* Injury Assistance Program is available to your staff/Clients 24 hours per day, 7 days per week, and 365 days per year.
* Employees call the 800 number
* The advice nurse guides the employee through the appropriate level of care:
• Self-Care/First Aid
• Direct referral to a network provider
• Referral to Private Physician (if non industrial)
• Direct to Emergency Room, if appropriate
RN's utilize the clinically approved Schmitt-Thompson Clinical Content to triage employee's symptoms
Depending upon the severity or type of the incident, AMC's advice nurse may make a follow-up call to the injured worker. A detailed report of the injury and medical advice provided to the employee is completed and all interested parties are faxed a copy of the report. Recommendations for TCM or Field Case Management (FCM) is provided and the call is logged and recorded.
* Injury Assistance Benefits:
• Reduced "Days Away" from work
- Reduced reporting time
• Decreased number of Workers' Compensation claims
• Increased penetration of Workers' Compensation managed medical care * Increased control of the medical benefit
* Greater medical benefit cost savings
* Increased overall control of claim by Claims Examiner • Reduced litigation
May 30, 2017
AIMS Proposal Response to City of Richmond
Third Party Workers' Compensalion Clalms Administration and Managed Care Services EXHIBIT A-1
CUME
Decreased Temporary Total Disability benefit costs
• Greater satisfaction experience by the injured employee promoting improved workplace morale
* Customized Communications:

While standard communication pieces such as workplace posters and "credit card" style wallet cards are available, Clients also have the ability to customize all communication pieces to fit their needs, including specifically designed cards and a dedicated toll-free number. • Information regarding claims contacts, Employee Assistance Program (EAP), Pharmacy Programs, etc. can be included on customized cards. • We will work to customize the program to fit your needs * AlliedCare Rx: AlliedCare Rx Case Management is an innovative approach to identifying, evaluating, and working with Medical Providers, Case Management, and the injured worker in utilizing eviderice based guidelines to manage chronio prescription drug (Rx) usage and help • resolve prescription medication dependencies with injured workers. Prescription medication related issues that are poorly managed may become catastrophic to the injured worker; dramatically increasing the cost of present and future medical benefits.

Third Party Administrators: AMC provides NCM services through the following TPA's:

Acclamation Insurance Management Services (AIMS), TRISTAR, and other self- insured/self-administered programs.

Physical location and number of employees: The City's Nurse Case Management program would continue to be conducted out of AMC's Sacramento office located at 10360 Old Placerville Road, Sacramento, California 95827.

Please see Exhibit X - Corporate Organizational Charts (AMC Org Chart) D. Client References: Provide three (3) references for which your firm provides nurse case management services including full contact information.

REFERENCE #1 - Nurse Case Management Services
Agency Name
County of Los Angeles
Contact Name
Alex Rossi, MBA, ARM, Workers' Compensation Contract Administrator Contact Phone Number Contact Email Ardress
(213) 738-2154 [email protected]
Brief Description of Scope of Services
All Managed Care Services / Client since 2006
May 30, 2017
AIMS Proposal Response to City of Richmond
Third Party Workets Compensation Claims Administration and Managed Care Services EXHIBIT A-1
21200000311ED
REFERENCE #2-Nürse Case Management Services
Agency Name
City of Huntington Beach
Contact Name
Patti Williams, Risk Manager
Contact Phone Number Contact Email Address
(714) 536-5290- [email protected]
Brief Description of Scope of Services
Workers' Compensation Claims. Administration and Managed Care / Client since 2010 REFERENCE #3 - Nurse Case Management Services
Agency Name
Central San Joaquin Valley Risk Management Authority
Contact Name
Kevin Werner, City of Ripon, City Administrator
Contact Emall Address
Contact Phone Number
(209) 599-2108 [email protected]
Brief Description of Scope of Services
All Managed Care Services / Client since 2012
REFERENCE #4 - Nurse Case Management Services
Agency Name
Schools Insurance Group
Contact Name
Jaxine Anderson, Return to Work Coordinator
Contact Phone Number Contact Email Address
(530) 823-9582 x205 [email protected]
Brief Description of Scope of Services
Workers' Compensation Claims Administration and Managed Care / Client since 2013 May 30, 2017 8D
Thie Party Wokers Come Gatior almo Admintelo and Managed Care Services EXHIBIT A-2
AIMS

ACCLAMATION INSURANCE

MANAGEMENT SERVICES
EXHIBIT 5 -
Proposed Annual Fee for Services
EXHIBIT A-2
IMS
Exhibit 5 - Proposed Annual Fee for Services
Acclamation Insurance Management Services, Inc., (AIMS) and Allied Managed Care, Inc. (AMC)
Proposed Cost Proposal
For
Cityol
Third Party Workers' Compensation Claims Administration and Managed Care Services

6. Cost Proposal
For all services offered in your written proposal, complete the appropriate cost proposal worksheet in Attachment sections A-1 - A-4 of this RFP and include them in a separate section of your written proposal. In addition, indicate on this cost proposal a schedule of rates for additional related services, if any, which the City may consider, at its sole option.

Please see our detailed Proposed Annual Fee for Services below.

Claims Administration Fees: Flat annual fee for service Acclamation Insurance Management Services, Inc. (AIMS) has included the completed cost proposal worksheets: Attachments A-1 through A-4, as requested by the City of Richmond (City).

The following is offered as supporting documentation of our cost proposal.

AIMS proposes a "flat annual fee" for the Workers' Compensation Third Party Administration Services which includes the handling of all current open claims, new May 30, 2017
AIMS Proposal Response to City of Richmond
Third Party Workers' Compensation Claims Administration and Managed Care Services EXHIBIT A-2

AIMS MANAGH CARD
IRCOTORATE•D
indemnity claims, and new medical only claims during the life of the contract. A flat annual fee, as opposed to the "per-claim or broken down fees" ', will provide a fixed and predictable budget item for the City. This flat annual fee eliminates the time and expense required to audit the per-claim fee or other project cost estimates which varies month-to- month.

In calculating the estimated flat annual rate for Clalms Administration, AIMS first determines what the appropriate staffing requirements are in orderto perform the required services. The required staffing is consistent with the requirements in the City's RFP. The estimated staffing is then used to calculate the total staffing cost associated with the City's program. The total staffing cost is then used to determine the total operating costs related to the program. Lastly, AIMS corporate overhead and a reasonable profit are added to the total operating costs to determine a reasonable claims administration fee for the program.

AIMS proposes the use of Allied Managed Care, Inc. (AMC) to provide any necessary medical cost containment services. As distinguished from other service providers, AIMS and AMC price their services on a stand-alone basis. In other words, AlMS prices the • claims administration services without regard to whether AMC's services as a managed care provider are being used and vice-versa. The fees are the same whether the services are bundled together or unbundled. This provides for a transparency for our Clients to clearly understand what they are payıng for.

AIMS estimates of the required claims staffing is calculated with the use of our recommended managed care strategic partner, AMC, for medical cost containment services. As a result of significant electronic interfaces with AMC, AIMS typically requires less staff, on a bundled basis, to complete the required work and, therefore, the fees and costs are typically lower on a bundled basis since there is more efficiency built-in for the claim handlers. AIMS has included the AMC fees for all Managed Care Cost Containment Services below.

The pricing below is based upon the open claims at takeover as set forth in the subject RFP and any Addendum(s) or additional information provided:
• Claims Administration Claims Volume:
402 total open claims
• 207 open Indemnity claims
165 open Future Medical claims
30 open Medical Only claims
As indicated, the pricing set-forth below are based on AIMS recommended staffing for the City's program to handling all the claims identified in the subject RFP and as noted above. The anticipated staffing will adhere to the requirements of this RFP and include experienced Claims Examiners that will manage an average of 125 open indemnity May 30, 2017 2
AIMS Proposal Response to Cily of Richmond
Third Party Workers Compensation Claims Administration and Managed Care Services EXHIBIT A-2

EUMS E MANAGHD CARE
claims each. Typically, Future Medical files are counted on a 2:1 basis or two future medical files are considered to be equal to one lost time indemnity file. • The City's AIMS staffing will have the appropriate claims supervision and, of course, a Claims Manager to oversee the dedicated claims unit and program. In addition, the necessary corporate management, claims management/supervision, IT management, clerical staff and other support staff will be assigned to the City's program.

As indicated above, the fees proposed cover claims administration for all new and existing claims set forth in this RFP and any Addendum thereto. This fee is premised on, and in reliance on, the claim volumes as set forth in the RFP or related information provided.

Should AIMS receive more claims than anticipated from the current claim administrator at the time of transfer and/or if there is a 5% increase/decrease during the initial transfer or during any period of the contract due to significant change in the number of employees, and/or as a result of a catastrophic event, then both AIMS and the City will negotiate, in good faith, a reasonable fee increase/decrease fee adjustment based on any revised required staffing.

Claims Administration
AIMS Proposed Fees:

Year One $ 558,655.00
Year Two $ 574,415.00*
Year Three $ 592,677.00*
Total 3 Year Fixed Sum $1,726,747.00
* Annual cost of living adjustment of 3.0%
Should AIMS be selected for consideration to be the Claims Administration service provider for the City's program then AIMS is open to negotiating a "best and final" fee arrangement that is based on any updated staffing and/or updated service requirements that will result in a fee arrangement mutually beneficial to both the City and AIMS.

The total annual flat fee proposed above contemplates handling all claims activity in a 12- month period (claims already open at the beginning of the 12-month term and any new claims reported during the 12-month term). The annual fee will be invoiced in 12 equal monthly amounts in arrears. The flat annual fees quoted above include all the services detailed in this RFP proposal response including, but not limited to, the following services:

May 30, 2017 3
AIMS Proposal Response to City of Richmond
Third Party Workers' Compensatton Claims Administration and Managed Care Services EXHIBIT A-2
GYMS
• Program Implementation Included
• All Claims Management Functions (currently open & new Included claims)
• Client RMIS Access Included
Data Management Included
• Claim File Storage Included
• Claim File Retrieval Included
• Account Management included
• Claim System Reporting Included
• Public Self-Insurer's Annual Report Included
• OSHA Reporting Assistance Included
• Prepare Federal form 1099 notices Included
• Custom AIMS "dashboard" Included
• Web Site Access (on-line) Included
• Detailed Stewardship Reports/Presentations Included
• Training Participation Included
• MMSEA Reporting Included*
*Costs associated with Medicare Set-Aside analysis and submission or Medicare Conditional Lien negotiations are Allocated expenses and paid off of the respective claim files.

Program Implementation, including Data Conversion
Generally, there is a one-time, direct pass through, fee for data conversion and transfer.

This fee will generally not exceed $15,000.00 per source entity. However, since the City is a current Client of AIMS there will be no data conversion and transfer fees.

Program Implementation is included in the Flat Annual Fee, Hourly rate for customization of reports and special reports requests Customization of reports: Most ad-hoc report requests can be completed by our Data Delivery Services (DDS) team without any additional charge to the Client. Should the City have a highly specialized report that requires special programming of the system May 30, 2017 4
AIMS Proposal Response to Cily of Richmond
Third Party Workers' Compensation Claims Administration and Managed Care Services EXHIBIT A-2
-
then DDS will secure and provide an estimate of the fees to complete the request and customized reports is approximately $250.00. All specialized report fees are on a "pass- seek approval from our Client before proceeding. A typical hourly rate for these through" basis.

Allocated expenses not covered under the base price
Allocated Loss Adjustment Expenses
In the normal course of administering workers' compensation claims there will be additional fees for services provided by non-affiliated, Client approved, service providers that are paid off of and allocated to the respective claims file. These Allocated Loss Adjustment Expenses (ALAE) or adjustment expenses are linked directly to the processing of a specific claim. ALAE is included as part to the expense reserves, along with loss reserves, on a claims file and are included in the calculation for the funding of the loss trust fund in order to pay claims, both losses and expenses, in a timely manner.

Allocated expenses would normally include, but not be limited to, the following:
• Fees of outside counsel for claims in suit, coverage opinions and litigation and for representation at hearings or pretrial conferences; • Fees for court reporters;
• All court cost, court fees, and court expenses;
• Fees for service of process;
• Costs of undercover operatives and detectives;
• Costs for employing experts for the preparation of maps, professional photographs, accounting, chemical or physical analysis, diagrams; • Costs for employing experts for the advice, opinions or testimony concerning claims under investigation or in litigation or for which a declaratory judgment is sought;
• Costs for independent medical examination or evaluation for rehabilitation;
• Cost of legal transcripts of testimony taken at coroner's inquests, criminal or civil proceedings;
• Cost for copies of any public records or medical records; • Costs of depositions and court reported or recorded statements; Non-AIMS Costs and expenses of subrogation;
• Costs of engineers, handwriting experts or any other type of expert used in the preparation of litigation or used on a one-time basis to resolve disputes;
• Witness fees and travel expenses;
• Costs of photographers and photocopy services;
• Costs of appraisal fees and expenses (not included in flat fee or performed by others);
5 May 30, 2017
AIMS Proposal Response to City of Richmond
Third Party Workers' Compensation Clalms Administration and Managed Care Services EXHIBIT A-2

LIMS CHANGED CARE

LOBORATED
• Costs of indexing claimants;
• Services performed outside our normal geographical regions; • Costs of outside investigation, signed or recorded statements; • Out of the ordinary non-AIMS expenses incurred in connection with an individual claim or requiring meeting with the Client;
• Costs associated with Medicare Set-Aside analysis and submission or Medicare Conditional Lien negotiation;
• Any other extraordinary services performed by AIMS at the Client's request;
• Investigation or possible fraud, including Special Investigations Unit services and related expenses;
• Any other similar cost, fee or expense reasonably charged to the investigation, negotiation, settlement or defense of a claim or loss or to the protection or perfection of the subrogation rights of the Client.

Performance-Based Compensation Alternatives: The City is willing to consider performance-based compensation alternatives. If offering such alternatives, please outline the options below and indicate the standards that would used to qualify:

AIMS is open to discussing and including the performance measures that are important to the City. As such, the following is general in nature as AIMS believes it is important to meet with the City to clearly develop and understand the performance guarantees.

AIMS has Client specific performance clauses with several of our Clients. Mutually beneficial performance and financial incentives include bonuses for above average results and reduced fees for below average performance. Determination of performance can be evaluated by random sample audits and/or information obtained via data collected and reported by our claim system and/or bill review and/or utilization review software.

Items have, in the past included topics such as staffing levels, closing ratios, penalties, timeliness of forwarding litigation files, timeliness of determining compensability, bill review savings, fee increases for subrogation recoveries, and fee increases for facilitation of Return to Work processes.

Sample Performance Clause: The following incentives are based on the score of an annual audit conducted by our Client. We are given an opportunity to discuss and review the audit with our Client. If AIMS is able to obtain a score between 85-89%, AIMS receives 1.5% of the Base Fee back, 90-94% is 3.0% and 95% or over is 4.5%. In addition, if we are able to score between 80-84%, then we are revenue neutral, 75-79% a negative 1.5% and anything less than 75% is a negative 4.5% of base fee.

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AIMS Proposal Response to Cily of Richmond
Third Parly Workers' Compensafion Claims Administration and Managed Care Services EXHIBIT A-2
•..-

CUMS EUNID CRE
-
Medical Cost Containment Services utilizing Allied Managed Care, Inc. (AMG) Bill Review: Flat fee bill
Medical Bill Review/PPO:

Official Medical Fee Schedule (OMFS) Review:

Flat fee per bill:
$9.00 per bill (flat rate per bill) plus PPO access fee (see below) Flat fee per line item:
$3.00 header plus $2.00 per line with a three (3) line minimum The following is included (at no additional charge):
• Full Duplicates
• Appeals
• Initial Setup
• Technology Fees for Interface
• Client Training
• Re-evaluation/Provider Inquíries
• Expert Testimony in Defense of Reviews
• Electronic Data Interface and On-line Access
• Courier Service
PPO fee for savings below fee schedule:

PPO Network Access Fee:

Anthem Blue Cross - CA 26%
First Health / Coventry 24%
Procura 22%
PRIME 22%
InterPlan 18%
ClarisPointe 18%
ASI Flex 18%
Specialty Bill Review:

Negotiation of Non-OMFS and Line-Item Audit bills, including Inpatient/Outpatient Hospital bills (non-PPO charges):

Niay 30, 2017 •
Thid Pany Wolice Compensator Elim admitrain and Managed Care Soniaus --..

EXHIBIT A-2

AIMS CHINERO RE

MOTELATED
12% of Savings capped at a maximum of $10,000.00.

Electronic billing:

Electronic and Standardized Billing Regulations: $1.00 per bill.

Utilization Review: Flat fee for UR provided by doctor, flat fee for UR provided by nurse
Utilization Review (UR)
a) Nurse Review:
$85.00 per UR (nurse) Referral. This includes unlimited treatment requests and reviews per referral.
b) Physician Review:
$225.00 per Peer Review Referral. This includes unlimited treatment requests and reviews per referral.

The following is included in the above fees:
• Initial set-up at the time of award of contract
• Customized Special Account Instructions
• Documentation letters post UR and Peer Review
• Technology Fees for interface
• Production Reports & Metrics
• Consultation with AMC's Medical Director
• Client Training
Nurse Case Management: Hourly fee for telephonic case management, hourly fee for field case management
Medical Management (Nurse Case Management)
a) Telephonic Case Management:
$90.00 per hour
b) Field Case Management:
$107.00 per hour*
May 30, 2017
AIMS Proposal Responsé to City of Richmond
Third Party Workers' Compensation Claims Administration and Managed Care Services EXHIBIT A-2

AIMS SHE CURR

ZECORFOLATED
*Travel for Field Case Management (On-Site) services will be charged at the Internal Revenue Service approved rate for mileage at the time the mileage is incurred
Allied Managed Care Service Entity Medical Provider Network (MPN) It is our understanding that the City currently does not utilize a medical provider network (MPN) at this time. The following information is provided to the City for their consideration.

AlMS Will work with the City, if they so desire, to establish an MPN, based upon the City's needs. AMC can install the MPN as the primary network. The following networks are available for secondary placement:
• Procura
• PRIME
• InterPlan
• ClarisPointe
• ASI Flex
AMC offers custom provider networks, both MPN and PPO, to be used exclusively by our individual Clients. These workers' compensation specific networks incorporate the medical providers with extensive, specialized experience in dealing with injuries incurred at the work place or job site.

SB 863 changes now allow for "Service Entity" MPN certification. On March 11, 2015 AMC received approval from Department of Industrial Relations, Division of Workers' Compensation Medical Unit for the AMC MPN (MPN Identification #2360). This approval is valid for a period of four (4) years.

AMC has been approved by the Department of Workers' Compensation (DWC) as a Services Entity MPN. What this means to a Client is that they can now join the AMC MPN without having to file an MPN on their own and take on all the regulatory requirements as an Employer.

We hope that the City takes advantage of this great opportunity to join the AMC MPN.

Some of the benefits would include:
• Medical Control for the Life of the Claim, if employee has not predesigned a physician.
.. Elimination of providers that over-utilize narcotics or medical treatment.

Quality Care from MPN providers.

Per DWC reduced medical care and reduced lost time.

Referral to specialists within MPN.

May 30, 2017
AIMS Proposal Response to Cily of Richmond
Third Party Workers' Compensation Claims Administration and Managed Care Services EXHIBIT A-2

WINS ERANAGO CARE

XOBPOBATEB
: Quality Care manitoring through MPN. Medical Access Assistant to assist employees from 7am to 8pm Monday- Saturday.
* Bottom-line reduced medical costs for higher quality medical care.

These workers' compensation specific networks incorporate the medical providers with extensive, specialized experience in dealing with injuries incurred at the work place or job site. Employees receive the necessary treatment to relieve and resolve the effects of a work related injury.

The MPN includes Certification from the State of California and Enrollment Notices to all Employees complete monitoring of the MPN for State Compliance and reporting with toll free access/assistance for Employers and Injured Employees and all services listed below. This also includes the continued monitoring of the Enrollment Process for New Hires.

Available Services:
• Assistance with creating MPN enrollment notices
•o MPN Application / Certification from State
• On-line provider locater
10% change monitoring
Toll Free Network Access Assistance to help locate providers Support for Network & Employer provided
• MPN roll-out meetings
o. Reporting
We will work collaboratively with our Clients to ensure a smooth transition, including comparing the current MPN to determine which providers are already in our available Networks. Network development can recruit, credential, and contract any specific qualified providers to participate in the City's provider network.

In addition to the MPN, AMC has an ever growing list of PPOs to offer and will work with our Client to determine the best PPOs for our Client's program. Our broad menu of network relationships is designed to offer our Clients the ability to match their own experience with the PPO option that would maximize cost effectiveness. By not being tied to or owning any network affiliation we can provide that expertise and flexibility to our Client for all bill types in all jurisdictions. Additionally, the system allows several ways in which we can maintain and support Client specific contractual discounts.

AMC's Bill Review software identifies PPO and negotiated fee providers by Tax ID Number. AMC can load virtually any PPO or negotiated fee arrangement by individual provider, by Tax ID Number, into the Bill Review software engine for automated May 30, 2017 10
AIMS Proposal Response lo Cily of Richmond
Third Parly Workers' Compensation Claims Administration and Managed Gare Services EXHIBIT A-2

GIMS CHARICR

PICOBOLER
application of discounts. Certain PPO networks are better than others depending on the locations of the providers, type of contracts, specialties of the providers, discounts etc.

Pricing for these services is dependent on the size and complexity of the MPN and will be provided should the City be interested in implementing this valuable cost containment resource, Iypical pricing, as a sample only, is as follows:

Allied Managed Care Service Entity Medical Provider Network (MPN) Fee: $2000.00 per month (estimate only)
The MPN Fee includes access to an already certified DWC MPN and Enrollment Notices to all Employees complete monitoring of the MPN for State Compliance and reporting with toll free access/assistance for Employers and Injured Employees and all services listed below. This also includes the continued monitoring of the Enrollment Process for New Hires.

Included Services:

Assistance with creating MPN enrollment notices
MPN Application / Certification from State
• On-line provider locater
• 10% change monitoring
Toll Free Network Access Assistance to help locate providers Support for Network & Employer provided
MPN roll-out meetings
Reporting
Please see the following RFP-related Attachments:
• Attachment A-1 Claims Administration Cost Proposal
• Attachment A-2 Bill Review Services Cost Proposal
v Attachment A-3 Utilization Review Services Cost Proposal v Attachment A-4 Nurse Case Management Services Cost Proposal End of Cost Proposal
May 30, 2017 11
AIMS Proposal Response 1o Cily of Richmond
Third Party Workers' Compensation Claims Administratton and Managed Care Services EXHIBIT A-2
AIMS

ACCLAMATION INSURANCE

MANAGEMENT SERVICES
RFP-Related Attachments
EXHIBIT A-2
Attachment A-1 Claims Administration Cost Proposal
Complete and include this cost proposal worksheet if you are proposing workers" compensation claims administration services. Proposals which do not contain this cost proposal may be rejected. If non-company owned vendors are used for any services proposed, attach their proposal to you for such services.

1. Claims Administration Services
Proposed fixed sum for Workers' Compensation Claims Administration Services to include assumption of all open claims, new indemnity, new medical only, new first aid; and all future medical claims for the proposed THREE (3) vear contract period:

Year One: $558,655.00
Year Two: $575,415.00
Year Three: $592,677.00
Three (3) Year Contract Total: $1,726,747.00
Other costs (if any) related to claims administration for the proposed THREE (3) year contract period:

Standard reports: $ Included in annual fixed sum
Customized reports: $ Included in annual fixed sum
Computer access fee: $ Included in annual fixed sum
Data transfer/conversion: $ Included in annual fixed sum Other: $ See Below
(Please specify): Customization of reports: Most ad-hoc report requests can be completed by our Data Delivery Services (DDS) team without any additional charge to the Client. Should the City have a highly specialized report that requires special programming of the system then DDS will secure and provide an estimate of the fees to complete the request and seek approval from the City before proceeding. A typical hourly rate for these customized reports is approximately $250.00. All specialized report fees are on a "pass- through" basis.

2. Performance-Based Compensation Alternatives: The City is willing to consider performance-based compensation alternatives. If offering such alternatives, please outline the options below and indicate the standards that would used to qualify:

AIMS is open to discussing and including the performance measures that are important to the City. As such, the following is general in nature as AIMS believes it is important to meet with the City to clearly develop and understand the performance guarantees.

AIMS has Client specific performance clauses with several of our Clients. Mutually beneficial performance and financial incentives include bonuses for above average results and reduced fees for below average performance. Determination of performance can be evaluated by random sample audits and/or information obtained via data collected and reported by our claim system and/or bill review and/or utilization review software. Items City of Richmond
EXHIBIT A-2
have, in the past included topics such as staffing levels, closing ratios, penalties, timeliness of forwarding litigation files, timeliness of determining compensability, bill review savings, fee increases for subrogation recoveries, and fee increases for facilitation of Return to Work processes.

Sample Performance Clause: The following incentives are based on the score of an annual audit conducted by our Client. We are given an opportunity to discuss and review the audit with our Client. If AIMS is able to obtain a score between 85-89%, AlMS receives

1.5% of the Base Fee back, 90-94% is 3.0% and 95% or over is 4.5%. In addition, if we are able to score between 80-84%, then we are revenue neutral, 75-79% a negative 1.5% and anything less than 75% is a negative 4.5% of base fee.

Submitted By: Dominic Russo, President & CEO AIMS/AMC
(Firm Name) Acclamation Insurance Management Services, Inc. (AIMS) A dinin Henr
(Signature of Individual Authorized to Bind on Behalf of Firm) City of Richmond
EXHIBIT A-2
Attachment A-2 Bill Review Services Cost Proposal
Complete and include this cost proposal worksheet if you are proposing bill review. services. Proposals which do not contain this cost proposal may be rejected. If non- company owned vendors are used for any services proposed, attach their proposal to you for such services.

1. Bill Review
Flat fee per bill: $9,00 per bill
Flat fee per line item: $3.00 header plus $2.00 per line with a three (3) line minimum
Percentage of Savings: 12% of Savings
Maximum Cap: $10,000 per bill Maximum Cap

2. Other Services Associated with Bill Review (Specify service and cost, if any:) The following is included (at no additional charge):
• Full Duplicates
• Appeals
• Initial Setup
• Technology Fees for Interface
• Client Training
• Re-evaluation/provider Inquiries
• Expert Testimony in Defense of Reviews
• Electronic Data Interface and On-line Access
Courier Service
Submitted By: Dominic Russo, President & CEO AIMS/AMC
(Firm Name) Acclamation Insurance Management Services, Inc. (AIMS) Peno
• (Signature of Individual Authorized to Bind on Behalf of Firm) City of Richmond
EXHIBIT A-2
Attachment A-3 Utilization Review Services Cost Proposal Complete and include this cost proposal worksheet if you are proposing utilization review services. Proposals which do not contain this cost proposal may be rejected. if non-company owned vendors are used for any services proposed, attach their proposal to you for such services.
1, Utilization Review
Flat fee per review (nurse): $85.00 per request of authorization Flat fee per review (Dr. peer review): $225.00 per request for authorization

2. Other Services Associated with Utilization Review (Specify service and cost, if any:)
The following is included in the above fees:
• Initial set-up at the time of award of contract
Customized Special Account Instructions
Documentation letters post UR and Peer Review
Technology Fees for interface
Production Reports & Metrics
Consultation with AMC's Medical Director
Client Training
Submitted By: Dominic Russo, President & CEO AIMS/AMC
(Firm Name) Acclamation Insurance Management Services, Inc. (AIMS) I dimin Peno
(Signature of Individual Authorized to Bind on Behalf of Firm) City of Richmond 4
EXHIBIT A-2
Attachment A-4 Nurse Case Management Services Cost Proposal Complete and include this cost proposal worksheet if you are proposing nurse case management services. Proposals which do not contain this cost proposal may be reiected. If non-company owned vendors are used for any services proposed, attach their proposal to you for such services.

1. Nurse Case Management
Per telephonic review: $90.00 per hour
Field review, per hour: $107.00 per hour

2. Other Services Associated with Nurse Care Management (Specify service and cost, if any:)
Claims Advice Nurses (CAN-do program) is a program designed to help our Clients understand the current laws and how to manage a specific situation. With this program, we are available to answer questions directly from Claims Examiners and Clients without having to send something through Utilization Review (UR). This helps in educating the Claims Examiner and saving our Client's money if something does not have to go through the UR process. The theory behind this program is that many times a Claims Examiner comes across a scenario that they are not sure how to manage. The Claims Examiner can pick up the phone and discuss it with a registered nurse.

Sometimes the answer will be "Send it through UR." However, many times the answer will be advice about the meaning of the request, how the scenario fits with the rest of the claim, or that the Claims Examiner may authorize the request. • Cost is included in the annual fixed fee for Claims Administration.

AlliedCare Complete - Nurse Early Intervention provides a comprehensive Nurse Early Intervention triage model that not only impacts the critical beginning stages of medical care but provides ongoing Utilization Management to facilitate and expedite medical treatment within the employer's network of providers. !
AMC recommends having a licensed Nurse perform triage and initial review of medical issues in coordination with the Claims Examiner. The Nurse will provide medical expertise in evaluating and estimating the medical needs of claims. In addition the nurse will provide prospective evaluation of any ongoing UR requests for the same file:
• Cost is per telephonic review hourly rate.

CallConnect -- 24/7 Triage Claim Reporting:
• Immediate Advice - Your employees get the medical advice they need, at the time they need it, within minutes of the incident.
• Immediate Reporting - Streamline the injury/iliness reporting process and receive accurate information for all incidents immediately after the call.

City of Richmond 5
EXHIBIT A-2
• Immediate Results - Decrease the number of unnecessary ~ Emergency Room visits :
• Direct Care to Preferred Providers
• Injury Assistance Program is available to your stat/Clients 24 hours per day, 7 days per week, and 365 days per year.
• Employees call a 1-800 number
• The advice nurse guides the employee through the appropriate level of care; v Self-Care/First Aid
v Direct referral to a network provider
• Referral to Private Physician (if non industrial)
• Direct to Emergency Room, if appropriate
• RN's utilize the clinically approved Schmitt-Thompson Clinical Content to triage employee's symptoms.

Depending upon the severity or type of the incident, AMC's advice nurse may make a follow-up call to the injured worker. A detailed report of the injury and medical advice provided to the employee is completed and all interested parties are faxed a copy of the report. Recommendations for Telephonic Case Management (TCM) or Field Case Management (FCM) is provided and the call is logged and recorded Injury Assistance Benefits:

Reduced "Days Away" from work.

Reduced reporting time.

Decreased number of Workers' Compensation claims.

Increased penetration of Workers' Compensation managed medical care. • Increased control of the medical benefit.
• Greater medical benefit cost savings.
• Increased overall control of claim by claims examiner. • Reduced litigation.
• Decreased Temporary Total Disability benefit costs,
• Greater satisfaction experience by the injured employee promoting improved workplace morale.

Customized Communications:
• While standard communication pieces such as workplace posters and "credit card" style wallet cards are available, Clients also have the ability to customize all communication pieces to fit their needs, including specifically designed cards and a dedicated toll-free number.
• Information regarding Claims contacts, Employee Assistance Program (EAP), Pharmacy Programs, etc. can be included on customized cards. • We will work to customize the program to fit your needs.

City of Richmond 6
EXHIBIT A-2
Sample Work Flow of Nurse Call -* 24/7 Triage Claim Reporting "Employee congral omnibyon
calle

HOTLINE
no deterine duncilale
medal treatient is neated).

INCIDENT REPORTING
regarding the Incidenl
403 10, dale & time of incident
LIFE
Emogency?
Repitling
Nürso Advice
YES
'CALL SELF PHYSICIAN
Cais/firal Aíd Care
911 Advice
Rerommerided
Riovideri

YES YES
+
Employa Post-Call ricident Repor
for Supervisor dowed tu stakeholders.
chills the hotline „Employoo
afterted throunh
5ü2g cillered înto Medical Provider Melvork
NAVRISK, showapplicalse
CaliConnect 24/7 Triage Claim Reporting Costs:

Call results in a claim being established: $150.00 per call Call does not result in a claim being established: No cost Submitted By: Dominic Russo, President & CEO AIMS/AMC
(Firm Name) Acclamation Insurance Management Services, Inc. (AIMS) (Signature of Individual Authorized to Bind on Behalf of Firm City of Richmond 7
For the Contract between the City of
Richmond and
Acclamation Insurance Management
Services, Inc.

EXHIBIT B

PAYMENT PROVISIONS
{PLEASE NOTE THAT THE CITY OF RICHMOND SHALL NOT PAY FOR SERVICES

THAT EXCEED THE CONTRACT PAYMENT LIMIT UNLESS A CONTRACT

AMENDMENT HAS BEEN APPROVED BY THE CITY COUNCIL OR THE CITY MANAGER}

1. Provided Contractor is not in default under this Contract, Contractor shall be compensated as provided below.

2. Any and all payments made pursuant to this Contract shall be subject to the Contract Payment Limit. The Payment Limit includes expenses (phones, photo copying, meals and travel etc. Invoices, shall be adequately detailed, based on accurate records, and be in a form reasonably satisfactory to the City. Contractor may be required to provide back-up material upon request.

3. Contractor 'shall submit timely invoices to the following address:

Attention: City of Richmond, Finance Department - Accounts Payable Project Manager: Kim Greer Department: Human Resources
PO Box 4046
Richmond, CA 94804-0046

4. All invoices that are submitted by Contractor shall be subject to the approval of the City's Project Manager, Kim Greer before payments shall be authorized.

5. The City will pay invoice(s) within 45 days after completion of services to the City's satisfaction. The City shall not pay late fees or interest.

6. A Richmond business license shall be obtained before any payment under this Contract shall be authorized and the business license must be kept current during the term of this Contract for payments to continue to be authorized.

7. All insurance coverage required by this Contract shall be provided by the Contractor before this Contract shall be executed by the City. The insurance coverage must be kept current during the term of this Contract for payments to continue to be authorized.

For the Contract between the City of
Richmond and
Acclamation Insurance Management
Services, Inc.

EXHIBIT C

AUTHORIZED REPRESENTATIVES AND NOTICES

1. Notices. All notices, demands, statements, or communications provided for by this Contract shall be in writing and may be delivered by deposit in the United States mail, postage prepaid. Notices to the City shall be addressed to the Department Head and (as delineated below in section 1.1) to the project manager responsible for the administration of or the supervision of the scope of work under this Contract. Notices to the Contractor shall be addressed to the party designated by Contractor (as delineated below in section 1.2). Notice shall be deemed delivered (a) upon personal delivery; (b) as of the fifth business day after mailing by United States certified mail, postage prepaid, addressed to the proper party; or (c) as of 12:00 p.m. on the second business day immediately after the day it is deposited with and accepted by Federal Express, or a similar overnight courier service, addressed to the proper party and marked for next business day morning delivery. For the purposes of this Contract, a "business day" means any day Monday through Friday that is not a holiday recognized by the federal government or the State of California.

1.1 CITY hereby designates as its Authorized Representative the Project Manager whose name and address are as follows:

Kim Greer
City of Richmond
450 Civic Center Plaza Suite 310
Richmond, CA 94804-0046

1.2 CONTRACTOR hereby designates as its Authorized Representative the Project Manager whose name and address are as follows:

Lynn Cavalcanti
Acclamation Insurance Management Services, Inc.
10445 Old Placerville Road
Sacramento CA 95827

EXHIBIT D

GENERAL CONDITIONS

1. Independent Contractor. Contractor acknowledges, represents and warrants that Contractor is not a regular or temporary employee, joint venturer or partner of the City, but rather an independent Contractor. This Contract shall not be construed to create an agency, servant, employee, partnership, or joint venture relationship. As an independent Contractor, Contractor shall have no authority to bind City to any obligation or to act as City's agent except as expressly provided herein. Due to the independent Contractor relationship created by this Contract, City shall not withhold state or federal income taxes, the reporting of which shall be Contractor's sole responsibility,

2. Brokers: Contractor acknowledges, represents and warrants that Contractor has not hired, retained or agreed to pay any entity or person any fee, commission, percentage, gift, or any other consideration, contingent upon or resulting from the award or making of this Contract.

3. City Property. The rights to applicable plans, drawings, reports, calculations, data, specifications, videos, graphics or ofher materials prepared for or obtained pursuant to this Contract, which, upon request, are to be delivered to City within a reasonable time, shall be deemed assigned to City. If applicable, Contractor shall prepare check prints upon request. Notwithstanding the foregoing, Contractor shall not be obligated to provide to City proprietary software or data which Contractor has developed or had developed for Contractor's own use; provided, however, that Contractor shall, pursuant to Section 15 below, indemnify, defend and hold harmless City from and against any discovery or Public Records Act request seeking the disclosure of such proprietary software or data.

4. Patents, Trademarks, Copyrights and Rights in Data. Contractor shall not publish or transfer any materials, discoveries, developments, concepts, designs, ideas, know how, improvements, inventions and/or original works of authorship resulting from activities supported by this Contract without the express prior written consent of the City Manager. If anything resulting from activities supported by this Contract is patentable, trademarkable, copyrightable or otherwise legally protectable, City reserves the exclusive right to seek such intellectual property rights. Notwithstanding the foregoing, Contractor may, after receiving City's prior written consent, seek patent, trademark, copyright or other intellectual property rights on anything resulting from activities supported by this Contract. However, City reserves, and Contractor irrevocably grants, a nonexclusive, fully paid-up, royalty-free, assumable, perpetual, worldwide license, with the right to transfer, sublicense, practice and exploit said license and the right. to make, have made, copy, modify, make derivative works of, use, sell, General Conditions/EJ/TE 01-19-11 1 of 13
import, and otherwise distribute under all applicable intellectual properties without restriction of any kind said license.

Contractor further agrees to assist City, at City's expense, in every proper way to secure the City's rights in any patents, trademarks, copyrights or other intellectual property rights relating thereto, including the disclosure to City of all pertinent information and data with respect thereto. Contractor shall also assist City in the execution of all applications, specifications, oaths, assignments, recordations, and all other instruments which City shall deem necessary in order to apply for, obtain, maintain and transfer such rights, or if not transferable, to waive such rights. Contractor shall further assist City in the execution of all applications, specifications, oaths, assignments, recordations and all other instruments which City shall deem necessary in order to assign and convey to City, and any assigns and nominees the sole and exclusive right, title and interest in and to any patents, trademarks, copyrights or other intellectual property rights relating thereto. Contractor further agrees that its obligation to execute or cause to be executed, when it is in Contractor's power to do so, any such instruments or papers shall continue during and at all times after the end of Contractor's services and until the expiration of the last such intellectual property right. Contractor hereby irrevocably designates and appoints City, and its duly authorized officers, agents and servants, as its agent and attorney-in-fact, to act for and in its behalf and stead to execute and file any such applications and to do all other lawfully permitted acts to further the application for, prosecution, issuance, maintenance or transfer of letters of patents, copyright and other registrations. This power of attorney is coupled with an interest and shall not be affected by Contractor's subsequent incapacity.

5. Inspection. Contractor's performance, place of business and records pertaining to this Contract are subject to monitoring, inspection, review and audit by authorized representatives of the CITY, the State of California, and the United States Government.

If the project or services set forth in Exhibit A shall be performed on City or other public property, City shall have the right to inspect such work without notice. If such project or services shall not be performed on City or other public property, City shall have the right to inspect such work upon reasonable notice.

6. Services. The project or services set forth in Exhibit A shall be performed to the full satisfaction and approval of City. In the event that the project or services set forth in Exhibit A are also itemized by price, City, in its sole discretion, may, upon notice to Contractor, delete certain items or services set forth in Exhibit A, in which case there shall be a corresponding reduction in the amount of compensation paid to Contractor.

General Condifions/EJ/TE 01-19-11 2 of 13
Contractor shall, at its own cost and expense, furnish all facilities and equipment necessary for Contractor to complete the project or perform the services required herein, unless otherwise provided in Exhibit A.

7. Records. Contractor shall keep and make available for inspection and copying by authorized representatives of the City, the State of California, and the United States Government, the Contractor's regular business records and such additional records pertaining to this Contract as may be required by the City.

Contractor shall retain all documents pertaining to this Contract for a period of five (5) years after this Contract's termination (or for any further period that is required by law) and until all Federal or State audits are complete and exceptions resolved for this contract's funding period. Upon request, CONTRACTOR shall make these records available to authorized representatives of the CITY, the State of California, and the United States Government.

Contractor shall keep full and detailed accounts, maintain records, and exercise such controls as may be necessary for proper financial management under this Contract. The Contractor's accounting and control systems shall be satisfactory to City. Contractor's accounting systems shall conform to generally accepted accounting principles and all records shall provide a breakdown of total costs charged under this Contract, including properly executed payrolls, time records, utility bills, invoices and vouchers. The City shall be afforded prompt access to Contractor's records, books, and Contractor shall preserve such project records for a period of at least five (5 years after the termination of this Contract, or for such longer period as may be required by law.

Contractor shall permit City and its authorized representatives and accountants to inspect, examine and copy Contractor's books, records, accounts, correspondence, instructions, drawings, receipts, subcontracts, purchase orders, vouchers, memoranda and other data relating to the project or services set forth in Exhibit A, and any and all data relevant to this Contract at any reasonable time for the purpose of auditing and verifying statements, invoices, or bills submitted by Contractor pursuant to this Contract and shall provide such assistance as may be reasonably required in the course of such inspection. Contractor shall also allow City access to the record keeping and accounting personnel of Contractor.

City further reserves the right to examine and re-examine said books, records, accounts, and data during the five (5 year period following the termination of this Contract; and Contractor shall in no event dispose of, destroy, alter, or mutilate said books, records, accounts, and data in any manner whatever for five (5 years after the termination of this Contract.

General Conditions/EJ/TE 01-19-1.1 3 of 13
Pursuant to California Government Code § 10527, the parties to this Contract shall be subject to the examination and audit of representatives of the Auditor General of the State of California for a period of three (3) years after final payment under this Contract. The examination and audit shall be confined to those matters connected with the performance of this Contract including, but not limited to, the cost of administering this Contract.

8. Changes and Extra Work. All changes and/or extra work under this Contract shall be performed and paid for in accordance with the following:

Only the City Council or the City Manager may authorize extra and/or changed work. Contractor expressly recognizes that other City personnel are without authorization to either order extra and/or changed work or waive contract requirements. Failure of Contractor to secure the authorization for such extra and/or changed work shall constitute a waiver of any and all right to adjustment in contract price due to such unauthorized work and Contractor thereafter shall be entitled to no compensation whatsoever for performance of such extra and/or changed work.

If Contractor is of the opinion that any work which Contractor has been directed to perform is beyond the scope of this Contract and constitutes extra work, Contractor shall promptly notify. City of the fact. The City shall make a determination as to whether or not such work is, in fact, beyond the scope of this Contract and constitutes extra work. In the event that City determines that such work does constitute extra work, City shall provide extra compensation to Contractor on a fair and equitable basis. A change order or Contract Amendment providing for such compensation for extra work shall be negotiated between City and Contractor and executed by Contractor and the appropriate City official.

In the event City determines that such work does not constitute extra work, Contractor shall not be paid extra compensation above that provided herein and if such determination is made by City staff, said determination may be appealed to the City Council; provided, however, a written appeal must be submitted to the City Manager within five (5) days after the staffs determination is sent to Contractor. Said written appeal shall include a description of each and every ground upon which Contractor challenges the staff's determination.

9. Additional Assistance. If this Contract requires Contractor to prepare plans and specifications, Contractor shall provide assistance as necessary to resolve any questions regarding such plans and specifications that may arise during the period of advertising for bids, and Contractor shall issue General Conditions/EJ/TE 01-19-11 4 of 13
any necessary addenda to the plans and specifications as requested. In the event Contractor is of the opinion that City's requests for addenda and assistance is outside the scope of normal services, the parties shall proceed in accordance with the changes and extra work provisions of Section 8 of these General Conditions.

10. Professional Ability: Contractor acknowledges, represents and warrants that Contractor and its employees are skilled and able to competentiy provide the services hereunder, and possess all professional licenses, certifications, and approvals necessary to engage in their ocupations.

City has relied upon the professional ability and training of Contractor as a material inducement to enter into this Contract. Contractor shall perform in accordance with generally accepted professional practices and standards of Contractor's profession. In the event that City, in its sole discretion, desires the removal of any person employed or retained by Contractor to perform services hereunder, such person shall be removed immediately upon receiving notice from City.

11. Business License. Contractor shall obtain a Richmond Business License before performing any services required under this Contract. The failure țo șo obtain such license shall be a material breach of this Contract and grounds for immediate termination by City; provided, however, that City may waive the business license requirement in writing under unusual or extraordinary circumstances without necessitating any modification of this Contract to reflect such waiver.

12. Termination Without Default. Notwithstanding any provision herein to the contrary, City may, in its sole and absolute discretion and without cause, terminate this Contract at any time prior to completion by Contractor of the project or services hereunder, immediately upon written notice to Contractor. Contractor may terminate this Contract at any time in its sole and absolute discretion and without cause upon 30 days' written notice to City. In the event of termination by either party, Contractor shall be compensated for: (1) all authorized work satisfactorily performed prior to the effective date of termination; (2) necessary materials or services of others ordered by Contractor for this Contract, prior to receipt of notice of termination, irrespective of whether such materials or services of others have actually been delivered, provided that Contractor is not able to cancel such orders. Compensation for Contractor in such event shall be determined by City in accordance with the percentage of the project or services completed by Contractor; and all of Contractor's finished or unfinished work product through the time of the City's last payment shall be transferred and assigned to City. Additionally, in the event of such termination, the City may proceed with the work in any reasonable manner it chooses.

General Conditions/EJ/TE 01-19-11 5 of 13
• 13. Termination in the Event of Default. Should Contractor fail to perform any of its obligations hereunder, within the time and in the manner provided or otherwise violate any of the terms of this Contract, City may immediately terminate this Contract by giving written notice of such termination, stating the reasons for such termination. Contractor shall be compensated as provided in Section 12 of these General Conditions; provided, however, there shall be deducted from such amount the amount of damage, including attorney's fees, expert witness fees and costs, if any, sustained by City by virtue of Contractor's breach of this Contract. Additionally, in the event of such termination, the City may proceed with the work in any reasonable manner it chooses.

14. Conflict of Interest. Contractor acknowledges, represents and warrants that Contractor shall avoid all conflicts of interest (as defined under any federal, state or local statute, rule or regulation, or at common law) with respect to this Contract. Contractor further acknowledges, represents and warrants that no City official or employee has any economic interest, as defined in Title 2, California Code of Regulations §S 18703.1 through 18703.5, with Contractor that would invalidate this Contract. Contractor acknowledges that in the event that Contractor shall be found by any judicial or administrative body to have any conflict of interest (as defined above) with respect to this Contract, all consideration received under this Contract shall be forfeited and returned to City forthwith. This provision shall survive the termination of this Contract for one (1) year.

15. Indemnification.
(a) If this Contract is a contract for design professional services subject to California Civil Code Section 2782.8(a) and Contractor is a design professional, as defined in California Civil Code Section 2782.8(b)(2), Contractor shall hold harmless, defend and indemnify the City, its officers, agents, employees, and volunteers from and against any and all claims, damages, losses, and expenses including attorneys' fees arising out of, or pertaining to, or relating to the negligence, recklessness, or willful misconduct of the Contractor, except where caused by the active negligence, sole negligence, or willful misconduct of the City. To the fullest extent permitted by law, Contractor shall immediately defend and indemnify the City and its officers, agents, employees, and volunteers from and against any and all liabilities, regardless of nature or type, that arise out of, pertain to, or relate to the negligence, recklessness, or willful misconduct of the Contractor, or its employees, agents, or subcontractors.

Liabilities subject to the duties to defend and indemnify include, without limitation, any and all claims, losses, damages, penalties, fines, and • judgments; associated investigation and administrative expenses; defense costs, including but not limited to reasonable attorneys' fees; court costs; and costs of alternative dispute resolution. Contractor's obligation to General Conditions/EJ/TE 01-19-11 6 of 13
indemnify applies unless it is finally adjudicated that the liability was caused by the sole active negligence or sole willful misconduct of an indemnified party.
(b) If this Contract is not a contract for design professional services subject to California Civil Code Section 2782.8(a) or Contractor is not a design professional as defined in California Civil Code Section 2782.8(b)(2), Contractor shall indemnify, defend, and hold harmless the City, its officers, agents, employees and volunteers from any and all claims, suits, or actions of every name, kind and description, brought forth on account of injuries to or death of any person or damage to property arising from or connected with the willful misconduct, negligent acts, errors or omissions, ultra-hazardous activities, activities giving rise to strict liability, or defects in design by Confractor or any person directly or indirectly employed by, or acting as, the agent for Contractor in the performance of this Contract, including the concurrent or successive passive negligence of the City, its officers, agents, employees or volunteers.
(c) It is understood that the duty of Contractor to indemnify and hold harmless includes the duty to defend as set forth in Section 2778 of the California Civil Code. Contractor shall be obligated to defend, in all legal, equitable, administrative, or special proceedings, with counsel approved by the City, the City and its officers, agents, employees, and volunteers, immediately upon tender to Contractor of the claim in any form or at any stage of an action or proceeding, whether or not liability is established. An allegation or determination that persons other than Contractor are responsible for the claim does not relieve Contractor from its separate and distinct obligation to defend under this Section 15. The obligation to defend extends through final judgment, including exhaustion of any appeals. The defense obligation includes an obligation to provide independent counsel if Contractor asserts that liability is caused in whole, or in part, by the negligence or willful misconduct of an indemnified party. (d) The review, acceptance or approval of the Contractor's work or work product by any indemnified party shall not affect, relieve or reduce the Contractor's indemnification or defense obligations. This Section 15 survives completion of the services or the termination of this Contract.

The provisions of this Section 15 are not limited by, and do not affect, the provisions of this Contract relating to insurance.
(e) Acceptance of insurance certificates and endorsements required under this Contract does not relieve Contractor from liability under this Section

15. This Section 15 shall apply whether or not such insurance policies are determined to be applicable to any such damages or claims for damages.

16. Safety. Contractor acknowledges that the City is committed to the highest standards of workplace safety. Contractor shall perform all work hereunder in full compliance with applicable local, state and federal safety requirements including but not limited to Occupational Safety and Health Administration requirements, and shall assume sole and complete General Conditioris/EJ/TE 01-19-11 7 of 13
responsibility for the safety of Contractor's employees and any subContractor's employees. If a death, serious personal injury or substantial property damage occurs in connection with the performance of this Contract, Contractor shall immediately notify the City by telephone.

17. Insurance. Insurance requirements are set forth in Exhibit F to this Contract. Contractor shall abide by the insurance requirements set forth in said Exhibit F.

18. Non-Liability of Officials and Employees of the City. No official or employee of the City shall be personally liable for any default or liability under this Contract.

19. Compliance with Laws. Contractor shall comply with all federal, state and local laws, statutes, ordinances, rules and regulations, and the orders and decrees of any courts or administrative bodies or tribunals, with respect to this Contract, including without limitation environmental laws, employment discrimination laws and prevailing wage laws. Compliance under this provision includes compliance with all provisions of the Richmond Municipal Code ("Municipal Code"), including Chapters 2.50, 2.52, 2.56, and 2.60, if applicable.

Contractor acknowledges that under § 2.60.070 of the Municipal Code ("Living Wage Ordinance"), Contractor shall promptly provide to City documents and information verifying its compliance with the Living Wage Ordinance. Also as prescribed in § 2.60.070, Contractor shall notify each of its affected employees with regards to the wages that are required to be paid pursuant to the Living Wage Ordinance.

Contractor shall comply with § 2.28.030 of the Municipal Code, obligating every Contractor or subcontractor under a contract or subcontract with the City for public work or for goods or for services to refrain from discriminatory employment or subcontracting practices on the basis of race, color, sex, sexual orientation, religious creed, national origin or ancestry of any employee, any applicant for employment or any potential subcontractor.

Contractor acknowledges that the City's Drug Free Workplace Policy, Violence in the Workplace Policy and the Policy Against Workplace Harassment, are available on the City's website at
http://www.ci.richmond.ca.us/workplacepolicies. Contractor agrees to abide by the terms and conditions of said policies.

20. Limitations upon Subcontracting and Assignment. This Contract binds the heirs, successors, assigns and representatives of Contractor. The Contractor shall not enter into subcontracts for any work contemplated General Conditions/EJ/TE 01-19-11 8 of 13
under this Contract and shall not assign this Contract, nor any portion hereof or monies due or to become due, without the prior written consent of the City Council or its designee.

Contractor acknowledges that the services which Contractor shall provide under this Contract are unique, personal services which, except as otherwise provided herein, Contractor shall not assign or sublet to any other party without the prior written approval of City, which approval may be withheld in City's sole and absolute discretion. In the event that City, in writing, approves any assignment or subletting of this Contract or the retention of subcontractors by Contractor, Contractor shall provide to City upon request copies of each and every subcontract contract prior to the execution thereof by Contractor and subcontractor. Any assignment by Contractor of any or all of its rights under this Contract without first obtaining City's prior written consent shall be a default under this Contract.

The sale, assignment, transfer or other disposition of any of the issued and outstanding capital stock of Contractor (if applicable), or of the interest of any general partner or joint venturer or syndicate member if Contractor is a partnership or joint-venture or syndicate, which shall result in a change of control of Contractor, shall be deemed an assignment. For this purpose, control shall mean fifty percent or more of the voting power or twenty-five percent or more of the assets of the corporation, partnership or joint-venture.

21. Integration. This Contract constitutes the entire agreement between the documents exchanged between Contractor and City may be used to assist in the interpretation of the Exhibits to this Contract.

22. Modifications and Amendments. This Contract may be modified or amended only by a change order or Contract Amendment executed by both parties and approved as to form by the City Attorney.

23. Conflicting Provisions. In the event of a conflict between these General Conditions and those of any Exhibit or attachment hereto, these General Conditions shall prevail; provided, however, that any Special Conditions as set forth in Exhibit E shall prevail over these General Conditions. In the event of a conflict between the terms and conditions of any two or more Exhibits or attachments hereto, those prepared by City shall prevail over those prepared by the Contractor, and the terms and conditions preferred by the City shall prevail over those preferred by the Contractor.

24. Non-exclusivity. Notwithstanding any provision herein to the contrary, the services provided by Contractor hereunder shall be non-exclusive, and General Conditions/EJ/TE 01-19-11 9 of 13
City reserves the right to employ other Contractors in connection with the project.

25. Exhibits. All Exhibits hereto are made a part hereof and incorporated herein by reference; provided, however, that any language in Exhibit A which does not pertain to the project description, proposal, scope of services, or method of compensation (as applicable), or any corresponding responsibilities of City, shall be deemed extraneous to, and not a part of, this Contract.

26. Force Majeure. Neither party hereto shall be considered in default in the performance of its obligations hereunder to the extent that the performance of such an obligation is prevented or delayed by reason of acts of God, strikes, boycotts, lock-outs, inability to procure materials not related to the price thereot, tailure of power, restrictive governmental laws and regulations enacted after the date of this Contract, nots, civil unrest, acts of terrorism, insurrection, war, declaration of a state or national emergency or other reasons of a like nature not within the reasonable control of such party.

27. Time of the Essence. Time is of the essence of this Contract. Contractor and City agree that any time period set forth in Exhibit A represents their best estimates with respect to completion dates and both Contractor and City acknowledge that departures from the schedule may occur.

Therefore, both Contractor and City will use reasonable efforts to notify one another of changes to the schedule. Contractor shall not be responsible for performance delays caused by others, or delays beyond Contractor's control, and such delays shall extend the times for performance of Contractor's work.

28. Confidentiality. Contractor agrees to comply with, and to require its employees, agents and partners to comply with, all applicable State or Federal statutes or regulations respecting confidentially, including but not limited to, the identity of persons served under this Contract, their records, or services provided them, and assures that:

All applications and records concerning any individual made or kept by Contractor or any public officer or agency in connection with the administration of or relating to services provided under this Contract will be confidential, and will not be open to examination for any purposes not directly connected with the administration of such service.

No person will publish or disclose or permit or cause to be published or disclosed, any list of persons receiving services, except as may be required in the administration of such service.

General Conditions/EJ/TE 01-19-11 10 of 13

29. Third Parties. Nothing herein shall be interpreted as creating any rights or benefits in any third parties. For purposes hereof, transferees or assignees as permitted under this Contract shall not be considered "third parties!

30. Governing Law. This Contract shall be construed in accordance with the law of the State of California without regard to principles of conflicts of law.

This Contract is made in Contra Costa County, California, and any action relating to this Contract shall be instituted and prosecuted in the courts of Contra Costa County, California.

31. Nonrenewal. Contractor understands and agrees that there is no representation, implication, or understanding that the services provided by Contractor under this Contract will be purchased or renewed by the City under a new contract following expiration or termination of this Contract, and waives all rights or claims to notice or hearing respecting any failure by City to continue the purchase of all or any failure to continue purchase of all or any such services from Contractor.

32. Claims. Any claim by Contractor against City hereunder shall be subject to Government Code §$ 800 et seq. The claims presentation provisions of said Act are hereby modified such that the presentation of all claims hereunder to the City shall be waived if not made within six months after accrual of the cause of action.

33. Interpretation. This Contract shall be interpreted as if drafted by both parties.

34. Warranty. In the event that any product shall be provided to the City as part of this Contract, Contractor warrants as follows: Contractor possesses good title to the product and the right to transfer the product to City; the product shall be delivered to the City free from any security interest or other lien; the product meets any specifications contained herein; the product shall be free from material defects in materials and workmanship under normal use for a period of one (1) year from the date of delivery; and the product shall be fit for its intended purposes). Notwithstanding the foregoing, consumable and maintenance items (such as light bulbs and batteries) shall be warranted for a period of one hundred and eighty (180) days from the date of delivery. All repairs during the warranty period shall be promptly performed by Contractor, at Contractor's expense, including shipping.

35. Severability. In the event that any of the provisions or portions or applications thereof of this Contract are held to be unenforceable or invalid by any court of competent jurisdiction, City and Contractor shall negotiate an equitable adjustment in the provisions of the Contract with a view General Conditions/EJ/TE 01-19-11 11 of 13
toward effecting the purpose of this Contract, and the validity and enforceability of the remaining provisions or portions or applications thereof, shall not be affected thereby.

36. Authority. City warrants and represents that the signatory hereto (the Mayor of the City of Richmond or the City Manager) is duly authorized to enter into and execute this Contract on behalf of City. The party signing on behalf of Contractor warrants and represents that he or she is duly authorized to enter into and execute this Contract on behalf of Contractor, and shall be personally liable to City if he or she is not duly authorized to enter into and execute this Contract on behalf of Contractor.

37. Waiver. The waiver by City of any breach of any term or provision of this Contract shall not be construed as a waiver of any subsequent breach.

Inspections or approvals, or statements by any officer, agent or employee of the City relating to the Contractor's pertormance, or payments therefore, or any combination of these acts, shall not relieve the Contractor's obligation to fulfill this Contract as prescribed; nor shall the City be thereby stopped from bringing any action for damages or enforcement arising from any failure to comply with any of the terms and conditions of this Contract.

38. Possessory Interest. If this Contract results in the Contractor having possession of, claim to or right to the possession of land or improvements, but does not vest ownership of the land or improvements in the same person, or if this Contract results in the placement of taxable improvements on tax exempt land (Revenue and Taxation Code 107), such interest or improvements may represent a possessory interest subject to property tax, and Contractor may be subject to the payment of property taxes levied on such interest.

39. Performance and Final Acceptance.

Contractor represents that it is experienced, qualified, registered, licensed, equipped, organized and financed to perform the services under this Contract.

Contractor shall perform the services under this Contract with that degree of skill and judgment normally exercised by professional firms performing services of a similar nature in the State of California, and shall be responsible for the professional quality, technical accuracy and coordination of the services it performs under this Contract. In addition to the other rights and remedies which City may have, Contractor shall, at its own expense, correct any services which fail to meet the above standard General Conditions/EJ/TE 01-19-11 12 of 13
City shall provide Contractor an opportunity to cure errors and omission which may be disclosed during the review of submittals, with no increase in the authorized Contract Payment Limit. Should Contractor fail to make necessary corrections in a timely manner, such corrections shall be made by the City and the cost thereof shall be charged to Contractor.

If warranted, City shall determine, and Contractor may request such determination, that Contractor has satisfactorily completed performance of this Contract. Upon such determination, City shall issue to Contractor a written Notice of Final Acceptance, after which Contractor shall not incur further costs under this Contract. Contractor shall respond to such Notice of Final Acceptance by executing and submitting to City a Release and Certificate of Final Payment.

40. Survival. The rights and obligations of the parties which by their nature survive termination or completion of the services covered by this Contract shall remain in full force and effect after termination or completion.

General Conditions/EJ/TE. 01-19-11 13 of 13
For the Contract between the City of
Richmond and
Acclamation Insurance Management
Services, Inc.

EXHIBIT E

SPECIAL CONDITIONS
The General Conditions are hereby amended to include the following modifications and/or provisions (if applicable):

Contractors standards shall include, by reference, the Request for Proposal proposer's submission by Acclamation Insurance Management Services, dated May 30, 2017.

For the Contract between the City of
Richmond and
Acclamation Insurance Management
Services, Inc

EXHIBIT F

INSURANCE PROVISIONS
During the entire term of this Contract and any extension or modification thereof, the CONTRACTOR shall keep in effect insurance policies meeting the insurance requirements specified in the insurance provisions which are attached hereto and incorporated herein by this reference.
_ Exhibit F
Section 8
City of Richmond - Insurance Requirements - Type 2:

Professional Services
In all instances where CONTRACTOR or its representatives will provide professional services (architects, engineers, construction management, counselors, medical professionals, hospitals, clinics, attorneys, consultants, accountants, etc.) to the City of Richmond (City), the City requires the following MINIMUM insurance requirements and limits.

CONTRACTOR shall procure and maintain for the duratlon of the contract, agreement, or other order for work, services or supplies, insurance against claims for injurles to persons or damages to property which may arise from or in connection with the performance of the work hereunder and the results of that work by the CONTRACTOR, its agents, representatives, employees or subcontractors. Maintenance of proper insurance coverage is a material element of the contract, Failure to maintain or renew coverage or to provide evidence of renewal may be treated by the City as a material breach of contract.

CONTRACTOR agrees that in the event of loss due to any of the perils for which It has agreed to provide Commercial General Liability Insurance, CONTRACTOR shall look solely to its insurance for recovery.

CONTRACTOR hereby grants to CITY, on behalf of any insurer providing Commercial General Liability insurance to either CONTRACTOR or CITY with respect to the services of CONSULTANT herein, a waiver of any right to subrogation which any such insurer of said CONTRACTOR may acquire against the CITY by virtue of the payment of any loss under such insurance.

Original, signed certificates and original, separate pollcy endorsements, naming the City as an additional insured for general liability coverage, as well as a walver of subrogation for Workers' Compensation insurance, shall be received and approved by the City before any work may begin. However, failure to do so shall not operate as a waiver of these insurance requirements.

City reserves the right to modify or require additional coverages for specific risk exposures depending on scope of CONTRACTORS work.

Minimum coverage is detailed below. The policy limits of coverage shall be made available to the full limits of the policy. The minimum limits stated herein shall not serve to reduce the policy limits of coverage of CONTRACTOR.

Minimum Scope of Insurance - the following forms shall be provided and coverage shall be at least as broad as the following:

1. Insurance Services Office Commercial General Liability coverage (ISO Occurrence Form CG 0001), and including coverage for bodily and personal injury, property damage, and products and completed operations (if applicable).

2. Insurance Services Office Automobile Liability coverage (ISO Form CA 0001, Code 1, Any Auto).

3. Original and Separate Additional Insured Endorsement for General Liability (ISO Form CG 20 10 11/85 or its equivalent) with primary and non-contributory language.

4. Workers' Compensation Insurance as required by the State of California including Employer's Liability coverage.

5. Original and Separate Walver of Subrogation for Workers' Compensation insurance.

Professional Liability or Errors & Omissions Liability Insurance appropriate to the CONTRACTOR'S profession (if required.)
Required Coverage Minimum Limits
Statutory limits as required by the State of California including $1 million Workers' Compensation and Employers' Liability per accident, per employee for bodily Injury or disease.

Employers' Liability IF CONTRACTOR is self-insured, provide a certificate of Permission to Self- Insure, signed by the California Department of Industrial Relations and Self- If contractor is a sole proprietor (has no employees) than General Liability 2,000,000 per occurrence for bodily injury, personal injury and propert lamage. If the policy includes a general aggregate, elther the genera (primary and excess limits aggregate shall apply separately to this project, service or location or the combined)
"mit a milton ed aggregate imit shall be twice the per accurrence Policy shall be endorsed to name the City of Richmond as an additlonal Insured per the conditions detalled below.

Type 2 - Page 1 of 3
_ Exhibit F
_ Section 8
City of Richmond - Insurance Requirements - Type 2:

Professional Services
Automobile Liability $1,000,000 per occurrence for bodily injury and property damage.

Professional Liability or Errors & PROJECT COST REQUIRED LIMIT Omissions Liability - $1 million p/o.

Required for all professionals _$1 million - $5 million $2 milion p/o including. architects, engineers, Over $5 million *5 million p/o consultants, construction
management, counselors, medical
professionals, hospitals, clinics,
attorneys and accountants, & other
consultants as may be required by
the City
Required Policy Conditions
Additional Insured Endorsement Applicable to General Liability coverage.

The City of Richmond, its officers, officials, employees, agents and volunteers are to be named as additional Insureds for all liability arising out of the operations by or on behalf of the named insured including bodily njury, deaths and property damage or destruction arising in any respec directly or indirectly in the performance of this contract ISO form CG 20 10 (11/85) or its equivalent is required. If the Contractor is supplying their product or providing a service then the endorsement must not exclude products and completed operations coverage. If it does, then CG 20 37(10/01) is also required.

SAMPLE Endorsements can be found at
http://www.ci.richmond.ca.us/index.aspx?nid=61.

Primary and Noncontributory
Waiver of Subrogation ontractor's Insurer will provide a Waiver of Subrogation in favor of the Ci Endorsement Form or Workers' Compensatlon Insurance during the life of this contrac SAMPLE Endorsements can be found at
http://www.ci.richmond.ca.us/index.aspx?nid=61.

Deductibles and Self-Insured Any deductible or self-insured retention must be declared to and approves Retentions by the City, At the option of the City elther the insurer shall reduce or eliminate such deductibles or self-insured retention as respects the City or the CONTRACTOR shall procure a financial guarantee in an amount equal to the deductible or self-insured retention guaranteeing payment of losses and related investigations, claims administratlon and defense expenses:

Contractor is responsible for satisfaction of the deductible and/or self-insured retention for each loss.

A. M. Best Rating A: VII or Better. If the A.M. Best Rating falls below the required rating, CONTRACTOR must replace coverage immedlately and provide notice to City.

Umbrella/Excess Liability Policies
If an Umbrella or Excess Liability Policy is used to meet the liability limits, coverage shall be as broad as specifiec for underlying coverage's and cover those insured In the underlying policies.

Type 2 - Page 2 of 3
Revised: September 2011
Exhibit F
Section 8
City of Richmond - Insurance Requirements - Type 2:

Professional Services
Claims-Made Policies
If any insurance policy is written on a claims-made form: 1) the retroactive date must be shown, and must be before the date of the contract or the beginning of contract work. 2) Insurance must be maintained and evidence of Insurance must be provided for at least five (5) years after completion of the contract of work, 3) If coverage is canceled or non-renewed, and not replaced with another claims-made policy form with a retroactive date pror to the contract effective date, the Contractor must purchase an extended perlod coverage for a minimum of five (5) years after completion of contract work.

Subcontractors
CONTRACTOR shall include all subcontractors as insured under its policies or shall furnish to the City for revlew and approval, separate certificates and endorsements for each subcontractor. All coverage for subcontractors shall be subject to all of the requirements stated herein.

CONTRACTOR agrees to defend and indemnify the City of Richmond for any damage resulting to it from failure of either CONTRACTOR or any subcontractor to take out or maintain the required insurance policies. The fact that Insurance is obtained by CONTRACTOR, and/or CONTRACTOR's subcontractors, will not be deemed to release or diminish the liability of CONTRACTOR, including, without limitation, liability under the indemnity provislons of this contract. Damages recoverable by CITY from CONTRACTOR or any third party will not be limited by the amount of the required insurance coverage.

Verification of Coverage
All original certificates and endorsements shall be received and approved by the City before work may beain.

The City of Richmond reserves the right to require complete, certified copies of all required insurance policies • Including endorsements affecting the coverage at any.time.

Original insurance certificates and required policy endorsements shall be mailed or delivered to the • Designated Project Manager for the City of Richmond.

Insurance certificates and endorsements may be faxed to the Designated Project Manger. However, CONTRACTOR must mail the original certificates and endorsements to Designated Project Manager once faxed.

Continuous Coverage
CONTRACTOR shall maintain the required Insurance for the life of the contract. Should the CONTRACTOR cease to have Insurance as required during this time, all work by the CONTRACTOR pursuant to this agreement shall cease until insurance acceptable to the City is provided, In the event that CONTRACTOR fails to comply with the City's insurance requirements, the City may take such action as it deems necessary to protect the City's Interests. Such action may include but is not limited to termination of the contract, withholding of payments, or other actions as the City deems approprate.

If services or the scope of work extend beyond the expiration dates of the required insurance policies initlally approved by the City, CONTRACTOR must provide updated certificates and endorsements indicating that the required coverage, terms and conditions are still in place. Renewal certificates and updated endorsements Cancellation
CONTRACTOR shall ensure that coverage shall not be cancelled, reduced or otherwise materially changed except after thirty (30) days' prior written notice has been given to the City.

Reporting Requirements
Any failure to comply with reporting or other provisions of the policles including breaches of warranties shall not affect coverage provided to the City, its officers, officials, employees or volunteers.

Consistent with Public Policy
The insuring provisions, insofar as they may be judged to be against public policy shall be void and unenforceable only to the minimum extent necessary so that the remaining terms and provisions herein may be consistent with public policy and thus enforceable.

Type 2 - Page 3 of 3