HomeMy WebLinkAboutIntermountain Claims, Inc. - Professional Services Contract For Third Party Administration Services ClaimsFOR THI
'1
PROFESSIONAL SERVICES CONT CT
PARTY ADMINIST TION SERVICES ON CLAIMS
THIS PROFESSIONAL SERVICES CONT' • CT is made and entered into by and
between the City of Yakima, a Washington municipal corporation (hereafter the "City"), and
Intermountain Claims, Inc., a corporation (hereafter the "Contractor", the "Third Party
Administrator" or the "TPA").
WHEREAS, the City of Yakima requires professional services related to Third Party
Administration Services for claims adjusting services on liability claims, including claims
investigation and review for the City of Yakima;
WHEREAS, the Contractor is in the business of providing third party claims adjusting
services and represents that it has the expertise necessary and is willing to perform the professional
services required by the City in accordance with the terms and conditions of this Contract;
NOW, THEREFORE, in consideration of the mutual covenants, promises, and
agreements set forth herein, it is agreed by and between the City and Contractor as follows:
Section 1. Statement of Work
Claims Management Services
The TPA will administer in all matters related to the processing, supervision and resolution
of City liability claims. It is the intent of this Agreement the claims services performed by
the TPA are provided in a manner compliant with industry best practices for all claims
matters. These claims services shall include the following:
A. Provide on call answering services on a 24 hour, 7 days -a -week basis to receive reports
of claims matters by the City or calls by claimants regarding claims.
B. Receive and review submitted reports of accidents, incidents, claims or cases which
may be or have the potential of becoming a claim.
C. Prepare claims reports.
D. The TPA adjuster will investigate the incident to determine legal liability and either
attempt to negotiate settlement with the claimant, or deny liability if appropriate, after
consultation with the City.
E. Assign an independent adjuster or an investigator to conduct investigation and review
of a claim, which may involve a field investigation and/or report.
F. Maintain files on each matter reported involving the City.
1
Professional Services Contract
Between City of Yakima and
Intermountain Claims, Inc.
G. Where applicable, make coverage determinations for claims based on the coverage
provided by the insurance coverage forms. It is agreed that final approval for coverage
determinations will be made by the City
H. Forward claims to the insurance carrier(s). The TPA shall proceed to adjust the claims
as per the agreements with the insurance carrier.
I. Where applicable, recommend assigning legal counsel to claims necessitating such.
J. Set and adjust reserves for open claims.
K. Retain all Release Agreements upon settlement of any claims or potential claims.
L. Provide status reports on a regular basis to the City as relating to the City's claims
matters.
M. Review claims with the City.
N. The TPA will administer in all matters related to the processing, supervision, and
resolution claims or losses that occur during the term of this Professional Services
Agreement, regardless of whether the claim or loss is considered under the terms of the
insurance policy as an occurrence or claims -made loss.
0. The TPA will administer a written claims administration program which includes, as
a minimum, the following procedures:
a) Claims filing procedures and forms.
b) Standards requiring case reserves for each claim be established.
c) Standards requiring case reserves be reviewed every ninety days or when
reasonably practicable and such review is documented in the claims diary.
d) Standards requiring appropriate adjuster workloads.
e) Standards requiring claims payment procedures include sufficient internal
controls to ensure adequate review and approval by claims management staff.
f) Standards requiring file documentation be complete and up-to-date.
g)
Standards requiring timely and appropriate claim resolution practices.
h) Standards requiring opportunities for recoveries be reviewed and documented for
each claim.
2
Professional Services Contract
Between City of Yakima and
Intermountain Claims, Inc.
i) Standards requiring compliance with Internal Revenue Service (IRS) rules for
1099MISC regulations, and all other applicable government regulations.
j)
Standards requiring claims files be audited on the following categories: Staffing,
caseloads, supervision, diary, coverage, reserves, promptness of contacts, field
investigations, file documentation, settlements, litigation management and
subrogation.
1.3 Contractor shall provide the services and staff described in the text of the Professional
Services Contract, including the services described in Attachment A entitled "Pricing
Schedule", which is incorporated herein by this reference. The Professional Services
Contract and Attachment A are referred to herein as the "Contract." The Contract specifies
the working relationship between the City and the Contractor, and specific obligations of
both parties.
1.4 The parties acknowledge that there are no other representations, agreements, or conditions
not specifically referred to or set forth in the foregoing documents which are a part of this
Contract.
1.5 Except as otherwise specifically provided in this Contract, Contractor shall furnish the
following, all as the same may be required to perform the services described in this
Contract, including Attachment A to the Contract: personnel, labor and supervision; and
technical, professional and other services. All such services, property and other items
furnished or required to be furnished, together with all other obligations performed or
required to be performed, by Contractor under this Contract are sometimes collectively
referred to in this Contract as the "Services."
1.6 All provisions of this Contract are intended to be complementary, and any Services
required by one and not mentioned in another shall be performed to the same extent as
though required by all. Details of the Services that are necessary to carry out the intent of
this Contract, but that are not expressly required, shall be performed by Contractor as part
of the Services referred to in this Contract.
Section 2. Period of Performance
2.1 The period of performance under this Contract will be three (3) years, commencing on
December 1, 2019, and continuing through November 30, 2022. An additional extension
of two (2) years may be offered, at the option of the City, making the total contract term
five (5) years, to November 30, 2024. In the event the City elects to extend the Contract
for an additional two-year (2 -year) term, the City shall provide written notice to the
Contractor at least ninety (90) days prior to the end of the initial three-year (3 -year)
Contract period, or on or before August 31, 2022. The three-year term of the Contract is
subject to an option to extend for an additional two (2) years if the City and Contractor can
3
Professional Services Contract
Between City of Yakima and
Intermountain Claims, Inc.
reach a mutually satisfactory agreement on the value of the services for the additional two-
year (2 -year) period.
Section 3. Compensation
3.1 As full compensation for satisfactory performance of the Services, City shall pay
Contractor as described in Attachment A on the Pricing Schedule. At the end of this term,
the parties may extend this Contract under terms and conditions then agreed. The three-
year term of the Contract is subject to an option to extend for an additional two (2) years if
the City and Contractor can reach a mutually satisfactory agreement on the value of the
services for the additional two-year (2 -year) period and as provided in Section 2.1 above.
3.3 City of Yakima shall pay each of Contractor's invoices within thirty (30) days after the
City's receipt and verification thereof; provided, however, that all such payments are
expressly conditioned upon Contractor providing services hereunder that is satisfactory to
the City.
3.4 Any additional service(s) provided by the Contractor which are to be paid by the City must
have prior written approval of the City.
Section 4. Performance by Contractor
4.1 Delegation of Professional Services. The services provided for herein shall be performed
by Contractor, and no person other than regular associates or employees of Contractor shall
be engaged on such work or services. Contractor shall not (by contract, operation of law
or otherwise) delegate or subcontract performance of any Services to any other person or
entity without the prior written consent of the City. Any such delegation or subcontracting
without the City's prior written consent shall be voidable at the City's option.
No delegation of subcontracting of performance of any of the Services, with or without the
City's prior written consent, shall relieve Contractor of its responsibility to perform the
Services in accordance with this Contract. Contractor shall be fully responsible for the
performance, acts and omissions of Contractor's employees, Contractor's subcontractors,
and any other person who performs or furnishes any Services (collectively, the "Support").
4.2 Contractor shall at all times be an independent contractor and not an agent or representative
of the City with regard to performance of the Services. Contractor shall not represent that
it is, nor hold itself out as, an agent or representative of the City. In no event shall
Contractor be authorized to enter into any agreement or undertaking for or on behalf of the
City.
4.3 Contractor shall perform the Services in a timely manner and in accordance with the
standards of the profession. At the time of performance, Contractor shall be properly
licensed, equipped, organized, and financed to perform the Services in accordance with
4
Professional Services Contract
Between City of Yakima and
Intermountain Claims, Inc.
this Contract. Subject to compliance with the requirements of this Contract, Contractor
shall perform the Services in accordance with its own methods.
4.4 Contractor shall take all reasonable precautions to protect against any bodily injury
(including death) or property damage that may occur in connection with the Services.
Section 5. Compliance with Laws
5.1 Contractor shall comply with all applicable laws, ordinances, rules, regulations, orders,
licenses, permits, and other requirements, now in effect, of any governmental authority
(including, but not limited to, such requirements as may be imposed upon the City and
applicable to the Services). Contractor shall furnish such documents as may be required to
effect or evidence such compliance. All laws, ordinances, rules and orders required to be
incorporated in agreements of this character are incorporated in this Contract by this
reference.
Section 6. Taxes and Assessments
6.1 Contractor shall be solely responsible for and shall pay all taxes, deductions, and
assessments, including but not limited to federal income tax, FICA, social security tax,
assessments for unemployment and industrial injury insurance, and other deductions from
Contractor's employees' income which may be required by law or assessed against either
party as a result of this Contract. In the event the City is assessed a tax or assessment for
Contractors' employees as a result of this Contract, Contractor shall pay the same before it
becomes due.
Section 7. Nondiscrimination Provision
7.1 During the performance of this Contract, Contractor shall not discriminate in violation of
any applicable federal, state and/or local law or regulation on the basis of race, age, color,
sex, religion, national origin, creed, marital status, disability, honorably discharged veteran
or military status, pregnancy, sexual orientation, political affiliation, or the presence of any
sensory, mental or physical handicap, and any other classification protected under federal,
state, or local law. This provision shall include but not be limited to the following:
employment, upgrading, demotion, transfer, recruitment, advertising, layoff or
teimination, rates of pay or other forms of compensation, selection for training, and the
provision of Services under this Contract.
Section 8. Records
8.1 Contractor will keep accurate records and books for all work provided under this agreement
with the City. The records of Contractor relating to the services pursuant to the contract
shall, at all times, be subject to inspection by the City. Contractor shall promptly furnish
the City with such information and records which are related to the services as may be
5
Professional Services Contract
Between City of Yakima and
Intermountain Claims, Inc.
requested by the City. At the City's request and at the City's cost, Contractor will permit
the city to inspect, audit and copy all pertinent books and records of Contractor related to
the work performed for and charged to the City, at any and all times deemed necessary by
the City.
8.2 Until the expiration of six years after final payment of the compensation payable for the
engagement, or for a longer period if required by the Washington State Local Government
Common Records Retention Schedule ("CORE") of the Office of the Secretary of State,
Washington State Archives, Contractor shall retain and provide the City access to (and the
City shall have the right to examine, audit and copy) Contractor's documents, papers and
records which are related to the services performed by Contractor.
Section 9. Confidentiality of Information
This Contract provides for the confidentiality of the City's claims information, program
data and other intellectual property of the program developed or shared during the course
of the Agreement, subject to the requirements of the law. The TPA shall not, without the
prior written consent of the City, disclose to third parties, other than insurance companies
or brokers of record for insurance coverage placement purposes, claims information, claims
data and any other confidential information received in connection with the services
pursuant to this Agreement unless:
9.1 information is known to the TPA prior to receiving the same directly or indirectly in
connection with the services; or
9.2 information is in the public domain at the time of disclosure by the TPA; or
9.3 information is received by the TPA from a third party who does not have an obligation to
keep the same confidential; or
9.4 information is provided to an auditor as required by law or who has been retained by the
City; or
9.5 information is required to be produced pursuant to a Washington Public Records Act
request, a subpoena authorized by law, or a court order. The TPA shall give to the City
notice of any judicial proceeding seeking disclosure of such information; or
9.6 information is required to be produced by federal or state law.
Section 10. Indemnification and Hold Harmless
10.1 Contractor agrees to protect, defend, indemnify, and hold harmless the City of Yakima, its
elected and appointed officials, officers, employees and agents from any and all claims,
demands, losses, liens, liabilities, penalties, fines, lawsuits, and other proceedings and all
6
Professional Services Contract
Between City of Yakima and
Intermountain Claims, Inc.
judgments, awards, costs and expenses, including reasonable attorneys' fees and
disbursements, which result or arise out of the negligent acts or omissions, if any, of the
Contractor, its officers, officials, employees, agents, and/or subcontractors in connection
with the performance or non-performance of this Contract.
10.2 The City agrees to protect, defend, indemnify, and hold harmless the Contractor from any
and all claims, demands, losses, liens, liabilities, penalties, fines, lawsuits, and other
proceedings and all judgments, awards, costs and expenses, including reasonable attorneys'
fees and disbursements, which result or arise out of the negligent acts or omissions, if any,
of the City, its officers, officials, employees, agents, and/or subcontractors in connection
with this Contract.
10.3 In the event the City provides to the Contractor specific instructions for handling the City's
claims, such instructions will comply with relevant state laws and regulations. The City
will indemnify and hold harmless the Contractor with respect to damages, judgments, fines,
penalties, fees, and liability or bad faith claims incurred solely as a result of Contractor's
utilization of the City's instructions that do not comply with relevant state laws, rules or
regulations.
10.4 Nothing contained in this Section or this Contract shall be construed to create a liability or
a right of indemnification in any third party.
Section 11. Insurance Provided by Contractor
At all times during performance of the Services, the Contractor shall secure and maintain
in effect insurance to protect the City and the Contractor from and against all claims,
damages, losses, and expenses arising out of or resulting from the performance of this
Contract. Contractor shall provide and maintain in force insurance in limits no less than
that stated below, as applicable. The City reserves the right to require higher insurance
limits should it deem it necessary in the best interest of the public. If in the future the City
requires higher limits of insurance in Section 11 which result in a significant insurance
premium increase to Contractor, an equitable adjustment in the compensation under this
Contract shall be negotiated to reflect such increase, and this Contract shall be modified in
writing with an amendment to reflect an increase to Contractor's compensation.
11.2 Commercial Liability Insurance. Before this Contract is fully executed by the parties,
Contractor shall provide the City with a certificate of insurance as proof of commercial
liability insurance with a minimum liability limit of Five Million Dollars ($5,000,000.00)
per occurrence combined single limit bodily injury and property damage, and Five Million
Dollars ($5,000,000.00) general aggregate. This insurance requirement can be satisfied
with a combination of commercial general liability insurance and excess or umbrella
liability insurance coverage. If Contractor carries higher coverage limits, such limits shall
be shown on the Certificate of Insurance and Endorsements and the City of Yakima, its
elected and appointed officials, officers, agents, and employees shall be named as
7
Professional Services Contract
Between City of Yakima and
Intermountain Claims, Inc.
additional insureds for such higher limits. The certificate shall clearly state who the
provider is, the coverage amount, the policy number, and when the policy and provisions
provided are in effect. Said policy shall be in effect for the duration of this Contract. The
policy and Endorsements shall name the City of Yakima, its elected and appointed officials,
officers, agents, and employees as additional insureds, and shall contain a clause that the
insurer will not cancel or change the insurance without first giving the City fifteen (15)
calendar days prior written notice. The insurance shall be with an insurance company or
companies rated A -VII or higher in Best's Guide and admitted in the State of Washington.
11.3 Commercial Automobile Liability Insurance, Before this Contract is fully executed by the
parties, Contractor shall provide the City with a certificate of insurance as proof of
commercial automobile liability insurance with a minimum liability limit of Five Million
Dollars ($5,000,000.00) per occurrence combined single limit bodily injury and property
damage. This insurance requirement can be satisfied with a combination of automobile
liability insurance and excess or umbrella liability insurance coverage. If Contractor
carries higher coverage limits, such limits shall be shown on the Certificate of Insurance
and Endorsements and the City of Yakima, its elected and appointed officials, officers,
agents, and employees shall be named as additional insureds for such higher limits.
Automobile liability will apply to "Any Auto" and be shown on the certificate. The
certificate shall clearly state who the provider is, the coverage amount, the policy number,
and when the policy and provisions provided are in effect. Said policy shall be in effect
for the duration of this Contract. The policy and Endorsements shall name the City of
Yakima, its elected and appointed officials, officers, agents, and employees as additional
insureds, and shall contain a clause that the insurer will not cancel or change the insurance
without first giving the City fifteen (15) calendar days prior written notice. The insurance
shall be with an insurance company or companies rated A -VII or higher in Best's Guide
and admitted in the State of Washington.
11.4 Professional Liability Insurance. Before this Contract is fully executed by the parties,
Contractor shall provide the City with a certificate of insurance as evidence of Professional
Errors and Omissions Liability Insurance with coverage of at least Five Million Dollars
($5,000,000.00) per occurrence and an annual aggregate limit of at least Five Million
Dollars ($5,000,000.00). If Contractor carries higher coverage limits, such limits shall be
shown on the Certificate of Insurance and Endorsements. The certificate shall clearly state
who the provider is, the amount of coverage, the policy number, and when the policy and
provisions provided are in effect. It is understood and agreed that the Contractor is part of
a risk pool for errors and omissions coverage and excess coverage is provided through
Swiss Reinsurance The insurance shall be with an insurance company rated A -VII or
higher in Best's Guide. If the policy is on a claims made basis, the retroactive date of the
insurance policy shall be on or before the inception date of the Contract, or shall provide
full prior acts. The insurance coverage shall remain in effect during the term of this
Contract and for a minimum of three (3) years following the termination of this Contract.
8
Professional Services Contract
Between City of Yakima and
Intermountain Claims, Inc.
11.5 Cyber Liability with Privacy Injury & Network Security Insurance. Before this Contract
is fully executed by the parties, Contractor shall provide the City with a certificate of
insurance as proof of Cyber Liability with Privacy Injury & Network Security Insurance
with coverage of at least Three Million Dollars ($3,000,000.00). If Contractor carries
higher coverage limits, such limits shall be shown on the Certificate of Insurance and
Endorsements. The certificate shall clearly state who the provider is, the amount of
coverage, the policy number, and when the policy and provisions provided are in effect.
The insurance coverage shall remain in effect for the duration of this Contract.
Section 12. SCHIP Mandatory Insurer Reporting
12.1 Under the conditions set forth below, the Contractor will provide Client Mandatory Insurer
Reporting pursuant to the requirements imposed by the Medicare, Medicaid, and the State
Children's Health Insurance Program (SCHIP) Extension Act of 2007. The Contractor
contracts with ExamWorks Clinical Solutions, LLC (referred to in this Contract as
"ExamWorks"), which is a company that represents that it provides Medicare compliance
services, including Workers' Compensation and Liability Medicare Set -Asides,
Lien/Conditional Payment Resolution and related services, and which will perform the
duties of the Reporting Agent and Account Manager on behalf of the City. The contract
with ExamWorks requires the Contractor to provide specific detailed claims information
to ExamWorks as is required by SCHIP. In turn, ExamWorks will comply with the SCHIP
Mandatory Insurer Reporting requirements in accordance with their contract with the
Contractor.
12.2 In order for Intermountain to provide SCHIP Mandatory Insurer Reporting services and to
ensure reporting compliance the City agrees to the following conditions: 1) fulfill its
necessary obligations as a Responsible Reporting Entity (RRE); 2) determine its reporting
structure and register on the Coordination of Benefits Secure Website (COBSW), obtaining
the necessary RRE-ID(s) relevant to the claims that are handled by the Contractor; 3) name
ExamWorks as the Registered Agent and the Account Manager for the relevant RRE-ID(s);
4) ensure that all reportable claims have been submitted to the Contractor and are entered
in Contractor's electronic claims management system; 5) fully cooperate with the
Contractor and ExamWorks to provide or collect any claim information or other necessary
data to ensure that the reporting is proper, correct and timely; 6) communicate to the
Contractor any changes in the City's RRE Reporting profile information, including contact
changes or termination notices, or any other changes that may affect the Contractor or
ExamWorks' ability to accurately report on behalf of the City.
12.3 Contractor and ExamWorks will not be responsible for any fines or penalties incurred
which are caused by the City's action or inaction, including but not limited to: 1) any claims
that have not been previously reported by the City to the Contractor and are not entered in
the Contractor's electronic claims management system; 2) missing claims information that
is or has been requested by the Contractor which is not provided by the City in a timely
fashion to ensure compliant reporting; or 3) claims information or data supplied to the
9
Professional Services Contract
Between City of Yakima and
Intermountain Claims, Inc.
Contractor by the City that is invalid or in error; 4) for any claims that become reportable
due to a payment issued directly by the City and not issued by the Contractor.
Section 13. Changes
13.1 The City may, at any time by written notice thereof to Contractor, make changes in the
Services within the general scope of this Contract (including, but not limited to, additions
to or deletions from any Services, suspension of performance and changes and location of
performance).
13.2 If any change under paragraph 13.1 causes a significant increase or decrease in the cost of
the time required for performance of the Services, an equitable adjustment in the
compensation and schedules under this Contract shall be negotiated to reflect such increase
or decrease, and this Contract shall be modified in writing accordingly by an amendment
to the Contract in Attachment A, the Pricing Schedule. Such equitable adjustment shall
constitute full compensation to Contractor for such change. If any change under paragraph
13.1 results in a decrease in the Services to be performed, Contractor shall not be entitled
to anticipated profit on Services not performed and the loss of anticipated profit shall not
reduce the decrease in compensation under this Contract resulting from such exchange.
Further, Contractor shall not be entitled to any reallocation of cost, profit or overhead.
13.3 Notwithstanding any dispute or delay in arriving at a mutually acceptable equitable
adjustment under paragraph 13.2, Contractor shall immediately proceed with performance
of the Services as changed pursuant to paragraph 13.1. If Contractor intends to assert a
claim for equitable adjustment under paragraph 13.2, Contractor must, within sixty (60)
days after Contractor's receipt of any notice under paragraph 13.1 that does not set forth
an acceptable adjustment, submit to the City a written statement of the basis and nature of
the adjustment claimed. Contractor shall not be entitled to any adjustment unless such
written statement is submitted by Contractor to the City within the applicable period. If
such timely written statement is submitted by Contractor to the City, the City must, within
thirty (30) days after receipt of Contractor's request for an equitable adjustment, respond
in writing to the request. If the amount of an equitable adjustment cannot be agreed upon
by the parties, either party has the right to terminate the Contract pursuant to Section 14
entitled "Termination" in the Contract.
Section 14. Termination
14.1 The City may, by giving the Contractor sixty (60) calendar days written notice of
termination, terminate this Contract as to all or any portion of the Services not then
performed, whether or not Contractor is in breach or default, and with or without cause.
Upon receipt of any such notice of termination, Contractor shall, except as otherwise
directed by the City, immediately stop performance of the Services to the extent specified
in such notice. Contractor shall have the same termination rights as the City in Section 14.
10
Professional Services Contract
Between City of Yakima and
Intermountain Claims, Inc.
14.2 In the event of telinination pursuant to paragraph 14.1, an equitable adjustment shall be
made in the compensation payable to Contractor under this Contract, provided that such
compensation as so adjusted shall in no event exceed a percentage of the total
compensation otherwise payable under this Contract equal to the percentage of the Services
satisfactorily completed at the time of termination. Further, Contractor shall not be entitled
to any reallocation of cost, profit or overhead. Contractor shall not in any event be entitled
to anticipated profit on Services not performed on account of such termination. Contractor
shall use its best efforts to minimize the compensation payable under this Contract in the
event of such termination.
14.3 If the City purports to terminate or cancel all or any part of this Contract for Contractor's
breach or default when Contractor is not in breach or default which would permit such
termination or cancellation, such termination or cancellation shall be deemed to have been
a termination by the City pursuant to paragraph 14.1 and the rights of the parties shall be
determined accordingly
Section 15. Miscellaneous
15.1 Assignment. This Contract, or any interest herein, or claim hereunder, shall not be assigned
or transferred in whole or in part by Contractor to any other person or entity without the
prior written consent of the City. In the event that such prior written consent to an
assignment is granted, then the assignee shall assume all duties, obligations, and liabilities
of Contractor stated herein.
15.2 No Conflict of Interest. Contractor represents that it or its employees do not have any
interest and shall not hereafter acquire any interest, direct or indirect, which would conflict
in any manner or degree with the performance of this Contract. Contractor further
covenants that it will not hire anyone or any entity having such a conflict of interest during
the performance of this Contract.
15.3 No Insurance. It is understood that the City does not maintain liability insurance for
Contractor and/or its employees.
15.4 Severability. If any portion of this Contract is changed per mutual agreement or any portion
is held invalid, the remainder of the Contract shall remain in full force and effect.
15.5 Integration. This written document constitutes the entire agreement between the City and
Contractor. There are no other oral or written Contracts between the parties as to the
subjects covered herein. No changes or additions to this Contract shall be valid or binding
upon either party unless such change or addition be in writing and executed by both parties.
15.6 Notices. Unless stated otherwise herein, all notices and demands shall be in writing and
sent or hand delivered to the parties to their addresses as follows:
11
Professional Services Contract
Between City of Yakima and
Intermountain Claims, Inc.
TO CITY: Finance & Budget Director AND TO:
City of Yakima Finance Department
City Hall — First Floor
129 North Second Street
Yakima, WA 98901
TO CONTRACTOR:
Mark Ingersoll, President
Intermountain Claims, Inc.
1543 E. 3300 South
Salt Lake City, Utah 84106
City Attorney
City of Yakima Legal Department
200 South Third Street
Yakima, WA 98901
or to such other addresses as the parties may hereafter designate in writing. Notices and/or
demands shall be sent by registered or certified mail, postage prepaid, or hand delivered.
Such notices shall be deemed effective when hand delivered at the addresses specified
above, or three (3) days after the date of mailing to the addresses specified above.
15.7 Governing Law. This Contract shall be governed by and construed in accordance with the
laws of the State of Washington.
15.8 Venue. The venue for any action to enforce or interpret this Contract shall lie in the
Superior Court of Washington for Yakima County, Washington.
CITY OF YAKIMA
By
INTE
OUNTAIN CLAIMS, INC.
Alex M yerhoff, I
Date:
int Ci Manager
Mark nge soli, President
Date:
ATTEST:
Byt ).‘
&Is; Clerk
City Contract No. 2020- OW
Professional Services Contract
Between City of Yakima and
Intermountain Claims, Inc.
12
STATE OF UTAH
) ss.
COUNTY OF SALT LAKE
I hereby certify that I know or have satisfactory evidence that Mark Ingersoll is the person
who appeared before me, and said person acknowledged that he signed this instrument, and on
oath stated that he was authorized to execute the instrument and acknowledged it as the President
of Intermountain Claims, Inc. to be the free and voluntary act of such party for the uses and
purposes mentioned in the instrument.
DATED this 1,5 day of April, 2020.
Notary Public
JULIE ANDERSON MOORE
COMMISSION NUMBER 6985771
My Callon Expires
Jarwary 22, 2022
OF
T
MOM WM. *MO 4.466.0.4, BOHM Nagi. on!
Professional Services Contract
Between City of Yakima and
Intermountain Claims, Inc.
tittandillA FY)
Prin Name:titiv.40(1-6/3twi Prole,
NOTARY PUBLIC in and for the State of
Utah, residing at —5
4/2
My appointment expires.
13
ATTACHMENT A
TO PROFESSIONAL SERVICES CONTRACT FOR THIRD PARTY
ADMINISTRATION SERVICES ON CLAIMS
PRICING SCHEDULE
In addition to the services provided by the Third Party Administrator, Intermountain Claims, Inc.,
in Section 1 of the Contract, services at the listed fees include the following as described in this
Attachment A, the Pricing Schedule, which is incorporated by reference into the Professional
Services Contract.
Intermountain Claims, Inc. (referred to as "Intermountain") will bill the City of Yakima (referred to
as the "City") on a monthly basis a flat fee per claim of $675 for each new claim filed in the prior
thirty days.
Intermountain will charge the flat fee of $675.00 for any type of claim filed. An occurrence may
involve multiple third -party individuals making a claim. Each individual claim file where the
incident or occurrence has up to six claimants will be subject to the flat rate fee, except for a
situation involving seven or more claimants as described below in the following paragraph.
Claims where the incident or occurrence has up to six claimants that remain open after 2 years
will be billed at a rate of $350.00 per year.
In an incident or occurrence which involves seven or more claimants, Intermountain will charge
one flat fee of $675 for the incident or occurrence, and then will bill the City based on time and
expenses rather than a flat fee for each claim, with the hourly rate and expenses billed as
described in this Attachment A, the Pricing Schedule.
In addition to the base fee, each fee is identified and itemized that is charged in addition
to the base fee above is listed in the pricing table below.
1
Included Services
Fee per claim (base fee)
Third Party Claims Administration.
This includes set up and handling of
all new claims received as well as
the previously incurred claims.
Cost
$675.00 per claim
Notes
The per claim fee shall be
charged for each new claim
received. The fixed per
claim fee includes the costs
of handling the existing
open run-in claims, as well
as the new claims received
during the term of the
Agreement. It does not
include the Outside of
Office Activities listed
below. Claims open over
two years shall be billed at
an additional $350 per year
or any part thereof.
(However, if an incident or
occurrence involves more
than six claims, refer to the
fourth paragraph at the top
of page 1 of the Pricing
Schedule.)
Included
Account Management
Outside Activity
(any activity not addressed
elsewhere in the pricing schedule)
Included
Time & Expense:
All- inclusive rate of
$98.00 per hour, plus
mileage.
Based on time incurred.
Mileage incurred per claim
will be billed at the Internal
Revenue Service ("IRS)
mileage rate at the time of
the travel (referred to as the
"IRS mileage rate").
Property Damage Appraisal.
(City requested appraisal only.
Property appraisal to include
necessary photographs to
sufficiently document damage
incurred, file set up, mileage, and all
office/clerical charges)
Time & Expense:
All-inclusive rate of
$98.00 per hour, plus
mileage.
2
Based on time incurred.
Mileage incurred per claim
will be billed at the IRS
mileage rate.
Included Services
Vehicle Damage Appraisal.
(City requested appraisal only.
Vehicles contained in Audatex
database or similar, photographs,
file set up, mileage, and all
office/clerical charges)
Incident Investigation and
Reporting.
(Non -claims investigation and
written report within 14 days of
assignment)
Emergency Investigation callouts
after normal business hours and on
weekends.
(Emergency contact process is
described in the Notes column)
Claim Index fee
Records Retention/File Storage
Cost
$125.00 Flat Fee
Time & Expense:
All-inclusive rate of
$98.00 per hour.
Time and Expense at all-
inclusive rate of $98.00
per hour during regular
business hours and $147
per hour after normal
business hours.
Notes
Mileage over 20 miles
billed at the IRS mileage
rate and $98.00 hour drive
time.
Appraiser time at $98.00
per hour for activity above
the appraisal.
Expenses incurred for total
loss evaluation by ADP or
other vendors at prevailing
vendor rate.
Based on time incurred.
Based on time incurred.
City may contact account
manager or lead adjuster if
account manager is
unavailable. Email, cell
phone or text messaging is
available.
Alternatively, calls to
Intermountain office after
hours' line will be routed to
an on-call adjuster.
$50.00 per indexed
search.
Included
In -House Subrogation Investigation Included
3
Index performed on bodily
injury claims, as needed.
Intermountain charges the
client 25% of any recovery
in a complex matter, if
preapproved by City. In a
routine matter, services are
billed at $98.00 per hour.
Included Services
Access to TPA RMIS system
Third Party Administrator (TPA)
Risk Management Information
Systems (RMIS)
Cost
2 users included at no
additional charge
Data transfer to City RMIS system
(daily) to include pertinent file notes,
if requested
Risk Management Information
Systems (RMIS)
Integration with City RMIS system
Surveillance Services
RMIS and Report Training/
Information Assistance
Excess Carrier Reporting
$200.00 per month
Notes
Additional users will be
charged at $500.00 per
user per year.
The initial set up fee as
invoiced by RMIS
vendor.
Billed at prevailing
vendor hourly rate
Included if provided in-
house
Flat fee. Includes one each
incoming and outgoing
data files per day.
Paid as an allocated
expense on the claim file.
If RMIS developer
assistance required billed
at $225 per hour.
Included
Monthly Reports to include Loss
Run
Quarterly closed claims reports
Claim Reviews (by phone)
Translation Services for LEP
Claimants.
Limited English Proficiency (LEP)
Included
Included
Quarterly by
phone included.
If Bi -Weekly is
requested: $350.00
As incurred. Billed at the
prevailing vendor hourly
rate.
4
Quarterly claim reviews
included. Additional claim
reviews are available, if
requested, and are billed at
$350.00 each.
Paid as an allocated claim
expense on the claim file.
Included Services
Section III Mandatory Insurer
Reporting RRE registration
Responsible Reporting Entity (RRE)
Cost
Included
Notes
Included if the City is using
the same RRE number for
liability claims as is used for
the City of Yakima workers'
compensation program. If
the City elects to obtain an
additional RRE number for
liability claims, the City will
be responsible for costs
incurred related to that new
RRE number.
MMSEA Reporting
Medicare, Medicaid, and State
Children's Health Insurance
Program (SCHIP) Extension Act of
2007 (MMSEA)
ExamWorks filing of Medicare
Secondary Payer Conditional
Payment Appeals/Disputes,
Preparation of LMSA
Allocation/Conditional Payment
Research
Included
As incurred
Intermountain will provide
Mandatory Insurer
Reporting pursuant to the
requirements Section 111
of the MMSEA/SCHIP
Extension Act of 2007.
Intermountain will process
Medicare Secondary Payer
Recovery Claim Dispute/
Appeals on behalf of City of
Yakima.
Paid off the claim file as an
allocated expense
Ad Hoc Reporting and Programming Billed to the City of
Costs Yakima at the prevailing
cost to Intermountain
"Ad Hoc" (currently $225.00 per
hour).
Report not in current production,
which is created from start upon
request
5
Intermountain Claims can
create a variety of ad-hoc
reports which typically
meet the client's reporting
needs. However, if
Intermountain is required
to utilize the system
developer to create special
reports or special
programming to meet the
City's reporting needs, the
service will be charged at
$225.00 per hour.
included Services
Any other services and expenses
not listed above but are provided by
TPA and may be of value to the City
of Yakima program:
After Hours
• Expert Witness and Court
Appearance
• Mediation
Cost
$147.00 per hour
$175.00 per hour
$125.00 per hour
6
AMENDMENT NO. 1 TO CITY OF
YAKIMA CONTRACT NO. 2020-068
WHEREAS, Intermountain Claims, Inc. ("Intermountain") and the City of Yakima ("City") entered
into City of Yakima Contract No. 2020-068 for Third-Party Administration Services on Claims
("Agreement") on April 13, 2020; and
WHEREAS, the Section 2.1 of the Agreement gives the City the option to extend the term of the
Agreement for an additional two-year period through November 30, 2024 subject to agreement
between the parties on the value of services for the additional period; and
WHEREAS, the City has elected to exercise its option to extend the contract and the parties
have agreed on the value of services;
THEREFORE, the Agreement shall be extended for an additional two years, through November
30, 2024, subject to all the terms contained therein, with the exception of ATTACHMENT A to
the Agreement, containing the pricing schedule, which is amended as follows:
1. The referenced per claim amount of$675 is increased to $715, and the referenced open
claim amount of$350 is increased to $375;
2. The rates referenced in the pricing table of ATTACHMENT A shall be replaced with the
rates referenced in the "Billing Schedule" and "Auto & Heavy Equipment Per Vehicle
Rate Sheet" attached to this Amendment and incorporated herein by reference.
This amendment shall become effective once authorized signatories of both Intermountain and
the City of Yakima have signed this Amendment.
CITY OF YAKIMA INTERMOUNTAIN
By:��G ' `t
y By: *
Aft
City Manager Title .. 7 1
Date: 142 l ' O Date: - k' 2_022--
ATTEST:
\OP"
* . 1�1
�wj-�r i 1' . " •.:40ii CITY CONTRACT NO.:2GU^OI,nS'C er i-
Sonya Cla-r Tee, City Ie • S
•'� INTERMOUNTAIN AUTO & HEAVY EQUIPMENT
® PER VEHICLE RATE SHEET
v. July 1, ,2022
Page 1 of 2
AUTOMOBILE APPRAISAL
Service Price Method
Standard Auto Appraisal Includes 20 miles free, photos, repair estimate, and 130.00 Flat Fee
administrative services.Applies only to vehicles included in the "CCC"database. All
others invoiced at Time& Expense Rates below.
Additional Mileage 0.69 Per Mile
Additional Drive Time after first 20 miles 89.00 Per Hour
TIME & EXPENSE RATES/ADDITIONAL SERVICES
ADJUSTER
Service Price Method
Standard &Specialty Vehicle Adjuster Rate * 89.00 Per Hour
Heavy Equipment Adjuster Rate * 96.00 Per Hour
Supplemental Inspection (When necessary to document hidden damages.) 75.00 Flat Fee
Mileage .69 Per Mile
Photos(Maximum Charge $20.00) 1.00 Per Photo
*Adjuster rates apply to phone&drive time(using Google Maps).
ADMINISTRATIVE
Initial File Set Up Clerical 54.00 Flat Fee
Initial File Set-Up Phone Time 10.00 Flat Fee
Additional Administrative 54.00 Per Hour
Postage Handling (in addition to postage cost) .50 Per Parcel
Long Distance Charges where applicable 1.00 .1 Hour
TOTAL LOSS CONSIDERATIONS
Condition Report 15.00 Flat Fee
Actual Cash Value Report 20.00 Flat Fee
"CCC"Valuation for ACV (Using ICI Account) See Fee Schedule Below
Non "CCC"Valuation for HE/Specialty Vehicles Adj Rate Per Hour
Diminished Value Evaluation Adj Rate Per Hour
3 Salvage Bids—Standard Vehicles Only. All others @ T& E. 25.00 Flat Fee
Salvage Handling (T& E—Standard or HE Adjuster Rate where applicable) Adj Rate Per Hour
PPV Branded Title 75.00 Flat Fee
Submit claims to: claims@intermountainclaims.com 1.800.349.0373
Property &Casualty I Workers' Compensation I Specialty Services
EIN#82-0360635
AtAkINTERMOUNTAIN AUTO & HEAVY EQUIPMENT
PER VEHICLE RATE SHEET
v. July 1, ,2022
Page 2 of 2
CCC VALUATION
(Provided using Intermountain Claims' Account. Adjuster Rate for time obtaining, not included.)
VALUATION TYPES
Private Passenger Vehicle (PPV) 44.50 Flat Fee
Commercial & Recreational Vehicles (CRV)
Motorcycles 40.00 Flat Fee
Personal Watercraft and Snowmobiles 50.00 Flat Fee
Specialty Automobiles &Vehicles 125.00 Flat Fee
Conversion Vans 125.00 Flat Fee
Trailers&Travel Trailers 25.00 Flat Fee
Large Trucks, Tractors, RV's, Construction Equipment Farm Machinery, etc. 125.00 Flat Fee
Manufactured Housing(Modular Homes) 200.00 Flat Fee
Boats—up to 30 feet 125.00 Flat Fee
Boats—30—65 feet 200.00 Flat Fee
Branded Title 75.00 Flat Fee
ADDITIONAL VALUATION SERVICE FEES
Telephone or Facsimile Submittal and Retrieval 2.50 Flat Fee
Settlement Tracking Report System 1.50 Flat Fee
Guidebook Reference Amount 1.50 Flat Fee
External Title Data 1.00 Flat Fee
Submit claims to: claims@intermountainclaims.com 1.800.349.0373
Property&Casualty I Workers' Compensation I Specialty Services
EIN#82-0360635
.: INTERMOUNTAIN BILLING SCHEDULE
♦ v July 1,2022
ADJUSTER RATES
Service Adjuster Price Per Hour* All-Inclusive**
Workers' Compensation Examiner 89.00 106.00
Nurse Case Manager 102.00 124.00
Property Adjuster 89.00 106.00
Large Loss Adjuster 111.00 134.00
Liability Adjuster 89.00 111.00
Construction Defect 111.00 134.00
Cargo 96.00 115.00
Origin &Cause Investigations 178.00 211.00
Origin &Cause Deposition/Trial Testimony*** 227.00 271.00
Mediation/Appraisal Clause 135.00
Expert Witness 190.00
Auto& Heavy Equipment See Auto Rate Sheet
* After hours emergency call out;1.5X the applied hourly rate.
** All-Inclusive rate includes file set up, administrative charges, and phone. Drive time and mileage will be charged at
adjuster rate.
*** Deposition/Testimony:minimum%day(4 hours)charge plus expenses. Exceeding four hours is a full day(8 hours)
charge plus expenses.
ADDITIONAL CHARGES
ADJUSTER
Service Price Method
Minimum Mileage Charge (up to 20 miles) 13.80 Flat Fee
Mileage (greater than 20 miles) .69 Per Mile
Drive Time (via Google Maps) Adjuster Rate Per Hour
Phone Time Adjuster Rate Per Hour
Photos(Maximum Charge $20.00) 1.00 Per Photo
ADMINISTRATIVE
Initial File Set Up Clerical 54.00 Flat Fee
Initial File Set-Up Phone Time 10.00 Flat Fee
Additional Administrative 54.00 Per Hour
Photocopies (first 25 free) .25 Per Page
Postage Handling(in addition to postage cost) 1.00 Per Parcel
Long Distance Charges where applicable 1.00 Per Tenth Hour
EVIDENCE RETENTION
Small Storage 40.00 Monthly
Large Storage 55.00 Monthly
Submit claims to: claims@intermountainclaims.com 1.800,349.0373
Property & Casualty I Workers' Compensation I Specialty Services
EIN#82-0360635
AMENDMENT NO. 2 TO CITY OF
YAKIMA CONTRACT NO. 2020-068
WHEREAS, Intermountain Claims, Inc. ("Intermountain") and the City of Yakima ("City") entered
into City of Yakima Contract No. 2020-068 for Third-Party Administration Services on Claims
("Agreement") on April 13, 2020; and
WHEREAS, the parties intend to extend the Agreement for an additional two-year term;
THEREFORE, the Agreement is amended as follows:
1. Section 2.1 of the Agreement is stricken and replaced with:
The period of performance under this Contract will be two years, commencing on
December 1, 2024, and continuing through November 30, 2026.
2. The current per claim compensation of$715 is increased to $750, and the current open
claim compensation of$375 is increased to $400;
3. The rates referenced in the pricing table of ATTACHMENT A to the original Agreement
and in any prior amendments to the Agreement shall be replaced with the rates
referenced in the"Billing Schedule" and "Auto & Heavy Equipment Per Vehicle Rate
Sheet" dated Feb. 1, 2024, attached to this Amendment and incorporated herein by
reference.
This amendment shall become effective once authorized signatories of both Intermountain and
the City of Yakima have signed this Amendment.
CITY OF YAKI A INTERMOUNTAIN
By: By:
ity Manager Title: Vic sident o roperty & Casualty
Date: ND V • ('? -1-1' Date: November 21, 2024
p,KIMA "
ATTEST: 1�vo
* : SEAL15
n
.� _L�/� 11 •.w'`���� % CITY CONTRACT NO v'�
R. alinda Ibarra, City Clerk .1%%‘,SHING