HomeMy WebLinkAboutFRED S. JAMES & COMPANY - 1981-03-02AGREEMENT FOR ADMINIFTRATION OF \
SELF-INSURANCE PROGPAM
THIS AGREEMENT, entered into on this a13rday of May, 1984 by and
between Fred S. James, a California corporation, (hereinafter referred to
as "James") 24i5 Campus Drive, Irvine, California, and City of Huntington
Beach (hereinaf--er referred to as "City")
WHEREAS, City has indicated it is desirous of obtaining the services
of James to admir,i seer its legally uninsured Workers' Compensation Program
and James administers such programs;
NOW THEREFORE, the parties agree as follows:
I. STATEMENT OF WORK
For the within agreed compensation James agrees to perform the services
more fully described on Exhibit "A" hereto which is incorporated by reference
herein.
II. COMPENSATION
The monthly cost of the services to be performed under this agr!ement
is 52,750.00 which sure will be advanced to James over the term hereof in the
form of monthly incremental progress payments. The final service cost will be
adjusted up or down in accordance with the following:
1. For the period April 6, 1983 through April `1, 1984, the prodiict
of one hundred twenty-six dollars ( 126) times the n=ber of workers` compen-
sation files that have been comenced by James daring the period.
2. For the period April 6, 1984 through June 30, 1985,-the product of
one hundred forty five dollars ($145) times the number of workers' compensation
files commenced by James during the period.
The ratin of indemnity claims per adjustor -claims examiner shall not
exceed 250-1. ,:ra.t. 1, however, chat it is agreed that any adjustor -examiners
assigned t,,) City' -es may also be assigned up to 200- medical only cases per
r,
AWL
year. In order to insure this critical service, James agrees to an offset
against service ch--irges of $100.00 per claic, whenever it is established that
the caseload excee rose amounts over a three month period.
III. PAYMENTS
' ~ies shall be paid progress payments as follows:
1) One -twelfth of the estimated annual compensation shall be .aid
each month of the term hereof in advance and dames will invoice the City for
each such payment,
2) James shall be reimbursed its expenditures by City upon receipt
and ,)rocessing of invoices approved by the City's Workers' Compensation
Coordinator.
TV. OPERATION COVERED
This agreement shall corer all legally uninsured workers' compensation
matters relating to City's operations.
V. TERM
This agreement shall be for the services performed and to be performed
in the period which has commenced April 6, 1953 and ends June 30, 1995. It may
be earlier terminated by either party, without cause, upon sixty (60) days
writt:{n notice to the other party, sent by certified or registered -fail to the
current address of the other party.
VI. RELEASE OF FILES
All reccrds and files generated by dames pursuant to this agreement
shall remain at all 'times the pr6perty of the City and will be released and
dAlivered to the City or its designee by James upon written demand of City
at any time.
VII, REIMBURSEMENT 3F ALLOCATED LOSS EXPENSES
Ailecated loss expenses as described below, incurred by James in the
perfc-rmance of its A igations hereuO.er, will be reimbursed oy City as provided
for in paragraph III hereof.
All costs, charges or 'expenses reasonably and necessarily incurred,
by James, in the performance of this agreement which are chargeable to the
defense of claims or the performance of James' other obligations hereunder
shall be reimbursed to Ja, .s by City.
Reimbursable allocated costs may include:
(a) Claims payments.
(1) Medical costs including medical prescriptions and
api icant's mileage costs.
(2) Applicant's permanent and temporary disabiiity payments.
{b°, Claims investigation costs.
(c) Rehabilitation costs.
(d) Such other costs agreed to by City in writing.
This contract is in no way to be construed as conferring upon Janes
cr any other non -city employee, officer or elected official, the power or
authority to disburse, handle or otherwise control CITY OF HUNTINGTON BEACH
monies, funds or accounts.
VITF. The City shall have the sale option to extend the term hereof for
additional annual periods., provided, haw.ever, the per claim fee of $145 in
ensuing years shall be negotiated upward or downward based upon changes in
applicabiP Bureau of Labor Statistics indices utilizing April 1, 1984 as
the base period.
IX. WORKER'S' C0.41PENSATION INSURANCE
James shall comply with all of the provisions of the Workers'
Compensation insurance and Safety .acts of the State of California, the
applicable provisions of division 4 and 5 of the California Gabor Code any'
all amendments thereof, and all similar state or federal acts or laws
applicable.
-3-
X. INSURANCE
James shall furnish City with evidence of general liability insurance
in the amount required by any current resolution of the City governing body
in form which is approved by the City Attorney and upon the City's certificate.
XI, INDEMNITY
James shall save and hold harmless, indemnify, defend and hold harm-
less City, %ts officers, agents and employees from and against all claims,
demands, payments, suits, actions, proceedings causes o; action or settlements
and judgements of every nature and description, including attorneys' fees and
costs, presented, hrought or recovered against City, arising out of Janes`
performance of this agreement..
XI1. NON-ASSICNABILIT"Y
This agreement is personal and non-assignatle by names and may be
terminatec without notice by City upon any purported or attempted assignment
hereof.
IN WITNESS THEREOF, the parties have caused this contract to be
executed on the day and date first above written.
Executed at Huntington Beach, California this _�'_. day of
d
1984, by and between the parties heretofore set forth.
-4-
r
`f)
FRED S. JAMES AND COMPANY FRED S. JAMES AND COMPANY
OF CALIFORNIA OF CALIFORNIA
sy� By
Robert W. Hoe1 Harr- r!,JlV(x hard
Sen3pr Fire President vice president
CITY OF HUNTINGTON BEACH
ATTEST:
Ile-
sACIer,'
APPROVE', AS TO FORM:
REVIEWED AND APPROVED
7
,,.... •r^,` yr' /,• .� - ^.,,..._�.... .-,....,..^. _.�_...........
City Attorney S(s
City Administrator
ICiITI D''AI APPRO D:
f Rd[n, £ra 've Se r yes
-5-
EXHIBIT „A„
A. Claims Administration
l) Provide at no additional cost, all of the necessary forms for
the reporting of employee accidents, doctor referrals and return to work slips;
2) Review and process all industrial injury ca es in accorda,,,_ with
the requirements of the State agency for reporting and notification;
3) Determine compensability of injuries and illness in accordance
with State Workers` Compensation laws;
k) Determine eligibility for aqd authorize payment of medical be -refits.
Authorize examination to determine the nature and extent of disability;
5) Determine eligibility for and authorize nayinent of temporary
disability compensation in coordination with medical aavise and ral,abilitation
efforts;
b) Determine the extent and degree of permanent disability, utilizing,
as necessary and desirable, advisory ratings, orders of the State agency;
7) Recomm.end payment cf permanent disability ccmpensation and death
benefits in accordance with advisory ratings, orders of the State appellate
agency or compromise and re,exse agreempnts
8) Provide to the City inforriation on chances on proposed changes in
statutes, rules and repulations affecting the City's responsibility under a
self -insured Corkers' rompen5ation Program;
9) upon request ,assist the City Attorney in the preparation of
litigated cases and negotiations of compromise and release settlements;
10) Maintain current esti.aates of the cost of all anticipated benefits
on each case,
11) Arrange for the services of independent investigators or experts
when requested by the City Attorney to:
(a) properly process questionable cases;
(b) assist in determining the status of disabled employees, or
(c) prepare litigated cases.
B. Medical Control
1) Reccnm3nd to City a panel of physicians for the first treatment
of employee injury or illness and a panel of medical specialists for treatment
requirinS 'long tern or specialty rare;
2) Monitor treatment programs Tor insured or ill employees, including
review of all Doctors First Reports of Work Injury;
31 Establish and maintain close liaison with treating physicians,
4) Provide consultation on the most effective utilization of in-house
dispensary and medical facilities;
6) Provide guidance in the evaluation of physical capacity of injured
employees anti their auilirx to return to work;
6) Assist in the development of medical standards and health require-
ments for all jobs, and incorporate such standards in a program of pre --employment
and periodic examinations;
7) Monitor all cases for potential subrogation recoveries, prepare
correspondence to effect collection, and assist City Attorney where litigation
is required to effect recover
8) Keep the City currently informed or developments in litigated cases.
-2-
C. Consultation
1) Provide information and guidance to injured employees regarding
the benefits they will receive in accordance with 5ei f-Insurer ` s policies;
2) Assist in solving employee non -legal problems arising out of
industrial injury cases;
3) Work with the injured employees, Cii v's personnel and other
agEricies to provide rehabilitation, retraining or reassignment of employees
with physical or performance limitations arising out of industrial injuries;
a) Consult, at City's direction, with employee groups on problem
cases;
5) Develop policies and procedures to insure that the return to work
by, or reassignment of injured employees is consistent with the findings of
any State appellat. icy.
U. Informati3a .tv ,Plana Bement
1) Utilize computer programs to provide City's management with
continuing information on paid lols., incurred costs, the progress of individual
claims, and effectiveness of safety and other cost control programs.
2) Submit monthly reports of 'losses accu stive throughout the
contract year and contal-iing open claims from prior contract; periods. This
rep ort will contain infor.nation including. Employee name, date of injury,
description of injury, sex, age, loss .)aid 4'ni3 rmt>rlth, loss paid to date,
estimated future loss and total expec!,_,, cost of each claim, and, at manage-
ment's request, shall segregate loss.;, by plant, unit division; state of
other categ.:ries;
-3-
3) Submit quarterly analysis of losses by type, part of body
and nature, segregated in a similar manner the monthly report Claims
so categorized in this report will reflect losses paid, outstanding and total,
4) Submit a comprehensive annual statistical summary survey and
narrative report to serve as the basis for evaluation of the City's program
and to permit preparation of reports required by the California Department
of Industrial Relations;
5) Prepare any reports on the City's claims and expenditures as
may be required by the California Department of industrial Relations;
6) Provide, upon reouest, narrative or analytical reports of major
cases:
F. Forms and Renewal of Self -Insurance Lrgjam
Provide all necessary renewal forms and to file all reports including
renewal applications to the appropriate State agency for the renewal of the
self, -insurance program which is the subject of this agreement.
-4_
,r
f
CER'TiFICATE OF INSURANCE Approvedm10Form
t.Kti c,! the xttn;tcrn iir.t• ti TO f,+e,i Hut{frn, City Attornay� `
f`,n t,ti„, CITY OF HUNTINGTON BEACh, CALIFORNIA tf�
I' +L lei,,, PM
Iixintin;Itur, i�.t.xci., t 1'i°.ta is
By
A MUNICIPAL CORPORATION
This is to certify that the policies of insurance; as described below have been irsued to the insured by the undersigned and are in 'force
at this time. If these policies are cancelled or changed in such a manner that will Of,= this certificate, the insurance company agrees
to give 1% days prior written notice, by mail, to City of Huntington Beach, P. O. Box 711, Huntington Beach, California 92648. ALL
ITEMS MUST BE COMPLETED, ANY DELETION OR CHANGE IN THIS FORM SHALL BE SIGNED AND DATED BY Ahi
AUTHORIZED REPRESENTATIVE OF THE INSURANCE COMPANY AND MUST BE APPROVED IN WRITING BY THE CITY
ATTORNEY.
Name of Insured '" J. —
Address of Insured 2415 CAMPOS DRIVE, SvITE 100, IRVItNE CA. 92713-9688
Location of WorP or Operations to be performed
Description of ;nark ar Operations
Ph; TGY bit i E5 —1
LIMITS uF LIABILITY
N — �^
NAME OF COMPANY
Effectxva
Exp iat,an
POLICIES IN FORCE
POLICY NO,
InTl.ousanda (od0)
(INS.)
GENERAL LIABILITY
�
-
K COMPREHENSIVE FORM
t l „'�L _
$ 1,000, �—CSL
Transamerica
,nsamerlca
p
PREMISES —OPERATIONS 1
(+ 10713382
1/1/84
Until
Each
Insurance Co.
EXPLOSION AND
Cancelled
+
i
COLLAPSE HAZARD
I I UNDERGROUND HAZARD
r\
2
(� PRODUCTS COMPLETED
OPERATIONS HAZARD
jXt CONTRACTUAL
I - .'9ANCE
t I BROAD FORM
PROPERTY DAMAGE
(y iNDEPENDENT
V f
CONTRAC'r jRS
i
$$
(j PERSONAL INJURY t
k
AUTOMOBILE LIABILITY
iXI COMPREHENSIVE FORM
1
In OWNED
AL-
t,0713 ,82
F
11/1/84 'J inti l
Is-i-,nnn,.— CSL
ran saweries
Insurance Co.
l Each occuranca
tHIRED
�
E Cancelled
;X) NOtv.04VNE0
EXCESS LIABILITY
O UMBRELLA FORM
4
S
{) OTHER THAN t
{
UMBRELLA FORM
WnRKERS' COMPENSATION
!1/1/84 6ti
and tvCiC92647
I
Transalserica
EMPLOYERS`LIABILITY +
l tCancelle
insurance CD. r
Additional Insured Endorsement
The insurer agrees that the City of Huntington Beach and its City Courc ., armtor ail 0ty Council appointed groups, c 0s.
commissions, boards and any other City Council anpc nteo body, andior ,iective and appointive officers, servants or em e f tf e
City of Huntington Beach, when acting as such &ire adtt4t+oval insureds hereundc- for tf+p acts of the iand ariceshai
he primary to any insurance of the City of Huntington Beach- as their interest may appear. rnsur
4/ it/O4 it
Date AUTHORIZED REPRESENTATIVE OF INSURANCE,S,OMPANY
t'ansatrierl Ca
INSURANCECOMPANY ....+ Ez $y I'f mod. S tid'"F%S p< iiti:
Name it Address 2415 Carlou s Dr., Suite 100
Address 1t fLSn=*.n 01ivia Str�clt i . city Irvine, CA. 92713-9688 _
Los Angeles, CA. 9C,215 i{ '714) 752-0990
City i t{ Telephone
HOLD HARMLESS AGPEEMENT
(to be executed by insured)
The insured cOi Atinrl_,agrees to protect, defend, indemnify, save, and hold harmless the City of H•intinglon Beach its
officers, agent&:, and employees against any hability. loss, damage, cost, or expense by reason of any end aft liability, suits, claims,
demands, )udgments and causes of action caused by insured, his employees, agents or any subcontractor or by any third party #,rising
out of or in corsegvence of the performance 7f oil or any operptiuns or activity for which this certificate of insurance is furnished,
°(1) Sole Proprietorship (2) Partnershili� (3)'bor�teration ` (4) tither (state)
HOLD HARMLESS,'GNED! 8 1nsur,"it!��'4-' °," Titer F ice Prr__Sjd t
(Ali "trips shhit be printed or typed 7-5
lfQ ti is y` {
be;**rgechsipnature.l , Senior Vice President
By Instuiid � s.sit�a
obert of . Noe l ..G.,_Ttit}
U Corp -'ratio", T+1Y0 offxcpn mutt sign, or prment evtdi-nce of authorization to bird Corporation. .
i`i-WIAtti'.;.5 A,. rQliDi-. 0471%,.f,;l".4 t
Tritnsairertca insurance i,yu. _
Ie' ,
Frivii. S. James Co.
2415 Campus Drive, Suitt: 100
Irvine, CA. 92713-968 4
i
• r
� F CirniY�4tliaisiiity,nTk :�y�tti,•"Gi"
' pp
X TAL °10713382 = Until
i Cancelled 1,000, 1,Ofit -
I 4 i
A Tr1-10713362 Until
Cancelled
h 1,000, i
^t L..
R•
A 1•iC?092647 until . -
Cancelled r:'. 1 ^30
aLi s ttJ : 20 FOP:Z.
iti {",svt.ns-ey
Adrlinistration of Self -Insurance Progra,=
�.; If y
Deputy city Attorrrwr,
x o XXxx Xx.xxx
:F :;X1{XXJ{xX�t:{Xxi{XkXXXxX• "* ", ' ,' Y s'X;rXX:CXXXXXXXXXXXJCXXXX�K.K.'.°:x
i
r
.y i, 3r 1
'. ^` of �([Iritifi:ftCn itE��., �`^
r ,)" )0 Main K t , t
oitington Uea:' n, GA. ''° -J!r>7
{ttn: td lhospYv-;, Pi'= , "0' Exec. Vicr�
,r- ;"�^'�'",. .'w*-.�+mR�....w.,'�i'! +:';-r."*"7^ �rra^,,w,•-+r.�saw-«Y i .:
HOW HARMLESS AGREEMENT
e`ea(1 (to be executed by insured)
The insure-d t agrees to protect, defend, indemnity, save, and hold harmless the City of Huntington Reach its
officers; agents,"and a loyees against any liability, loss, damage, cost, or e+Pense by reason of any and all liabifit, suits, claims..
demands, rudgment% and causes of action caused by insured, his ernnloyees,,agents or anY subcontractnr or by any third party arising
out of or in consequence of the performance of all or any operations or activity for which this, certificate a insutanc0 is furnished.
' 11I Soto Ptopnetorship (2) Parsiarrship (3) Carpontion f41 Other foottil
HGL01J'RWP,8$51GNEO- Bylnsured. fitly -
Wt rurvn "It ba printvo or typod BY Insured: Title
:.lw�nv' stCli! y;+atUrs)
If Corporiaion, Two Officers must sign, at present evidence of authorization to bind Corporation-
� 1�
�R2:G/rvRL
7-7
Ah
S4'PPLEMENTAL AGREEMENT 110. 1 O THE AGIR.EEhiENT
'FOR ADMINISTRATION N 01' ,SELF-II1 URANCE PROGRAM
DATED APRIL 7, 1981, BY AND 9E` WEEN THE CITY
OF HtJNTINGTON BEACH H AND FRED S . .3'A ES
THI L7pp
REEI,:FN'T 11'. 1 'is entered irno thisda; o",_G✓ 1;a 7, b a and between the 'TTY O
BEhO.- , a municip.al corp�zati.... t.?f State G _aliccarni3,
herein Called ttCTTY,u and FRED AT,!FS hc:r i': cafe_ ur A.MES.
The part es hereto satrrE?k? rij
E i 3 " +, s
in c.asi.._.,.: c.1 tea^.e riuGjai: tr,,mie.a ,,., }a:�red ::ere3.n, than
cert�41n 2o2`k*ract ':'' .AD!M1TNIS'?.'I"it`iTa -'}1 ;,tl.,'1 entered into tetween
hey CITYy. and JAi`t�3,.S at�dtt
is
and
I. Farr:��;r�t�t �. - m ,l x,.., a'..eLdeJ
rn'v.. .x Fz } i Tt .. #` c t t" !, +, t' x . r ' .. i • 't de,: lP..c 7
sc♦t„. na.. t:. a i, .,. r ..:�l, ,. .�.. ...�1... �1 �,w. ..�.l�. :
w ; t is .
""his `?irx<,e"ient .>h:ll > E;' :.,.the tot.rv1ce-.cy.
I:E?i'f Pied in the }"e ,) " t P1, 1 1 7,
1982 and en&� a rl l 6,
2.. Paragrar. h. ;.I ._ .,« .,':.'..��.�`.�t11..i S..�ar '4r �,�rtp1ilal :;?.CF by the 11,0110w-irg,
which is to replace Exht%)iw
ADLL : b
II/2/8
COMPENSATION
The estimated set��cnd year cGst of the services to be per-
formed under this agree.men4� is t-7.3,000 whicl., sum be ad-,_-n,2ed
tc jAMES )ver the term hereof In _ne forin i3f twelve (12) mcrithly
increnental progreas payments in the amo,,.inw f y -h.
- f, ea- At
the end of the contract year the eLltimated -,-��,ond �;ear will
1)e ad, '-uzitej u.-9,,ards, o.- d,_*vm-.,:a-.ds in will'!-, tLe :ollvwllng:
she p r,) d uo t of c n e Lu i id r -t d ~.;,en t y -z *4 x d -1 . a r , ($ 12 4 , " i.e
e S
the nu!nber of new wcrkersl flleo ,,ri-,inated f--_�r 'CITY
by 'j'A.MES durinj7, tP_ :,cntr,,:tct year X.1,any
Fara��r.%,_h :11. 1: amende�j ty the
entire subparaL:7raph 2) ail,i
zhall L,;, expenditurez by
CITY u-,o: re:..,fpt- and Inv the "I'Y1Z
WorkiE�r.� I Ccmypf,�ia' ion
4. -a, -1, a 7 1- am-n d ed L ald I r g, the
f'� L,I o,�. -1 ng:
This o,,,.�.ract 11., .1.... wt v e ,,, ""n I, t r a fd ao con -
I eoC e 4-
ferrilniur � on JAiXES or ,:iny otiler: r nc-c-It,, s:lmj.Irlye fficer _ -ed
of fioial, the power- or %,uth,-Drity to handle or �,,therwize
coitrcl C"ITY 'DIF HUTIIINT'Z'!�"N I'l—Jo cr accounts.
ec' �4) is hereby doleted in
Exhibit oubo 1:L)n
its entirety.
r �I:
6. All the germs, conditiDns, and provisions thereof,
unless specifically modified h rein, are to apply to this modifying
contract.
WHEREFORE, the Supplemental ACreenent No. 1 is executed by and
between the parties as otl the date first above �:rittert,
a�mau iciia1 c,-r;:.ratjc:n
ATTEST:
By
ty '.erg
jU,14EZI AIND " - g - 11_/�'
.x P.: it1. ... Z? i1.:¢ •-'y,i .l3t.��Lixi� <. �. a. i.?r:a.. i.fie. LiA3 a.:��1»'�`'�—
1 i
u, la _ „
-:x ut 4 why r ' _it i.t
R;
Vi e President
Iiiiii1mvp
t IV Yit 11� Igt"% ki'mch TO Gail Hutton. City Alturney
II)o CITY OF HUNTINGTON BEACK, CALIFORNIA By
CAII-1648
'uoy in R,.k NA.rAq.r aItit spprpvsl
A MUNICIPAL COf�POI`IATION
his is to cortIfy that tta policitii, of sravranca its described below have bears issued to the insured by the undvrsiI;-ied wits ere In i, ri of .
fit this time It these policies are cancelled or rhanged in such a marmot that will affect this certificate, the insurance company a-, aes
to give 10 days prior Written riLtic- by mail, to City of Huntington Beach P. O. Box 711, Huntington Biizch, California 92FAU Al. L
ITEMS MUST BE COMPLETE I NY DELETION OR CHANGE IN THIS FORM SHALL BE SIGNED AND DATED PY A%
AUTHORIZED REPRESENTATI..: OF THE INSURANCE COMPANY AND MUST BE APPROVED IN WHIIING 8V THE CITY
ATTORNEY.
Name of Insured ^Frp..! S. o", Ca1"-"1rI?'i"-Z
Address of Insured
r
Location ci Work or Operations to be perfo;rned -rA A
Oescription of Work or Operations Progre2m
I
POLICY DATES
LIMITS OF LIABILITY
NAME OF COMPANY
Effec;;ve
ClIpilation
POLICIES IN FORCE
PO LILY NO.
In Thousands (000)J
INS.)
GENERAL LIABILITY
I COMPREHEN VE POR),4
'XXXX XyXX':=—L
I?t1 PAL fIISES - OPERATIONS
P�x
Xe'lV.PM'X1*t:XXXXX
I EXPLOSION AND
COLL APSE HAZARD
K I UNO. RGROUNU HAZARD
Bodily Injury -
KJ PRODUCTi COMPLETED
�',:F�14 135 9L4 5
1 /S
$500,CCO. ea. cc../
Traxsportatic.,
OPERATIONS HAZARD
&
5CO,CCO. aggregite
&
LX I CONTRACTUAL
1785014
Continental C,
INSURANCE
NJ DROAD FORM
Property Canage
-
PROPERTY OAMAoE
Sl,C0C,CC0. ea-
;cc./
I fNOrPENOENy
$l'CCC'000. aggr-gate
CONTRACTORS
I PERSONAL INJURY
.AUTOMOBILE LIABILITY
lZod-ily injury -
V-r� COMOREHENSIVE FORM
'500,CCC. ea. PL
scn/ Transportat
DC I OWNED
IJ 11 3 3
7
Fcoc. 'ccm':'Sac
ident Ins. Co.
HIRED
:t; Naw.
-
Continental
CO.
EXCESS LIABILITY
UMBRELLA FORM
I OTHER THAN
S
UMBRELLA FORM
VVORKr, RS'COPAPENSATION
and
�A
11ransj.'oria,tic.. In
EMPLOYIERS'l-17AWLITY
iAdditional Insured Endorsement.
The insure: agrees that the City of Huntington Beach and its City Council, and,or all Qry Council appointed groups, conImIl—es,
,7ummissions, boards and any other City Council appointed body, anti `nr elective and appointive officers, servants or arriployees 4I the
City of H -,ntington Beach, when acting as such are additional insurr-f4 hereunder, for the acts of the insured, and such Insurance shall
be primary to any insurance of the City of Huntington Beach, as theit Interest may appear.
LC
CL-,
S Lf `
Data AUTl-J0RIZCUREPVESEN AT1V5',OFI`7SURNCE COMPANY
!
INSURANCE COMPANYti`.& ,
13
Con"inental casi-alty Co. Y Fred. S. & Cc- Qf Illinois
-Addtfti —23i.,
Addrims Chicago, Illinois 60606
City -2#�g�zzo, ru. City
T
HOLD HARMLESS AGREEMENT
(to be executed by insured)
The insured agrees to protect, defend, indemnify, save, and hold harmless the City of Huntington Beach its
officers, agents, and employees against any liability, loss, damage, cost, or expense by reason of any and all liability, suits, claims,
demands, judgments and causes of action caused by insured, his employees, agents or any subcontractor or by any third party arising
o - of or in consequence of the performance of 211 or any operations or activity for which this certificate of insurance is furnished.
(1) Sol* Proprietorship (2) Partnership (3) Corp 're"
lion '141"Othet'lssate)
HOLD HARMLESS: SIGNED-. By Insured), Title y
L IAII names shall be printed or typed By Insured: Ti L�11ff
birlow dacl- stoneturiij
.If Corporation, TWO Officers must sign, or present evidence of authorization to bind Corporation.
Orr. ? ..- ...
i'
1 U
:
•rfp xpV '•'•Y Kk h' R K'''{
AW! AD'VWN5 if AG€W ICOMPANIES
rNAME
AFFORDING COVERAGESFred.
S. James
Pennsylvania General
Public Ledger Bui1dingI
ranee C npan
Philadelphia, PA 19106
,ti`ANGeneral
Accident Fire
Life Insurance Co._
AT7!} h�E!gFSS ;Sf tttStaAEb
-
_, ._._ _ _.,_____
Peat, Marwick & Mitchell & Co.
345 Park Avenue
New York, NY 10022
This isto certify that pr,3r cs of insurance I,sted below have bet
of arhr contract of other document with respect to which this
terms. exclusions and ixndit:ons of such vollues.
f �^
CIETIENYttEir TYPE �r iWUQAWf � rn•, ,�I, a10
CCfn
B rt1MFPEHENSIE r)'Ar:,(
®(h}7E MI�tS "Ft AA i�rs.
AN f:%EP Sf
—t IIA.7A An
[rrr���.��1'''';Nt`far,A•,:. ra�� HAZAa!+
{� rSnf Ft f Rxk A
f kRROA0 f;R4.
SMP 251282
AUTOMOF LE C IL1TY
3
B?
d;t ,,,. ::.,
BAP 217791
f.:,a�d ;,.
EXCESS LIABILITY
ULP 5818676
IWORKERS CGOMPENSATION
Al
and
U 588572
EMPLOYE95' LIABILITY
t OT' E
American Excess
_..,Insurance Company_
�e§ii*A'aw
.ftrtra
n issu!d to the insured named abme and are r-re at this t.me Nctw,thstand+^g a r rr+':.,••r• r ^. '
C!'rttt,Gate may be''SS4ed. c, may peol'n !hp -:n§Uranre a'fn•ded by the [tn?r,ri rrcr'r, h•,.!
�4 All
7/1 /83
y; rursq R*Y "AMASe � 5 S
I
-SiH"rr T
<1,000
%
7/1 /82 i 500
1,.000 a�
500
r y.
I 7/1 /82 10,000 i t 10,000
7/l /82
(Pf'.0 B':r' tIN rir of EPA*a4a•..a.,k ar,,,Ne, Y='>rt` y.. ��� r��� 0�
City of Huntington Beach is na.-od as T,cldit:Lonal Insl
Cancellation: Should any of the atsnve desf rAI Itt Pailrfe5 IIP C 1n€etir 3 hPtr,rn IhP PxpuiltiVA,!!ite thereof the ''stprI T . Oln
piny wstl endeavor to mast { nays written notice to the t)elnw nimed certificate hn'dpr but fa,furs, r.,)
must such no'dce shaltkind uport file eatnpany-
Nk>tC arwL: At�;saCss flf �t ax,fir aC =+iyi iC R �j %25/$1
Alicia M. Wentwor-th, City Cleric t PA=f i�4feh _
City of Huntington 130ach
2000 Main Street
Flzcington Each. t 9264? �.
CITY OF HUNTINGTONEACH!
2000 MANN STREET CALIFORNIA 92648
OFFICE OF THE CITY CLERK
December 7, 1982
Fred S. "'awes & Co.
Robert 'noel
2415 Campus Drive # 100
Irvine, CA. 9271 -9688
'she City Council of the City of Huntington Beach at its regular meeting
held Monday, Jecembe- 6, 7982 approved Supplemental,, Agreement 41 to the
Agreement for Administration of Self Insurance Program dated April 7, 1981,
by and between the City of Huntirgton Beach and Fred S. �ar.ies.
,We have enclosed the original agreement. Please sign and return to this
office as soon as passible.
Y..
ie have enclosed a copy of your insurance certificate which has expired.
The Cicy will be unable to execute your agreement until your insurance
is made current.
Alicia M. Wentworch
City Clerk:
AMW. CB:bt
Enclosure
(Telephone: 714.536-5277)
CITY OF HUNTINGTON BEACH
INTER -DEPARTMENT COMMUNICATION
HVNTiNGTC)N BCACN
To Alicia. Wentworth From Edward H. Thompson
City Clerk Director, Personnel and
Labor Relations
Subject FRED S. JAMES COWANY Date December 16, 1982
Attached for your file is the original of the Supplemental Agreement Yll to the
Agreement for Administration -f Self insurance Program, dated April 7, 1981, by
and between the City of Huntington Beach and Fred S. James. The document has
been properly signed by all parties and should be finalized by your office and
filed. The completed insurance certificate is attached also For your f-ile.
EHT.ms
J
CITY tiFiUNTI>itGTQN BEACH
ney
R'Z(IUE5T FOR LEGAL SERVICES White
hn ry city clerrk
Pink City Administrator
Goldenrod DeFartmisntal
"ONUNGT6N aFACH
Date
RagUrst Made BY
Department
INSTRUCTIONS, File request in the. City Attorneys Office z• soon as possible. Print or type facts necessary for City Attorney. Out-
line briefly reasons for the request. attach all. information and exhibits pertinent to the subject.
Type of Legal Service SeService Requested-.(1
Ord`nance O Insurance I l Other
{ I Resolution { { Bonds
{ � Contract/Agreement { 1 Opinion
All. exhibits must be attached; at this request will be returned to you.
[ j Exhibits Attached
If for Council !?:coon, if not tor'Gaultcil action, dstirgd completion da#a Signature,,
Agenda deadline
CITY OF HUNTINGTOPU BEACH
2000 MAIN STREET CALIFORNIA 92648
OFFICE OF THE CITY CLERK
December 28, 1982
Frpd S. Oarms
Robert noel
2415 Carious Drive - a 0C,
Irvine, CA. 92713-9688
tie are returning the certificate of
connection with your agreement for administration of se7'-insurarce
program with the City of Huntingtrn. 're +".ity Attorrpy`s CFf ice wi ;
not approve this certificate of insurance as it is not sighed by `Ile
insurance agent or broker.
Please '_or.nlete Iris certificate and return it to th>s Grfice. Sv o;e-
mental .Agreem, nt *1 cannot be signed by tine Mayor and City C.lerx until
yoo do so.
Ai;cia M. Wentworth
City Clerk
AMW: CB: ht
CJ
Enclosures
I�'alopha�a 7 t4 53G a2�71
°yy CITY OF HUNTINGTON BEACH
k. ' "JO MAIN' STREET
CALIFORNIA 92648
�4
OFFICE OF THE CITY CLERK
December 28, 1982
Fred S. James
Roberz Hoe?
2a15 Campus Drive #100
Irvine, CA. 92713-9688
We are returning the certificate of insurance which you submitted in
connecticn with your agreement for administration of self-insurance
program with the City of Huntington. The City Attorney's Office will
not approve this certificate of insurance as it is not signed by the
insurance agent or broker,
Please complete this certificate and return it to this office. Supple
mmtal Agreement �l cannot be signed by the Mayor and City Clerk until,
you do so.
Alicia M. Wentworth
City Clerk
AMW: CB: bt
Enclosures
(TMaphona@714-636.6227)
E
Hoj-zj
kiLN'nNGTON BEACH
CITY OF HUNTINGTON BEACH
REQUEST FOR LEGAL SERMES
White
Ca11$ry
NO
City Attorney.
city clerk
CRY AdItiinIstrator
bldenrod
Departntentar
Data
R.:.uast Made By
Da art ent
12j21j82
City Clerk's Office
INSTRUCTIONS: file request in the City Attorneys Office as soon as possible. Print or type facts necessary for City Attorney. Out-1
lice briefly reasons for the request. Attach all i,.$orrnation and exhibits pertinent to the subject.
1
Type of Legal Servica Requested:
[ I Ordinance NI insurance [ j Other
I Resolution j j Bonds
[ I Contract/Agreement [ I Opinion
All exhibits must be attached, or this request will be returned to you.
j Exhibits Attached
This agreement with Fred S. James & Co. was approved by Council De -ember 6, 1982,
It has not been executed by the Mayor and City Clerk because we did not have
approved insurance on file.
Attached is a copy of the agreement and the original insurance. Please approve
the insurance as to form.
If it cannot be approved alease inform Mr. Ed Thompson so he can yet the proper
insurance.
Connie Clerk's Office 5405 `t��
SKr
If fw` Council Action,
If not for Councii action, di sired completion date
Signatures
Agenda daadtins
Council meeting
f 1Q'1�,t78
�. CI
";ANTI TON BEACH
1 2000 MAIN STREET CALIFORNIA 92648
OFFICE OF THE CITY CLERK
December 7, 1982
Fred S. James & Co.
Robert Hoel
2415 Campus Drive #100
Irvine, tern. 92713-9688'
The City Council of the City of Huntington Beach at its regular meeting
held Monday, December 6, 1982 approved Supplemental Agreemen- rl to the
Agreement for Administration of Self Insurance Program dated April 7, 1981,
by and between the City of Huntington Beach and Fred S. James.
We have enclosed the original agreement. Please sign and return to this
office as soon as possible.
We have enclosed a copy of your insurance certificate which has expired..
The City will be unable to execute your agreement until your insurance
is made current.
`' •ads-,c'���o
Alicia M. Wentworth
City Clerk
AMW:CB:bt
Enclosure
,trr
XV
aed�
(Usplwne, 714-536-52V)
TO Gall Hutton, CI.y Attorney
All", a',
wi,'�I�B..cn t A9:848 CITY OF HUNTING"fON BEACH, CALIFORNIA By.
, r t I
�r .o ,nq t.za . t.r rpprova A MUNICIPAL CORPORATION
I,
This as to cirtrfy that the polmms of insurance as described below have been issued to the insured by the undersigned and art in force
as tnls t,mai {I theta policies art cancelled o. changed in such a manner that will effect char certificate, the insurance company agrees
r, viva ICdays prior written notice, by mail, to City of Huntington Beach P. U. Box 711, Huntington Beach, California 92b48 AL
0%,S NILST BE COMPLETED, ANY DELETION OH CHANGE IN THIS FORM SHALL BE SIGNED AND DATED BY AN
A,j1HU4l7EO REPRESENTATIVE OF THE INSURANCE COMPANY AND MUST BE APPROVED IN WRITING BY THE CITY
.Vtl tlKNEY
No ne of Insured FRED. S. JAMES & COMPANY OF CALIFORNIA
Address of Insured 2415 CAMPUS DRIVE, SUITE 100, MINE, CA. 9?715
Luedtlon of Work or Operations to be performed SAA
ADMINISTRATION OF'SELF-INSURANCE PROGRAM
Description of Work or Operations _
a
�POLICY DATES ��
LIMITS OF LIABILITY
NAME OF COMPANY
F C
Effective
Expiration
POLICIES iN FORCE
POLICY NO.
In Thousands (000)
�GENERAL LIA131LITY
ih COMPREHENSIVE FORM'
S__ . CSLy9
Each Ocaurance 1
111
1
' 1 PR:.MiS£S• OPERATIONS !
I EXPLOSION AND i
COLLAP!,E HAZARD
I UNDERGROUND HAZARD iCCP041359245
7/1182
7/1/83
i PRODUCTS COMPLETED
OPERATIONS HAZARD
I CONTRACTUAL
INSURANCE
i BROAD FORM
i
PROPCRT"Y DAMAGE
I
i I INDEPENDENT.
CONTRACTORS
I I PERSONAL INJURY
AUTOMOBILE LIABILITY
I I COMPREHENSIVE FORM,
O
rBUA007890983
7/1/82
7/l/83
I� OWNED
}
S CSL
r
Each OcFurani:e
t HIRED
i
t I NON-owNED
EXCESS LIABILITY
i
I I UMBRELLA FORM
7
I i OTHER THAN
i1
$
UMBRELLA. FORM
I
WORKERS' COMPENSATION
z
and
14CO06860086
7/1/82
7/1/83
$700,000
EMPLOYERS' LIABILITY
Additional Insured Endorsement:
The insurer agrees that the City of Huntington Beach and its City Council, and/or all City Council appointed groups, committees,
commissions, boards and any other City Council appointed body, and/or elective and appointive officers, servants or employees of the
City of Huntington Beach, when acting es Such are additional insureds hereunder, for the acts of the insured, and such insurance shall
be primary to any insurance of the City of Huntington Beach, as their intere;trnay-appear.
Date 12 14 82 AUTHORIZED REPRESENTATIVE OF INSURANCE COMPA°b 4M�
INSURANCE COMPANY Transportation Ins. CO.
8y
Name .yd cam,. 24,15 Campus Drive. 5u.3ire. 1.00
CNA Plaza
r..,.-
Addr,9nx I ry ne CA.
City a 3a City
-- (71 ') 752 09g0
Telephone
j HOLD HARMLESS AGREEMENT
t (to be executed by insured)
The insured agrees to protect, defend, indemnify, save, and hold harmless the City of Huntington Beach its
officers, agents, and a I'oyites against any liability, loss, damage, cost, er expense by reason of any and all liability, suits, claims,
demands, judgments and Causes of action caused by insured, his employees, agents or any subcontractor or by any third party arising
out of or in consequence of the performance of all Or anY operations or activity for 'which this certificate of Insurance is furnisho(L
id Sol* Proprietorship . (2) :Partnership' 13}. Corporation (41 Other (state)
HOLD HARMLESS Sic'N80- fi By insured: Title
'All names snail be pontsd or t�pod By Insured: Title
b-10" »ach ugoatura)
If Corporation, TWO Officers must sign, or present evidence of authorization to Sind Corporation.
�r
=ers.t etar it) C1113TIFICATE. Of- INSOKAN%..' •htlftr.fv„xat ,is tI+ r .,,,..
TO ii„u: Holton r(,,t c ;0 t:,,
siX AEI-..x.{ey
V ti it.... ua) CITY OF HUNTINGTON HTACH. CALIFORNIA
By.
>f.,�.i,nyinn Bach ,`A 91848
t opy ra R,rF M.n.ii.r .R.r .pp,4vss A MUNICIPAL CORPOitATION
This is to cart,fy that the poticias of Insurance as described balow hava bean Issued to the-nsuroo by the undets+pneri anw a,µ "+ "
of this time If that# potrctei are cancelled or changed in such a manner that Will affect this cort,ficsta„ the insurance co moo s «u<
to give 14 days prior writtan notice by malt, to City of Huntington Beach P O Box 711, Huntington Haarh. Ca�ifornia 112b4p A
ITEMS MUST BE COMPLETED. ANY DELETION OR CHANGE iN THIS FORM SHALL BE SiGNEO AND DA" t )= hi 4 `
AUTHORIZED REPRESENTATIVE OF THE INSURANCE COMPANY AND MUST BE APPROVED IN WRITING By Tsif
ATTORNEY.
Name of insured _r�f�yE, S. Ir�t�;t,,ytt$t�rp t,u,.PAN. t�• e.r+it.ray1'le^s'4:rili
Address of Insured .
24#5 CAMPUS DRIVE, S 1 •�. if,O, IRVINE, CA. 9277J
Location of Work or Operations to be performed SAA
Doscription of Work or Operations AI^"^.INTSTRATION OF SizF-TN5JRAN E PROGRAM
POLICIESIN FORCE POLICY NO.
y GENERAL LIABILITY
I
Iry COMPREHENSIVE FORM
I [ PRFMI'SES.• OPERATIONS
( I EXPLOSION AND j
Cdt_LAPt£ HAZARD I r1
1I UNDERGROUND HAZARD ACCP04i359245
I I PROOLCTS COMPLETED I
OPERATIONS HAZARD t
I i CONTRACTUAL ¢
t
INSURANCE
I I 13R.OAD FOR-M. }
PROPERTY DAMAGE
! I .NOEPENDENT I r
CONTRACTORS P
PERSONAL INJURY
POLICY DATES
LIMITS OF LIASILITY1 NAME Or COMPANY
Ictivo Expiration in Thousandst000i 1, IiNS'°
7/l/82 7/1/83
t I
S� CSL
Each Occurance
s
t
i
i
4
AUTOMOBILE LIABILITY
{
(
COMPREHENSIVE FORM
F ,
30=789v983 7/1/82 7/1/83
II
OWNED
! S- CSL
i i
HIRED
i EAch Occura." 4
! t
"ON -OWNED
} G
EXCESS LIABILITY
i I
UPARRELLA FORM
t
i I
OTHER THAN
}
S
UMBRELLA FORM.
WORNERS'COMPENSATION
and 4WC006860086 € 7/l/82 7/1/33 c I C, 3,303
EMPLOYERS' LIABILITY v 4
A
Additional Insured Endorsement,
The insurer agrees that the City of Huntington Beach and its City Council, and/or ai; ;.Ity CoonCsl appointed groups, committe'-s
commissions, boards and any other City Council appointed body, andlor elective and appointive officers, servants D, empint,ees of rah
City of Huntington Bcaoh, when acting as such are additional Insureds hereunder, fnr the acts of the insured, and such insurance sh 01
be primary to any insurance of the City of Huntingtun Beach, as their InteresLmay appear.
Date — 12/ AUTHORIZE RE RE RES NTATIVE OF INSUR�GtOMPAN'
INSURANCECOMPANY Transportation "ns. CO. S
� k
Name i,INA Plaza Addrao, cc CargSri ve, Suite , UiJ.
Adsireu i ry i re . CA.
R
City Cfl(CdIIf3 T ,_ YClry
'r'�Tataphona
HOLD HARMLESS AGREEMENT
�^y (to be executed by insured)
The insured agrees to protect, defend, indemnify, save, and hold harmless the City of Hurtt;.)Oon Beach its
offices, agents, and a loyees against any Iiabiiftr, loss, damage, cost, or expanse by reason of any and all Lability, suits, claims.
demands, judgments and cause; of action caused bt, insured, his employees, agents or any subcontractor or by any third party art: Ing
but of or in consequence of the performance of all or any operations or activity for which this certificate of Insurance it furrilil1ed.
' it) Sole Proprietorship (2) Partnvrshlp (3) Corporation (4) Other Iltetel
HOLD HAAMLESSSIGNED: By Insured. Tit)a.
IAII names shalt be printed or tj,pe<.i By insured; 7nls
below each .s(i7nas urs,i
It Corporation. TWO. Officers must sign, or present evidence of authorization to bind Corpo-ation.
.R f t diR ,Ka !t. 'r g<4 •' :j l S* ..�" e•,r' to a ,a. rA7� !jai . ,l.,r 1'
.n v.m ,�..+...�«.: a f a•. � �!_#�. "" �" "." ra ^ h' A' . _.jjl'�/////yyyyy �. ��y.
FEED. S.. AM%S & M OF CALIF. Yl/
2415 cAhl t;s I) ., SUITE ioa A TRANSPORTATION' INSURANCE CO.
IRVINE', CA 92715
w # TEt ; (714,1 75.4-0990 and (213) 924.2351
- .
Fred. S. James & Co. of California
':1- 2415 Campus Drive, Suite 100 C/ ,,-
I Irvine, CA. 92715 `
•
j
i el Dag t. xt q. t or G
'tErtrlS,yWq>.
,•i,.„ � LAn7125 of LiabdAty m iFiousands fM1 _
' r{
! 4
A X CCP007437013 7/1f82
500, 500,
R.
AE1TOh'RJ+91f.E 0-6,E1r ! A,
Xi
t;l iIG0789CB76 7,•1/E2500,
; lu
A I and t,CGO5386181 7;1,i82
fi
rr^�-
m, j } ,r. ,,. tx-..,;...,,,, .ra.•r.,;.. ,,. .a ..,,.,,+.... _,—.r.,_. ,".x,,.�..,,x.,.>,.+..,.».,„•.,rz---'+*-B'. ...,,,�:r•...o.,,. �� \ �...r ..
.u° Administration of Self-insurance Progra!a
n «711t;rf, PO ,'.
x XXXXXXX C ?'i }C5i ,Xy,Y
XXXXXXXXXXXXXXXXXXXXXXXXX.`iX,<XXXXXXXX;4XXXXX:XXXXXXXXXX/dXXXXXX
.€
City of Huntington Beach
P. 0. Box 711
Huntington Beach, CA, 9264
Atta* Risk Manager
4 ,
A�
AGREEMENT FOR ADMINISTRATION OF
SELF-INSURANCE PROGRAM
i
THIS AGREEMENT, entered Into on this it 1rf day raf
1981, by and between Fred S. James, a California
corporation,
(hereinafter referred to as "James") 2415 1an1pus
Drive, Irvine,
and =pity of Hurit].n.-ton P_eawa (he_ro.na:f'ter referred
to as 'f,•-ity"
).
rdHEREAS, City has it iz desirous :,f c'sta.ining
the services
of Jame. s -,,f administer its iei-ally 1*iin;ure ,
Workers'
"orrrn a ,=�, r Frt%rrxam, • A ri, James, alz,ristern: ,y
pr=; rams p..
Jt,v� }'HERF :M"�)R;E, the az, f,; l icc'rs
.
STATEMENT GF WORK
e:, the within 'i?"r t:eel ,..;,nr !'xjs at on ��.3,.rus 'A,Tes s T C"
perform 41"be
"
servii'es hill e litil Lr �t.'.. il'��x:A .i Va .F xbibll "RhherpS:�
3. �9 4.
which.
«$ii �.. �'. P.•t.. l"c x
pp ,{ T-f`t
As the zo i o and under this.
agreement,
City agrei',y to wiy James the aR°roun! _'a:.,,'?1l<ated from
1.
Exhibit: "D"
hereof whir.•h is in,,:orporated blv reference herein.
James shall be paid pro r.�ss $'ayme is as follc�ws
2) One-twglftb of the esti.r..: t.ed annual comp»nsa.tion
shall be
paid each rgonth of the terra hereof Inadvance and James
will invoice
the City for each such payment.
v
JA :hit
3/20/81
?) James shall be reimburse ri its expenditures
from the trust account of the allocatod loss expenses daily.
I TT . OPERATIONS `-'Okl-ERED
This agreement shall c o-er all legally uninsured
I workers' compensation matters relat~inr to amity's operations.
This a reement shall be for `'ate servriwe: to be
performed in she year period which C'.C;mT:^ien-es 7
and eras ,, n> 6, I�YP- it may be earl Ior terriln,3ted by
either_party wirhout ,YausF. up n -ixty ��C) ;:lays w ri t t en not c$,
which t ae shall.
f�.� n t-0 � f. ,u a?� ; �c* yt� r+ re Sri r-
i� ?i� i' i;�� v �. Ater.: ir'itT� �iEYYif, uy �,. .T w �.k. C3 .E, �'t�
E'er mail to the adareos of the (3t,t1!?r ;` xrty `"l.r: , ;' vlded abc,'v ''.
V1. REI-EEAS�E OF FILES
All re±wn)rd<', ,;3.fd k1,Ci ;,E'ri...3,'_':i C-„y <i,aT<?l*'z pursuant 4o
this agreement shall remair, at; all t ; e; 7 '..he rr r+ pei—1 y f th'-
City and will b-� and Aelivered t.�� the 'ity or it.
iesir nep by .I<:rr�.0 . up`�.-5n �:r t tJ� r. r r i _t "It any t irre
VII.. REIMBURSI:'viEN : P A111`` 'iv'iFr ,S`S XP'".14�F>;
Allo,, ,ted lo-,z expenoo <i.� de :vr*lbei in Fxhibi:t• "B"
hy+X't.of, which Is is Tlk`'t;rp+",riatC,'.'i. b- I'�7':y'�:?2>en,'t' herein, till:'tired tb,y
James man the �ht;z'i�'',:Jr��rrran,,.f:: � to. `..}�tl1k*, i'�. �. .i4 �ti. hor°*'ul rider will Aid'
reimbursed by Cit;° as p3rrw'vi.dod f,pr In parr,'raph III her,,nf.
VT -II. The City shall have the sole-piion to extend tht',
term hereof for additional annual periods, provided, however,
that the start-up fee of $10,000 is a. one—time charge only and
the per claim Lee of $115 in ensuin years shall be net; .ttiated
uUward or downward based upon changes in appliearle Bureau of
car Statistics indict';, utilising April 1, 1981 as the base
period.
IX. WORKIMA IiI l CC3t1i'USATION IN-SURANCE
James shall ::,arrrly with all of the pr wisions of the
Worker's Compensation Insurance and Safety Acts of the State of
C,t liforni_a, the appl i(able provisions off" Division h and 5 of
the California Labor 'Wnie and :' . amendments thereof; and all
similar state {:,r at.ts or laws, apyp?i,2able az.d shall
indemnify, defend and holl .i h� rmle:.:: City from and ar ga Lest all
claims, demandz, payments, su ts, a,; t -:,,ns, and
udg -ents of eery nature and des crir uion, ineludln�r ':attorneys'
fees and costs, rre entea, bro,-i:7hr; ,. ' recov:-red against City,
for or on a,^cou.nt of a-ry li.ab.lity under any cif :,,,aid ::acts which
may be i..it>x{»red by reas;,n of any w,.,rk ; o be perf,..)rmed by James
under this a:rreement .
X.
SUHANCE
HAN
James shall furn1sh clt.y with evidence of insurance in
the amount required by any currt�t resolu;,lon of the City
overnin2; body in fnwir which is apncroved by the City Attorney
and upon the city's city',ert,i.f`i'ate. C,()pic's of city's current
resolution and certificate are 'attached hereto and ai toRether
are incorporated by reference herein as Exhibit "C" .
Xi . TNDEMNITY
James shall save and, hold harmless, indemnify and
defend City, its officers, agents and employees from and against
3/20/81
all (,,laims, causes of action or settlements ari.sinF out of
James' performance of this agreement.
XIi. NON-ASSIC-NABITUITY
This agreement is personal and non -assignable by James
and may be terminated w thrr ut notice by Ci;y upon and; purported
or attempted assignment
IN WITNESS WHERE`-)F, the pczrt.i.eS have '2=1u":.ed this
contrae.t be e}iE'tutfi r an the 'day and dYat�- first abo-,,*e written.
Executed at Hunt trim 1 u Bees _,h , C ii ' •r i a ' fa 2,7th day
f "r?r^h �? 19by and between+;lid ft �I'�.IE' lher i �.- fore set
o -h.
F RED S . 4 ri �EI A .7 FRF S . Y A%'F AND 'OMPANY
OF CALIFORNIA OF CALIFORNIA
Xn30W ExecUti pie 'Di ce Prey,
r
l
. ATT T —
3 k�x..�l
T71el AFFHOVED AF TO FORM:
REVIEWED AND APPROVED r �
f 4 f
✓ el %✓' Ah,%.i d" t, -yam
City Adzr,irl� s#.r:at�r � iidl': T ATED AND APPROVEDRelations
:
ldl,1_4 U 7si
Tirrtrr�, I'e�=scan e7 Labor
/20/ l �t .
F Ytf i 11,11 "rill
A Claims Adminlutration
1) Provide at no additional cost, all of the necessary
rorms for the reporting: of` employee accidents, doctor referrals
and return to work slips.
t) Review and process all indurtrial injury cases in
accordance with the requirements of the Z7tate af7ency for report-
ing and notification;
a) Determine compensability of irz.? z: iE=s and illness
in accordance with State Workers' Compensat i(n fairs;
'4 Det-ermine elivibilit.y fr)r anal aw oorize payment: of
medical benefits. Authorize examination to determine the nature
and extent of disability;
Determine ellgibilify for find aurt:hori e payment: or
vemprrary r14-5abili y compensation in ^^c,r9ir,a`i T3 with Med;<:al
advice and rehabilitation efforts;
6) Determine t:he extent and degree of permanent dis-
ability, utilt. inr., as neressary and desirabl(.-, advisory ratings,
orders of the State ar*enxov;
7) Re—)umv,nd paym,ont. r71' -)mponsa-
t.Ion and d(-IUj hrr no. f'f is In wt' k,
orderrr of the 'It,aty.e appol latte or and relea�,,o
3greement,s ;
Provide to the City information on chancres on
proposed f,,iyanF;os in statW,e:s, rules and :°ez ?zlat.Ions a.ffectitlp; the
�'Ityls, responsibility under a s elf-Insurfo t x.(,,mpnn:,attion
f'rn�;ram
`i .
g) Establish Procedures and necessary �iorument:rtinn
to provide for the payment of benefits, medical costs, legal
fees and other related costs.
lll) Upon request assist thr- City Attrrney Jn the
preparation of litigated cases and negotiation- of compromise
and release'settic:ments;
11) Maintain current estimate: of the cost of all
7
anticipated benefits on each case;
12) Arrange for the services of inder'endent investi-
gators or experts when requested by the-? City ' Iltorney to:
(a) properly process questional~le ,:asps;
(b) assist in determining; the status, of
disabled employees, or;
(c) prepare litigated ^,aser.
B. Medical Control
)) Recommend to City a panel of physicians for the
first treatment of employee injury or illness and a p z lf: 1 of
medical specialists for treatment requiring lrng term or specialty
care;
2) Monitor treatment pros;rams frr insured or, ill
employees, including review of all. Doctor's First deports of
Work Iniury;
3) Establish and maintain 'cl z liaison with treatinrr
phyFiciails
41 Provide consultation on the most effective utili-
zation of in-house dispensary and medical facilities*./�
1i) Provide t;Ltidance in the -v-iiii~rt lon of phy.aical
capacity of injured employees and their ability to return to
work;
} Assist in the development of medical standards
and health requirements for all .jots s, tinri inrorr-prat r r,'ach
standards in a program of pre -employment- and pori(dik, examina-
Lions;
7) Monitor all cases for rotent ial subrogat.ion
re'`-,veri+es , prepare correspondence t r.i r> f f e c t —1 1 ec t i :)Ji , and
assist City Attorney where litit�,cit- ' :s rr,ritzired to effect
recovery;
) Keep the City currently #nfnrmrr] -f developments
in litigated cases.
G. Consultation
1) Provide .information Fin'i F' 1i;7 irin * i injIttrod
employees, rei?;ar.lnr, the berief t.s they will rrs=~e:ve In ar^crdance
with Self-Xneurer's polir^ies;
2) Asz�ist in >rlvi,n e` p]r ,ye ' Cl' tl l 'j i1 problems
arising out of industrial injury cases;
3) Work with the Jn,jured emr lr: yce;` , Ci t,y l s personnel
and other of encie o provide ret.r*ainint`, or �
reassir,timent of employee with t-hy ie".l or, perPormancn llmitat.ions
arising out of Industrial njurz, s;
tf) Consult, at Ci.ty's direct ion, with employee groups
/ on problem cases;
'i
`) Develop policies and procedures t.:? insure that the
return to work by, or reassignment of iii,jured employees is can-
sistent with the findings of any State appellate agency.
D. Information To ManaCe,ment
1) Utilize computer programs to provLde Citv's
management with continuing information can paid loss, incurred
costs, the progress of individual claims, and effectiveness of
safety and other cost control programs;
2) Submit montnly reports of losses accumulative
throughout the contract year and conta,ininp; oj, --n claims from
prior contract periods. This report will contain, information
including: Employee name, date of injury, desc ription of intur�r,
sex, age, loss paid this month, loss paid to date, estimated
future loss and total expepted cost ^f each claim, and, at
management's re-juest, shall. segref;at;e 1 u e: by plant, unit
division; state of other categories
3} Submit quarterly a;.alyoes of lnrs(-47 by tyre, part
of body and nature, segregated in a similar minner as the monthly
report. Claims so categori::ed in this report; will reflect losses
paid, outstanding and total;
4) Submit, a comprehensive annu it st,,itistica:l summary
survey and narrative rpport to serve as the basin for nvalu._i+Jon
of the flirt I; program and to permi±, prep -tuition of reporr,,s rQglAred
by the Califorr°ia Department of Industrial Pel_;tions
5) P,^epa.re any reports on the City's claims and expen-
ditures as may be required by the California Department, of
Ir�du.atrial elat�bns,
s
6) Provide, upon request, r
reports of major cases;
7) Establish niic
5,t.i cr c;aanalytical
�0(,5!7,iry donuanentatinn
® F. Fonts and Renewal of 'elf-Insuvtance rr of r n!j
Provide all necessary rn)ewal farms to file all
reports includint rene-aril applinaill'-In, D,,) 4-11£, a.r*ni"Irria".e 5t."'Ite
agency for the renewal of the r>i f- Dt , as aai� �> r r ^tram tr}tirh is
the subjie^t of this a€:rr-en-,nt.
F. Appendix I to n-3n4 r`nl
Frov ? dj l ssat It ot,bQr and ;l ftarf hr�!' r F.r..: ' ^E :i$ tlr£? pro,%rldt-j
For In Arperi(lix I he?r,74{7f . In t Le t"t onf 01n, h— !-II 1i t int)!7, I'f
App,t,tr°lix I 7ortfiw:t,}t the (-ttiif;i��r:.� �'tt�a���eap., rkt«n t}r� r.�?ra,iitirgjs
of Appr aivli x. i nh-all ''-W r,_�1,
G. A sS vnpk ion :ff I xI a' 'nr d i litr
For t h£ v-,( (p'ara i:f' #-fwt.—, .1d 3rai" r n (if T I,`" , tiOCt as provided
for' herei rt} + "3`a�.'^ Q, 11 .'t 'a;. "1?Ttt ' I)o "0,fun't 4r'.olit {' `! i 1 olalms which
re #anro -o lved at tin i n"-(?p t i on or f' Et j s h t-; �nnD£ ar
APPENDIX r to ExhJbit, A of the ar,reement:
ty
vid iir tt Je—n 4.l,c 'iiY. O ✓UCYT-a1'F ,T3N S..A..
and t"ht? ''REP O iV .l.`* r;r) t ORA T 3 , "
i';t=t1vini-n of
Admiritstt,:tt.ivi, :1rrOe.cs
Occember 17, 1980
(5 entlemenc
The City of Huntington l3nnch wishes to invite bids from gttralified insurance cnrriers or
service. ngencie� to provide, r:oniroct services and excess insttronco coverage in
connection with the City's legally uninsured worker's compensation program.
Allochment t to this letir-r-,AJinrs thosp -,nt•vires desirrd by thr- (`fy. Should your
carrier/agency desire to Laid on this contract, your proposal shot)ld include;
I. An nlreetner, io raerfortr those specific services oodined in Porogrnphs
through V of the altachment;
2r A ,stotninent substantially equivalent to Poroctraph Vf of flit- of tochment;
3. A f-rrnin�:ation of ngreement statement as outlined in Poragroph V11 of the
at lachment;
't, prvicrs riot pro.Idvd for tannin, but normally porfnr-lr-d by ynctr
rarrierlogency tinder such uninsured contracts, for w►1ict) an additional charge
will be proposed; and
S. A bid on excess insuronep as outliner( in Paragraph Vill of attachment.
1hr City :,rill tray all worf!r'r's com.prr)-,alion iarrtr+fiIs, fnplitr,il enre refits, or,ri Special loss
exporises in connrr, lion witti tlar adjustment of cloirns, P-xr`rpt In It- oxi-tit t"lot the
rorrierhoenry will br, oYieJott-4 to indemnify the City under the terms and provisions of
a worker's cornpens+ation excess insurance policy.
Mrl, stAitniIIPI sl ni)ldboe bna;P,I -%t� f AI nnc4 rarrrtalete payrttrrtl for cll services req,resterf
for the contract poriod Frtirunt , 1, 1081 to Febriinry I, OP2. 1r N5 may he submitled on
either a flat fry or incurred loss basis and should be so irlcntifird.
next ponce, pfemse .... .
i
7- Deceam5vr 17, 1980
Rids m=as€ be received in the of fire of the Personnel Dirvf or nr) lnlrr thnn 5:')0 p.m,
January?, 1981. The ('it} resorve5 tlae right to reject any or nli bids received. Selpction
will he mode on the following criteria:
1. Ability and experience at delivering service
?. Cost of odministrative service
3. Cost of legal service
t#. Cost of safety consulting service
All prnposr3is shoirirt include a List of self -insured accounts presently, render contract
services to the bidder.
f�lrnse confacat Mr. F'dvard H. Pin,npson, Pe=rsonno.1 IN-Prlir, of ",P Cify of 1-4,.,n, ingfnn
Reach (711) 536-5491 for nny work injury data and other infcrrn Won pertain%nq to this
offering that may be desired.
Sincerely,
f= riward fit. Thompson
Oirer;tor of Pnrsonnr�l and
Labor Relations
V.HT:KSF:sh
Attnchin-nt
C/
I�
i
Allacl7ment i
The conditions desired in the formulation of any proposals to I-e submitted are as follows:
1. Administrative Services:
A. Forintdote, in cooperation with flip rify, n Mnn-ril of Operating Procedures
pertaining to the operation and odministration of the Norker's
I_
Compensation Self -Insurance Program.
a 13. Complete, in cooperntion with the City, any forms that will focilitote.
implementation of this program.
C. Provide all necpssory injury benefit adjustment services, and in that
connection specifically:
l . Fxnrnin(- FMPLOYFIVZ EZ'EPOR TS nF 1.1 JOI ISTPIAL lh JI VRY form.orded
1 by the Cify and determine compensOility of such claims under the
California Worker's Compensation Lnws.
2. Assists in the p�jrs+rai of quality n)Priir-.-il rnr- f-)r injured ?rnplover s
whose rlohns are ndj,lsted under this Program in conjunction wilh the
City's Panel of Doctors.
3. Detprrnino lompnrnry disahility crrnpensgFnn 601)efits and per-rinnpnt
disability rompnnseWon benefits for ini{irrad eml?lnveec %,.,Knsp cfaiins ,
nre adjusted and apprise the City in order thnt nedi^al pnvments are
promptly paid and aimbilify krnefil i)°7vrnw?t5 or wrages under the
City's industrial leave schedule ns opproprinh- ore rnade.
It. Assist flip �-ity in -nordirvilina 1'vnt'1{<'r's ("a,�,11r,o—,fit!on benefits "kith.
special stlrvivnrs' her.pfit for Safety porsonnoP -M-r the Strafe
Retir(nnr~ryt Code, len.,v owi ^V11,10 Collfinu-rt=rr7 "wit -fits prnvid-d by
City recloinlions oni'nr C'nlifornio t_ohnr and nny benefits flint
rnoy occruo to �disnblwi employeP; from oviside agencies who provide
such services under contract to the City.
5. C'onr«i�nnle orM isson the pnyrne-its of campensnhon benefits, medical
care costs and special loss expenses.
6. Assichi n spec.,iffc cfri;ms ndj-islor rmfl-Lilly to the City and
the agency to perform appropriate services cinder this Program.
7. Consult with the City on the orcosion of claim,,.
13. C'ondi,wl proliminewy ing,riries inlo qti-;hnnnWr- rl.iinis, nnf'r in concert
with., and approval of, the City, prieplt"io t'rn qs—A!-Ps of a atside persons
or fir•ns for sp(r. -vil investigation of vic') cloirns. ("nst of
invpsligntions nim, ho borne by the City if nal corning within the scope
of the services outlined above.
g.
Wortt in rinso rnnporr)tirni y1l1h ntlnrnr,.- '"ity to
defr*nrt rhiiirts gat flee WC AR by tyro-i linq rrrt ork on,l i.�forrtyatan
requested by the ottorny or the City.
i0.
Advise the Cily concerning retroininqtiod rol,nlhilitation of seriot,sly
injured employees within thr- menninq o,"d intr*nt of thn Coli`ornin
Lobar (-od, I)Poriny on this rnnttPr; rairsr n,-tificalion as rectr;ired to
he mad,; land, rirronge for and direct vocational retrair,irrq of the
injr.)red employees so affected.
11,
Identify claims pofenfintly siif]jpct to rn'it)rnrm <ard rOonsR
setftements and confer with the City rectnrdinq vic.h claims.
12,
Consult with the City prior to instit,ition of litigation reduction,
proceedings,
f7. Provide necPssnry claims adminstrotian and reporting services, and in that
connection specif—Ily:
i,
';Pt 'Jp find rriaintnin a file for enrk 1,iirn, rnriininin a record
of PPnrh non-'lxsn))iltfy clni,n an,t shim«' ttSr'iP tilts, and reL'o-ris
available for review by the City.
2.
Maintain loss dr)trt.
3.
Compute informal perincinent disability ratinas.
4.
Consr)it with thry r'ity in thr> nd,ninisfrntion of p1 ,-nrhnel matters an l
po!icip- involving or effecting tlhe'Vor'•<er's C`nrnponsatlon
Self-insurance f rogrom.
5,
Provide the. City with a quarterly report of acriJenf profile as
roquirryi.
6.
f'rov;dn n •nnnthly report or series of rprorts !),- reryltirorj by the t" itv
listing e,nployee injury claims by ('ily rlopfirlm-it onrl sko:vinq stratos
of each rltaini, rarrtoiiois paid for medirnl nth.{ fhrnefits
per rhino, arn-)iint of reserves regn-)ire l f ry 1— fir-ol rani ro-npensratidn
henefils per cfnim, find total amounts pairs mit find total amounts
required for n?serves.
Z.
AtfvisP the City of its ohligritions rind ferpil rigthls nn aaclh nrcasion of
on ernploy-e ripplicniton filed withh fl,P Worl('Ws Compensation
Appeals f)vr)rd, for disnhility henefils.
f3.
Provide, IN, City with o-P-,i-nrhniril rpidit r.-c-on-ilieation of konefit
dishurst-monts erld spe-ciot loss exl`,-nsPw fnr lhi� r-ity's Worker's
CornpAnsfitinn r; ff-[rtsitronce f'rnrlrcr7�, irtictiarlinrl fi Hepartmental
cost/injury breakrkawn.
9,
Trrnnsmit r1nitns, file* mo-dicnl reports rho wI)O h [t+ra
sr)slaint-d disohility injuries in order that the City be ma&-. o core of
my work rPslr Om' ns.
11. finfefy Services /1
A, ✓insist in the implerneifolion and odministration of flip Pity's industrial
safety program and in that connection:
1. Provide safety inspection services ns requested.
2. Stahmit perindir nvmlontion reports, as rippi aprinfe, roncvrninq flip
progress of the safety program.
`t. Assi,, the Pity in the development of sofoly training programs.
't. Alert the City when accident/injury trencls rievelop.
5. "+n<e ovoilnt,lp safety training materials, safety posters and safety
films on request,
111. Evaluation of porker's Compensation Self-Insnrrnnre Prop umi
A. The City will ronrfrirt a cnntinuinq fpotii`,ility <tIr.-1,,, ref prngra.�
effertivenpzs rand roses. To nrd Pais olij,- •M'.fr, Ow l-;ign of rrrtnin farms
for the collection of npproprimfe 4afn is anti.--ipnfnd. fr,e mr;jrnt ,will lie
expPcted to portirip ite in rinvr'ir?ping surli p rFnrrncanrP Qvn4�rotiG>n theta, to
review prohte'n'crrens, mnd rnnkp tern°no Findr,tinns Far imprnvp „enf in each
of ft,pse nrens. Siar•11 an r,vralrrntion .Hilt inrfzrrf- n r ,,n'n,ry of flip praid
rinims and otitstnndinrl erase linl,ilitir's rrf!rclinq the f ;ty's exn-r'ienrp as a
'vhotr , occordinq to deprlrtrnentnl Pvp F,riPnrp, Air,, *,, r^ ,,+qprj 'vilf lift a
compilation of certain proel mrn pprformon<r= ir,°i°^,tars of tr,P'Vorknr's
(-nn,pr,nsotinn Self-insurance f'rograin as rn,,trnmliv noreed ttpcxa by flip Pity
mar}fhe ogpncy.
IV. Frnployee Services
A. fxrnv=.+ rrar,sralt��li*an n!,rf rpro, nee tnrievploprnerit of
policies and prorprisrres for ernploypP inforn,otion sorvire ortivilies.
13. On req+ar,st of fray .Pity, consult with employee groups to explain and resolve
benefit conflicts.
C. Provi-le slapportinq drito rierp_s-mry to forrn,71nf, a inh related medical policy
for lase as a pre -employment examination goidn.
V. Fiscal 5rrvicPs
A,.. Providrr all finonrml sa,pport rlolo wid th- fis,-,al tsar,-d,,rP% nnr,r-;sriry to
Pffert o sm',oth interfoc'e hot meen the (,'it of Huntington Reach and the
benefit services.
AM VI.
C 1
Inspection and Audit of Records
A. The t;il y vill reserve the right to inspet-t rind rmrtit thn miencv's records
rc*Invont to the City's account at nny tione tlpon cti.inq of reasonable
notice. The. City will permit the ngenry to insw rl and audit the City's
pgyroll and ,worker's nnmpensntion rr>cnnk nt nnv firm 11pon givinq
reasonable noticR. The City will pro -!id- nnressnry infortnutir?n pr-lnininq
to claims reported for adjustment under the provisions of any ogreement.
VII.
Termination of Agreement
A. Any ragn-nmvnt arrived nt `aet .vein the City rind ri 1,-ncv will hnve a
teinination clause of sixty (60) days, exercisable by either party.
13. Upon termination of this ogree-nent, 11ir, mioncy nptrp-s tp dnti•ver to the
City oll €ilrs and rox nrrk pertoininq to clnims cac;;nit,isiered by it under the
provisims of taxis agroe-nent.
- VIIi.
Excess insuranr_e
A. Rini on premittrn fnr oxcess invirrinr,- lirnhility rnvornrao in the a•nounts of
� I0(),000 and 5200,000 per ocr_urrenrn.
IX.
PayrollOota
¢
The estirmited payroll by worker's com.pensotion codes fir the fiscal year
is:
g11,1t7 ,,ate q"tl
7IN)
77?tl pt, St; , �„ 1
V 10 3, Sit 7,
91410 l ,'tE31, x,'a?
As of this dnte, tt)e City has npprnx*,mnt--Jv n r, pnrinnnrnt employees anti ?22
lemporory employers on a port tirrtr= or hotirly l,asis.
X.
Loss fiun
Ibe Ines r-jr) for ttie period 44ny 1, 1`174 throw iq°4 (:cto, if-t 11, 1080 is enclosed
for your review, As of October 31, 1980. t he City hod I tin open cloitrae.
EXHIBIT "B"
Allocated Loss Ex nse .
All costs, sham es or f-xPenser, reasnnnbly and
necessarilyneciess,irily incurred by ,7amr?v,, in t11e F of s hz
agropment Which arc to the ,7-{'et►r ^t' Maims or the
performance of flames' .,t her obl.ip.at ions 11F,-1w.-ler s ha11 be re_
Imbursed to- James by C'l t.y .
Reimbttr-ah,lo ai1c,,,:1ted r!n- .,+s mv,: it1(`1±1-ify:
(a) Claims payments.
(1, ? Me'l i na l rnn ' :; ir1 .1+t t1r. med ir`11
prescriptions and ?rs1t1 i ^ ?t:#. t tsi l coat"+
21 A iea 11 fti. � rvr}.rv?.'7. t�Tf''t'. 'r.„i1t'1ri"a1+y
disabilit..y r,ayi-ac nf—,.
�b} `1.1air;:' i11'dF'f?-tirat :`•t1 ^"t: i
��'} �r�itabil itak.inrl er�;±t;;,
(1) "±t .11 r'i hc't' crst.s ;1l vvot$ 1 - i,.y i'ity in
writ i C1r.
irk
RESOLUTION NO. 4337
A RESOLUTION OF THE CITY COUNCIL- OF THE CITY
OF HUNTINGTOdd BEACH ESTABLISHING A MINIMUM
LIABILITY INSURANCE LIMIT
WHEREAS, there are persona engaged in various activities
In ,the city which subject the city to possible liability for
damage to property and injury to persons; and
For the protection of the public health, safety and wel-
fare, the city requires such persons to maintain insurance
naming the city additional insured; and
The city desires to establish uniform minimum liability
limits for all suc2, persons engaged in said various activities
w ire required by ordinance, resolution or otherwise to
ide such liability insurance,
NOW, THEREFORE,, BE IT RESOLVED by the City Council of
the City of Huntington Beach that the minimum liability limits
shall be as follows:
1. Combined Single Limit Bodily Injury and/or Proper
Damage including Products Liability: $300,000 combined limit
per occurrence, except as otherwise provided by ordinance or
contract.
2. Additlonal Insured Endorsement: The insured agrees
that the City of Huntington Beach City Council, and/or all
City Council appointed groups, committees, commissions, boards
and any other City Council appointed boly, and/or elective and
appointive officers, servants or employees of the City of
Huntington Beach when acting as such, are additional assureds
hereunder,
3. Any person engaging in any activity determined by
ordinance, resolution or the City Administrator to subject the
city to a, possibility of liability shall provide the city- with
a certificate of insurance containing the additional insured,
endorsement and the void harmless agreement.
«�.en .
EXHIBIT "C "
ANIL
tt. Hold Harmless Agreement. The insured agrees to
protect, defend, indemnify and save harmless the City of 1
Huntington Beach against loss, damage or expense by reason
of any suits, claims, demands, judgments and causes of action
caused by insured, his employees, agents or any subcontractor,
arising out of or in consequence of the perfDrmance of all
or any operations covered by the certificate of insurance,
and such insurance shall be primary to any insurance of the
city.
Resolution No. 4013 and all other resolutions in conflict
herewith are hereby repealed.
PASSED AND ADOPTED by the City Council of the City of ;
Huntington Beach at an adjourned regular meeting thereof held {
on the 6th day of October, 1976.
ATTEST: -77
Y
�= ce
City Clerk
APPROVED AS TO CONTENT: APPROVED AS TO F'ORhi:
Aamr,g City'Adminstrator City Attorne
APPROVED,, NITY I2J0 DEPARTMENT:
NO FISCAL 'IMPACT r
FISCAL IMFA(-,T - P'')GETED
its city 1r:°tu"w FISCAL IMPACT NOT BUDGETED
Cj of HunUnBfon Beech, Ce1it
REQUIRES FINANCIAL IMPACT RE°URT
E
I
i
I
2.
S'CATE OF CALIFO )
COUNTY OF °ORANGE ) s
CITY OF HUNfINGTON BEACH
I, ALICIA M. WENIVORTH, the duly elected, qualified City
Clerk of the City of Huntington Beach, and ex-officio Clerk of the
City Council of said City, do hereby certify that the whole number of
members of the City Council of the City of Huntington Beach is seven;
that the foi;•egoing resolution eras passed and adopted by the affirmative.
vote of move than a majority of all the members of said. City Council
at a regular adjourned meeting thereof held on the 6th day
of October , 1976 , by the following vote:
AYES: Councilmen:
Bartlett, Coen, Gibbs, SS.ebart, Shenkman, Wieder
NOES: !7ouncilmen:
Bone
ABSENT: Councilmen;
r
Pattinscn
City Clerk and ex-officio Clerk
of the City Council of the City
of Huntington Beach, California
w
t
EXHIBIT "D"
COINITENS Am. ION
I'he estimated first ;rear cost the services to
be performed under this a_reement Is $33, 000 which sum., will
be advanced to james over the term hereof in the form of
incremental pro�,,ress payments. At the :end of the contract
year the estimated first year ccyst will be adjusted upwards
or downwards in a ,cordan, e witl-, t:ht= fr.�Ilowin�-:
T. The City will pay to James
a) the .c.'..um -'If a one t•;i..n.ie ,..inl,,F
start-up fee of ten thou: and dollars $10,0110) r,..us
b tht, vrndtasct nf` one hundred
fifteen dollar > $ 11 ' tlmt,,Ys. t: he number c..' new workers'
C;{?FT;L enzat i€ n files f',riginai.-A: i fvr '11 Y 1-y James in the
contract year.
compensation shall n�_,t
exceed thirty-three thousand dollars ($33,000) in<rlusive
the start-up fee for the total work to be performed her_�ander
but James shall not be obligated to process awre than 200
new cla3lzz without an inerease in such total co!7`ipensation.
III. On early terr. ? nat ion James will
receive as its sole compensation the sum determined by
3/20/81
multiplying $90.00 times the number of days in which services
are actually performed, which sitm shall be accepted in lieu
of the sum of the start-up fee and the per claim fee of $115.
r�{;3 2.
cq, , rs cxrttr se to CE Btll ICAl E OF INSURANCE
Qty of Hunungron 6k a0i to
0 19u
P CiTY OF HUNTINGTON BEACH, CALIFORNIA
F3.,x
Hurmngmn deach, Cataforma 92648 A MUNICIPAL CORPORATION
This is to certify th,,t the policies of insurance as described below have been issued to the insured by the under.
ragged and are in force at this tin-. if these policies are cancelled or changed in such a manner that will affect this certificate, the
insurance company agrees to give 30 days prior written notice, by mail, to City of Huntington Beach, P. O. Box 190, Huntington
Reach, California 92648.
Name of insured. l'pdi+U .n, T4r4RS AND f'`t" MPatly 0�1EQRi I
2415 CAMPUS DRIV�uite
Address o�yINE CALIFORNIA 92715
f. Insured ,
Location of Insured Operations SAA
Description of Operations ADMINISTRATION OF SELF—INSURANCE PROGRAM
POLICIES IN FORCE
i NR
�UMB
LIMITS OF LIABILITY
EFFECTIVE
EXPIRATION
A. Workers Compensation
Statutory
Employers' Liability WC005
6379
7/1/80
7/1/81
S 100,000.
B. Public Liability:
` $300,000 combined single
Bodily Injur y� CCP00
55062
7/1/8Q
7/1/81
limit per occurrence,
Manufacturers and
Contractors 0
$ Each Person
Comprehensive
General ED
S Each Accident
(Including products completed
operations)
Property Damage
5 Each Accident
C. Automobile Liability:
Bodily Injury
S Each Person
BUA00
89233
7/1 /80
7/1 /81
s Each Accident
Property Damage
S Each Accident
Does policy cover.,
All owned automobiles (x ) Yes ( ) No
Non -owned automobiles (x ) Yes ( i No
Hired automobiles { X I Yes { ) No
Q. Additional Insured Endorsement:
The insurer agrees that the City of Huntington Beach City Council, and/or all City Council appointed groups, committees,
comrnisxi.:'s, boards and any other City Council appointed body, and/or elective and appointive officers, servants of
employees of the City of Huntington Beach, when,acting as such are additional assureds hereunder.
E. Hold Harmless Agreement: By Insured; r,
The insured agrees to protect, defend, indemnify and save har less the City of Huntington Beach against foss, damzj e or
expense by reason of any suits, claims, demands, judgements P d causes of action caused by insured,his employees, agents-
or any subcontractor arising out of or in consequence of the performance of all or any operations covered by the certificate
of insurance, and such insurance shall be primary to any insurance of the city.
F. Minimum Limits Required: APPROVED AS TO FORM:
Combined Single Limit Bodily Injury and/or Property Damage including Products Liability:�, /
combined single limit per occurrence. City Attorney v e t+
G. Remarks:
iE5ai, ttorn y
Date 3/16/81
IN5URAi+ICE COMPANY REPRE T_ �AVV5''�B�K1=R
Name Ti'dnSoortation Tt15UrdfiCe CO. By
t; Snatlfre utti sized RepreseatativelAgent
address -CNA Plaza Addrei 2415 Cali us drive, Suite 100. I-rvine, CA
c,ty Chicago, Illinois Zlephone714/752-0990
f > 2'-50' T XIS[ .4'/7-
{ REQUE FOR C;lTY COUNCIL ACTION
Date May 1, 1984
Submitted to: Honorable Mayor and City Council
Submitted by: Charles W. Thompson, City Admi ni str o
Prepared by: Robert Franz, Chief of Administrative Servi ces-
Subject WORKERS' COMPENSATION ADMINISTRATION
Statement of Issue, Recommendation, Analysis, Funding Source, Alternative Actions, Attachments.'
STATEMENT OF ISSUE: The City has contracted with Fred S. James Co. to provide
administrative services for the self funded Workers' Compensation Program for three
years. It is time to renew the contract for those services,
RECOMMENDATION: Approve the attached contract with Fred S. James & Co.
ANALYSIS: The annual cost of this service, based on the proposed $145 per claim
charge and an estimated 250 new claims, would be about $36,000. This is the most
cost effective manner in which to perform these administrative services for employee
injury claims. Included in the services (complete listing in Exhibit "A" of proposed
contract) are normal processing of paperwork and documentation, payment of benefits
in accordance with State Law, eligibility determination, coordination with doctors
regarding medical evaluation,'treatmont, anr, pre^aration of monthly listings and
management reports on all claims. The $145 per claim proposed charge is consistent
with the charges to other cities. in general, claims costs are currently ranging
from $130 to $160 per claim in comparable cities, with 5-10" increases being
projected for 1984-85 by most cities.
The City has self funded Workers' Compensation for the past 8 years, and has utilized
the services of Fred S. James Co. for the past 3 years. James performs in a highly
competent and satisfactory manner and have been very competitive from a cost stand-
pt.,'nt. The City has developed an excellent and productive working relationship with
James, and it is in our best interests to continue this relationship for at least
another year. James perfonas a great deal of service to the City for the rather
modest cost involved. A rectnt audit by Warren, McVeigh & Griffin attests to the
fact that •.'ames is perfonninj a highly effective service to the City.
Th ough oversight of both the City and the Fred S. James Company, the prior service
contract was not renewed when it expired on April 6, 1983. This oversight, while
inexcusable, was probably caused primarily by the fact that the compensation to the
Fred S. James Co. was not increased, Services have continued to be provided in accord
with the contract and payments have been made simil ly. The recommended contract
is to cover, retroactively, the past year plus an extension through June 30, 1985,
FUNDING SOURCE, Funding is contained in the budget.
ALTERNATIVE ACTIONS: 1. In-house administration
Z_ Select different administrator
AT Recommended contract.
r
P1O 4191
CITY OF HUNTINGTON. BEACH
_ 2000 MAiN STREET CALIFORNIA 92648
OFFICE OF TIOE CITY CLERK
May 12, 1983
Fred S. James and Company of California
2415 Campus Drive, #100
Irvine, CA. 92.715
The City Council of the City of Huntington Beach at a regular meeting
held December 6, 1982, approved Supplemental Agreement #1 with your
firm to provide continuation of services in administrating the Workers'
Compensation Program.
Enclosed is a duly executed copy of said agreement together :with a
copy of the insurance which you have submitted.
Alicia M. Wentworth
City Clerk
ANW CB:bt
Enclosures
CC: Ed Thompson, Risk Manager
Judy John, Finance
4
t IiTelephone. 71463E-5227) x
REQUE` FOR CITE' COUNC . ACTION
Date November 9, 1982
§vbmitted to: Honorable Mayor and City Council Members
Submitted by Charles W. `Thompson, City Adainistrat:r/� ciL
Preparcd by Frank B. Arguello, Chief Administrative ervices Departmen 1_9---
Subject: I Fred S. James Supplemental Agreement No. I
Statement of Issue, Recommendation, Analysis, Funding Source, Alternative Actions, Attachments:
STAMM OF ISSUE
The need to extend the Fred S. James CoTTTpany contract for third party administration
of IATorker s' Compensation.
RECOU-MATION:
City Council approve the Supplemental Agreement No. 1 to provide continuation of
services in administering Workers' Compensation Program.
ANALYSIS:
The City bas self -funded the Workers' Compensation Program and utilized the services
of an outside third party administrator since May 1, 1976. The services provided by
Fred S. James Company have been satisfactory and the agreement with them should be
continued..
FUNDING SOULE:
The finds for the Workers' Compensation Program are included in the current budget
approved by City Council.
ALTERNA:rIVE ACTIONS:
Purchase Workers' Compensation Insurance. Consideration now under study to do all work
in-house.
ATTARS::
Supplemental Agreement No. 1 for approval.
Q4r:FBA -.EU-skd
U—
PTO 011 � �
REQUEP FOR CITE" COUNC#ACTIO,
Date 11/13/81
Submitted to; Honorable Mayor .and City Council Members y, -6pii
e pp'V , r
Submitted by: Charles W. 'Thompson, City Administrator
Prepared by, Frank B. Arguello, Chief -- Administrative S.*'v .ce `r
i
Subject: Excess Workers Compensation Insurance
Statement of Issue, Recommendation, Analysis, Funding Source, Alternative Actions, Attachments:
Statement of Issue:
The City Council had given approval to solicit bids for excess Workers compensation
insurance. We have received quotations from Robert F. Drivers Company, Coast Insurance
Agency and Fred S. James and Company.
Recommndation:
Purchase excess workers compensation of $250,000 Self Insured Retention With unlimited
coverage from the lowest bidder, Fred S. James and Company at a cost of $'_9,100.
:Analysis
Excess Workers Compensation Bids
Self Insured
Retention
$2 Million Limit
$5 Mi ll icn-i Limit:
No Limit
$100,000
Fred S. James & Company
.319*
Deposit $74300
$150,000
Fred S. Jags & Company
.152*
Deposit $35,390
Coast Insurance
.1969*
(Per Accident Per Payment
Deposit $45,850
Year)
$200,000
Robert F. Driver
.140,*
.173
Deposit $36,518
Deposit $42,400
Coast Insurance
.128*
.139
Deposit $29,803
Deposit $32,364
$250,000
Robert F. Driver
.119*
.143
Deposit $29,165
Deposit $35,047
Fred S. James
.02'`
Do, it $19 , oa
NO 4187
1
y
REQUEST FOR CITY COUNCIL tON PAGE 2
Re: Excess Mbrkers Compensation Insurance
Self Insured
Retention $2 Million Limit $5 Million Limit No TArfLit
Coast Ina_urance .09* .099* .10*
Deposit $20,955 Deposit $23,051 (Per Accident
Per Payment Yr. )
Deposit $23,284
*Rates quoted per $100 of payroll
Excess workers compensation coverage is needed if there is a.ny probability of a major
loss.
Funding Source:
Self insurance «orkers Compensation Fund.
Alternative Action:
IVot to purchase excess workers compensation to save the $19,100 premium costs and
assume all risks of any possible major loss through the self insurance fund. Another
alternative would be to select a lower deductible and/or different inane company
for a higher premium.
Attachments
Nona
C
CITY OF HP...'ON'TINGTON BEACH
i
INTER DEPARTMENT COMMUNICATION
HUNTINGTON BEACH
i
Tu Charles W. Thompson From F. B. Arguello
City Administrator Chief of Administrative Services
Subject Funding for Excess Workers Date December 10, 1981
Compensation insurance
FIR # 81-87
In response to the request of the Administrative Services Department, a Financial
Impact Report has been preparedand submitted with respect to the funding for excess
workers; compensation insurance it has been suggested that the cost for the lowest
bidder - Fred S. James and Company will be $19,100.
Adequate monies are available in the self insurance, workers compensation fund for
this purpose. Should the City Council choose to approve this expenditure, the balance
in the account will be reduced to $1,746,231.82,
F. B . A g uellll�o
Chief of Administrative Services
FBA/AR/cg
R«.
0
CITY OF HUNTINGTON BEACH
F
FINANCIAL IMPACT REPORT
Project Name Excess Workers Compensation Insurance
Description Requested funding to accommodate lowest bidder of City's offer to
purchase excess workers compensation insurance.
1 DIRECT PROJECT COSTS
1.1 One -Time Costs
Land
urn., aci i-
Acquisition
Construction,
ties, Equipment,
Other
Total Cost
19,100
19,100
1.2 Recurrin;l Annual Coats
Payroll
Aclditlonal
Personnel
Materials E
Su lies
utside
Services
Revenues
Total Cost
19,100
19„1OO
s Financial Impact_Repor '
Page Z
3. NON -DOLLAR COSTS
N/A
4.. BENEFITS TO BE DERIVED FROM THE PROJECT
Minimize the risk of a catastrophic loss which could deplete the City's self
Insurance fund.
5. PROJECT USAGE
N/A
IN 6. EXPENDITURE TIMING
Subject to City Council approval.
COST OF NOT IMPLEMENTING THE PROJECT
Increase the risk of a catastrophic toss to the City°s serf insurance fund.
REQUEf FOR CITY COUNCIL ACTION
S
Submitted by Frank B. Arguello Department Administrative Services
Date Prepared March 26 11981 Backup Material Attached Q Yes ❑ No
Subject Fred S. James and Company Contract - Administration of Workers
Compensation Program
City Administrator's comments
Approve as Recommended. APPROVED BY CITY COUNCIL
. �.
CITY 1L1r
Statement of Issue, Recommendation, Analysis, Funding Source, Alternat;ve Actions.jj� „e
Statement of issue:
At the meeting of March 2, 1981, Council approved the selection of Fred S. Names and
Ccmpany as the administrators of ti-,e City's Workers Compensation Program and directed
staff to negotiate a, contract.
Recc m ndation
Approve the attached contract with Fred S. James Company.
Analysis:
The City has been with R. L. Kautz and Campany since becoming self insured for workers
compensation 4h years ago.. While the City has saved a considerable amount of many as
a legal uninsured entity, the claims service provided by R. L. Kautz and Company has
been less satisfactory. The level of service was sporadic and would improve
temporarily only after repeated ccmplaints. Consequently, we felt we could obtain
better, more efficient claims service with another workers compensation administrator.
Following inquiries of numerous professionals in the workers compensation field., i.e.,
attorneys and administrators, as well as with other self insured public agencies,
Fred S. James and Ccnpany was the most highly recorme-nded firm. Additionally,
Fred S. James has experience with administering the claims of public agencies wnicb
would undoubtedly ease the transition due to the distinct and divergent laws covering
public safety employees. The estimated first year cost of the services to be
performed under this agreement is $33,000 which sum will be advanced to James over
the term hereof in the form of incremental progress payments.
Funding Source
Provision has been made for the administration of the Workers Compensation Program in
the 1980-81 budget.
Alternative Actions
The alternative would be to administer the Workers Compensation Program in-house. This
would entail hiring an experienced claims examiner, obtaining office furniture and
ccuputer terminal access. The estimated annual cost of in-house administration is in
excess of $35, 000.
REQUEST _ FOR CITY COUNCIL ACTION
N
Submitted by ':Edward H. Thompson, Director Department Adm. Services, Personnel Division.
Date Prepared February 13 , 1981 Backup Material Attached 0 Yes I_ 1 No
Subject Administration of Worker's Crpensation Program
City Administrator's Comments
�i""LOVTD i3 G1TY C UL'iQClL
Approve 15 Recommended.
1
l�-
Statement of Issue, Recommendation, Analysis, Funding. Source, Alternative Actions:
a
iI
Statement of Issue;
The City of Huntington Beach had cancelled its contract with R. L. Kautz and Ccnpany for
the Administration of our Workers Ccxrrpensation Program on 12/12/80. We had solicited
proposals frcm six corkers compensation administrators and have received bids from;
Fred S. James and Company, Universal Self Insurance Inc., Bierly and Associates and
Brown Brothers Adjusters. Following review of the proposals, I recocmend that the
City contract with Fred S. James and Company to administer our Workers Compensation
Program.
Reconu endation :
Select Fred S. James and Company as the administrators of the City's Workers Compensation
Program and direct staff to negotiate a contract.
Analysis:
The City has beem with R. L. Kautz and Company since becmiilg self insured for workers
cmtpensation 4' years ago. While the City has saved a miisiderable amount of money as
a legal uninsured entity, the claims iervioe provided by R. L. Karatz and Ccaj->any has
been less than satisfactory. The level of service was sporadic and would improve
temporarily only after repeated complaints.. Consequently, we felt we could obtain
better, more efficient claims seivice with another workers carpensation administrator.
Following inquiries of numerous professionals in the workers compensation field, i.e.
attorneys and administrators, as well as with other self insured public agencies,
Fred S. Jadms and Carpany was the most highly recctm-ended firm. Additionally,
Fred S. James has experience with administering the claims of public agencies which_
would, undoubtedly ease the transition clue to th<a distinct and divergent laws covering
public safety employees. The annual administrative service cost is the same as .that
with R. L Kautz and axrpany $20,000, with an additional one time fee of $10,000 for
assuming and administering all open claims.
Funding Source:
Provision has been made for the administration of the Vbrkers Coaperisation Program in
the 190-81 budget. i
trio araa
REQUEST ,FOR CITY COUNCIL ACTION PFB— R[AW 13, 1981
Re Administration of Workers Compensation Program Page 2
Alternative _Action:
The alternative would be to administer the Workers Compensation Program in-house. This
would entail hiring an experienced claims examiner, obtaining office furniture and
computer terminal access. The estimated annual cost of in-house administration is in
excess of $30,000.
f
y
L
SUnIARY-SHEET ON BID
SUBMISSION FOR WORKERS COMPENSATION
SES,F INSURED PROGRAM
Administrative Fee For Location of Total. Cost
Service Open Claims Office of Bid
Cost
(Est. 200 Claims
(Est. 105
Per Year)
Open Files)
Bierly &
$120 per claim
No
Santa. Ana
Associates
($24,000 annually)
Charge
Universal Self
$27,500
$50 per claim
Long Beach
Insurance, Inc.
($5,250)
Fred S. James
$20,000/aw--mually
$10,000/
Irvine
($115 per claim)
Flat Fee
Brown Brothers
$100 per claim
$100 per claim
Los Angeles
Adjustors
($20,000)
($10,500)
Note; All bids are annual with a 60 day notice of termination clause.
$ 24,000
32,700
30,000
30,500
1