Res 148-2009 11/3/2009 r
RESOLUTION NO. j ySS . fc,o�
Resolution Authorizing The City Manager To Enter Into A Contract
With Edwards Risk Management, Inc. For Third Party Administration
Of the City's Workers Compensation Program
WHEREAS, the City has self-administered its worker's compensation program
for decades; and
WHEREAS, new worker's compensation laws and other requirements are
making administration of this program more complex and less efficient; and
WHEREAS, the City desires to contract the administration of this program to a
third party administrator; and
WHEREAS, proposals from various third party administrators have been
reviewed to determine which proposal is in the best interest of the City.
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY
OF WICHITA FALLS, TEXAS, THAT:
The City Manager is hereby authorized to enter into the attached Service
Agreement with Edwards Risk Management Inc. for third-party administration of the
City's workers compensation program, with such changes to form as are approved by
the City Attorney.
PASSED AND APPROVED this the 3� day of November, 2009.
MAY
ATTEST:
Clerk
SERVICE AGREEMENT
This Agreement dated this 3rd day of November, 2009, by and between Edwards Claims Administration,
a Texas carporation (hereinafter referred to as Edwards Claims) aniJ the City of Wichita Fa(fs, (hereinafter
refeRed to as Clierrt). The Client hereby agrees that Edwards Claims sha�l pertorm services for and on
behalf of Clierrt upon the tertns and conditions set foRh herein.
I. RELATIONSHIP - EDWARDS CLAIMS AND CLIENT
1. Definitions
Adjust - process of investigation, evaluation, and dsposition of Gaims alleging bodily injury as a
result of an on-the-job injury or incident.
Alloqted loss expense - expenses payable by the Clierrt to third parties as a result of Gaims
services, but not induding dired daims payments or fees paid to Edwards Gaims.
Claim - any incident that could, in Edwards Claims' judgemerrt, resuk in financial loss to or
fina�ial liability of the Client, and fior which Edwards Claims has established a file.
Disaetionary settlement authority - stated sum(s) of money set forth under this AgreemeM under
which Edwards Claims shall have full and sde discretion and final authority to adjust and make
Gaim payments on behalf of the Client.
Reserve - monetary evaluation af the ClienYs total financial exposure on any claim or incideM as
established by Edwerds Claims.
Third party - any person, partnership, corporation, or other legal entity except Edwards Claims,
employees of Edwards Claims, the Client, or employees of the Client.
2. N�ture of ContraCtual RelaHonship
Client has elected to employ the administrative services of Edwards Claims relative to the
operation and maiMenance of an individuaily or co0ectively self-insured workers' compensation
program. In retum for and in consideration of the fees set forth F�ein, Edwards Ciaims agrees to
fumish senrices to Clier►t in accordance with the provisions of this Agreement. Edwards Claims at
all dmes shali be considered an independent contrador, and employees of Edwards Claims shafl
in no eveM be considered employees of the Client. Edwards Claims reserves the right, in its sole
discretion, to assign pertormance oi activities under this P�greemeM to any of ils personnel and to
subcorttrad to third parties any part or aA of Edwards Claims' duties without the necessity of the
ClienYs approval, provided, however, that any subcontracting by Edwards Claims shall not relieve
Edwards Claims of its obligations to the Client under this Claims Service Agreemerrt.
3. Tertn of Aareement
This Agreement shall remain in efted from December 1, 2009, to November 30, 2012, at which
time the Agreement may be renewed for an additional period by agreement of the parties. This
Agreement may be terminated by eiiher patty upon 60 days written nodce prior to anrtiversary or
upon mutual agreement by both parGes at any time.
Ecaeny or rr,enns Fans ay�om.nr w�e + nee.mee. r, zoo9
II. SERVICES TO BE PERFORMED BY �DWARDS CLAIMS
During The period or periods of this Agreement, Edwards Claims shall act for the Client as Administrator of
its wofkers' compensation program and resultlng claims arising under the Texas Wake,�s' Comoensation
Ad, and shall devote its best efforts in the condud of its duties hereunder. Such duties shall indude the
following: '
1. Review, investigate, adjust, settle or resist all reported claims of occupational illnesses or injuries.
Any claim to be denied w911 be discussed with Clierrt priar to denial.
2. Monitor medical treatment of injured employees and obtain appropriate medical reports.
3. Issue checks or authorize payments of workers' compensation benefits and medical treatrnerts
considered related, reasonable, and necessary.
4. Fumish all Gaims forms necessary for proper daims administration.
5. Negotiate settlemerrts with claimaMs or their attomeys in accordance wdh discretionary
settlemeM authority provided by the Client.
6. Provide naRative reports on all senous claims and as needed by the Client.
7. Prepare and monitor files re6erred to defense counsel for ciisposition, discovery, and arry legal
woAc.
8. Consutt with the Client and defense attomeys on the cost impad and cost control strategy
available on daims.
9. Assist in the selecton and aid in the supervision of aftomeys retained to defend Gaims against
the Client.
10. Evaluate and reserve all daims.
11. Monitor daims ior potentiat subrogation and dired and supervise efforts to pursue subrogation
recovery.
12. Audit medical, hospital, and miscellaneous invoices prior to approving for payment
13. Provide monthty, quartery, and annual daims reports.
14. Devebp and assist in the implemer�on of written procedures and instructions necessary to the
effiaent opera8on of the ClienYs program.
15. Provide reports required by excess insurers upon written direction from the Client.
16. Provide Client with current infortnation on workers' compensation statutes, Texas Department of
Insurarx:e, Departrnent of Workers' Compensation rules, and any subject which may have effect
on the ClienYS program.
17. Assume handling of all outstanding workers' compensation daims with accident dates prior to the
effective date of this Agreement, as requested by the Clierrt.
18. Prepare and submit IRS fortn 1099 for all vendor payments made by Edwards Claims on behalf ,
of the Clier�t during each respective calendar year.
r-cacny of wr�nn. Fa►�s a�oM �e s veeamwr +, �noa
III. SERVICE FEES
In consideration for the Gaims services provided by Edwards Claims, Client shall pay Edwards Claims in
accordance with the folipwing fee schedule:
Indemnity Claims (other than medical only) $ 630.00
Medical Only Claims $ 90.06
Record Only Claims S 20.00
This flat rate pricing appiies for the duration of this Agreement Medical only Gaims wili be converted to
indemnity daims when incurred reserves exceed $7,500. Any daim that remains open more than two
years from the date of receipt will be charged to the Client at a rate of 5300 per year. Upon termination or
non-renewal of this Agreement, Edwards Ciaims will continue to adjudicate existing Gaims at the rate of
$300 per year per open claim.
Edwards Claims will accept the handfing of Gaims filed prior to December 1, 2009, under the following fee
schedule:
Indemnity Claims (other than medical only) $ 375.00
Medical Only Claims $ 75.00
These fee strvctures exclude allocated expenses defined as:
attomey fees, index bureau fees, EDI Vansmission fees, medical audit andlor cost containment
fees, fees tor claim related medical opinions, independeM mediql examinations, witriess fees.
e�ert fees, witness/expert travel expenses, extraordinary trave! expenses incurred by Edwards
Claims at the request of the Client, fees incurred for representation at hearings andlor trial
proceedngs, court reporter fees, transcript fees, photographs, detecdve services, the cost of
obtaining public records, cost of checks and banking fees. Attechmeni B proNdes a Ifsting of
�u�reM allceated expenses arml related fees. Note U�at such fees are subJeci to change.
Any change in federal, state, or local laws affecbng daims handling, claims repordng, or medical oost
coMainment activities may resutt in a modification of the handling fees outlined above.
An annual minimum fee of $60,000 shall apply to this Agreement.
IV. PAYMENT OF FEES
The Client will be billed at the beginning of each morrth for the prior month's claims activity in accordance
with the fee schedule ouNined in Sedion Ilf above. Paymerrt wili be made by the Client within ten (40)
days of receipt of the bill. Auditing of annual billings will be completed within 60 days of the conVact
anniversary date.
V. INSURANCE
A. Insurance requirements are addressed in AttachmeM A. Prior to the commencement of any work
under this coMrad, Edwards Claims ahall furnish an original oompleted certificate(s) oi insurance
to the ClienYs Purohasing AgeM, which shall be completed by an agent authorized to bind the
named undervvriter(s) and their company to the coverage, limits, and termination provisions
shovm thereon, and which shall fumish and coMain all required i�ormation reterenced or
indicated thereon. The aiginal certificate(s) must have the agenPs origina{ signature, include the
signer's company affiliation, tftle end phone number, and be mailed directly from the agent to
Client. T'he Client shall have rw duty fo pay or perform under this corrtract ur�til such certificate
shall have been delivered to the ClienYs PurChasing Agerrt.
ECNC�YY o/ YYfchifa Falls Agreemeet Pega 3 Deeembs► t, �i00Y
B. The Clierrt reserves the right to review the insurance requirements of this sedion during the
eifective period of this Contract and any extension or renewal hereof and to modify insurance
coverage and their limits when deemed necessary and pruderrt by the Cliern's Purchasing Agerrt
based upon changes in statutory law, court decisions, or arcumstances suROUnding this
Corrtrad, but in no instance will the Client allow modifica6on whereupon the Client mey incur
increased risk.
C. Edwards Claims' finanaai integrity is of irterest to the CIieM, therefore, subject to Edwards
Claims' right to maintain r�sonable deductibles in such amour�ts as are appro�ed by the Client,
Edwards Claims shall obtain and maintain in full force and effect for the ciuration of this coM�ad,
and any extension hereof, at Edwards Claims' sole expense, insurance ooverage written by
companies author¢ed and admitted to do business in !he State of Texas.
D. The Clier�t shall be entiUed, upon request and without expense, to receive copies of the policies
and all endorsements thereto as they apply to the limits required by tl►e Client, and may make a
reasonable request for deletion, revision, or modification of particular policy terms, cand'Rions,
limitations or exclusions (except where policy provisions are eshablished by law or regulaCwn
binding upon either of the parties hereto or the unde�writer of any such policies). Upon such
request by the CI'�ent, Edwards Claims shall exercise reasonable efforts to a000mplish such
changes in policy coverage, and shall pay the cost thereof.
E. Edwards Claims agrees that with respect to the above required insurance, all insurance contracts
and certificate(s) of insurance will oontain the following required provisions.
1. Name the Client and its directors, officers, employees, agents and eleded officials as
additional insured with respeds to the operations and activities of, or on behalf of, the
named insured performed under contrad with the CIieM, with the exception of the
wakers' compensation/employers' Gability and fhe professional liability policies.
2. Edwards Claims' insurance shall be deemed primary with re,apect to any insurance or
self-insurance carried by the Client for liability arising out of operations under the contract
with the Clierrt.
3. Provide for an endorsemerrt that the "oU►er insurance" clause shall not apply to the Client
where the Clierrt is an additional insured on the poiicy.
4. Workers' CompensatioNEmpbyers' liability policy will provide a waiver of Subrogation in
favor of the Client
F. Edwards Claims shall notify the Client in the everit of any notice of cancellation of any notice of
cancellation, non renewal or material change in coverage and shall give such notices not less
than 10 days prior to the change, or 10 days for nonpayment of premium, which notice must be
accompanied by a replacement Certificate of Insurance. All notioes shali be given to the Client,
by Certified mail, at the following address:
Client of �chita Falls
1300 SeverKh 3treet
VYichita FaIIs TX 76307
Attn: Peggy Gahagan
G. If EdwaMs Claims fails to maintain the aforemerrtioned insurance, or fails to secure and maintain
the aforemerdioned endorsemeMs, the Clierrt may obtain such insurance and dedud and retain
the amount of the premiums for such insurance from any sums due urxfer the agreement,
however, procuring of said insurance by the Client is an altemative to other remedies the Client
may have, and is not the exGusive remedy for failure of Edwards Claims to mair�tain said
insurance or secure such endorsement. In addidon to any other remedies the Client may have
upon Edwards Claims' failure to provide and mairrtain any insurance or pdicy sndorsements to
the extertt a�d within the time required, the Client shall have the rigM to order Edwards Claims to
ECA/CHy of YV1cM1G Falls Ayreana+t Pape � Datem6or 1. 200�9
stop work hereunder, and/or withhold any paymerits(s) which become due to Edwards Cfaims
heseunder until EdwarcJs Claims demonstrates compliance with the tequiremelttS he�e0f.
H. Nothing herein corrtained shafl be construed as Iimitir�g in any way the exteM to which Edwards
Claims may be held responsible for payments of damages W persons or property resulting from
Edwards Claims' or its subcontractors' pertormance of the work covered by this contrad.
VI. GENERAL CONDITIONS AND INDEMNIFICATION
All claims and related files generated by Edwards Claims as a resuR of its acGvity under this program
induding all files transferred Yo Edwards Claims from prior administrators shall remain at all times property
of the Client and tollowing reasonabte notice to Edwards Claims, ClierK shall have the rigM to conduct an
annual audit on Edwards Claims' premises of aU Clierrt files processed by Edwards Claims. Individuals
performing such audit may be ClienYs personnel or other represerrtatives designated for that purpose by
Client. Edwards Claims shall maintain adive and inactive claim files for a reasonable period following
which at the option of Client they will be retumed to the Client or destroyed. Edwards Claims shall treat
all of ClienYs files and other records generated under this program with complete confidentiality and no
information related thereto shall be released by Edwards Claims to anyone without authorization of the
Client
In the event of tertnination of this Agreement, Client shall have the option of requiring Edwards Claima to
retum all daim files to Client for turther handling or attematively to continue to handle all Gaims invdving
acader�ts that occurred pria to terminabon of this Agreement to their final resolution with additional
compensation as outlined in Section III.
Edwards Claims' responsibility for the performance of activities described in Sedion II is condi�oned upon
the ClienYs cooperation with Edwards Claims in all reasonable matters with respect to the activities of
Edwards Claims, induding, but not limited to, responding to Edwards Claims' requests for infortnation
promptly, meeting wfth Edwards Claims and/or third parties as may be needed, and making decisions on
matters which, as requi�ed by this Agreemerrt, or in the professional opinion of Edwards Claims should be
made by CIieM.
The ownership of all systems created or utilized by Edwards Cleims in perfortnance of activides under this
AgreemeM shall belong to, and remain as property of Edwards Claims; the Client having no interest
therein. 'Systems" as used herein shall include, but is not limited to, computer programs, computer
equipmerrt, fortnats, risk data record formats, procedures, documentedon and intemal reports of Edwards
Claims, but shall not inGude claim files retumed to the Clierrt pursuaM to this Sechion, or any materials
delivered by Edwards Claims to the Client.
The services provided by Edwards Claims are not of a legal nature and Edwards Claims shall in no everrt
give, or be required to give, any legal opinion or provide any legal represeMative to the Client, nor may
any communication prepared by Edwards Claims be relied upon by the Client as a legal opinion or
interpretadon. Edwards Claims shall in no event be cor�sidered as engaged in the ptactice of law.
The terms of this Agreement between Edwards Claims and the CIieM shall be govemed by the State of
Texas. Any adjudicatlon by any court of competerrt jurisdiction which invalidates any paR of this Claims
Service Agreemeni shall not ad to invalidate any other part tF�eof. All notices, requests, and other
communications from either party to the other shall be in writing and delivered either personalfy or by
certified mail, retum receipt requested. Any such notioe, request or other oommunication shalt be
deemed to have bee� given on the date of personal delivery or, if mailed, on the date of maifing. All such
notices, requests or other communications shall be delivered to:
FOR Edwards Claims: Edwards Clalms Adminfstratlon
ATTN: Klm Edwards
1004 NFarble Helghts Drlve
Marble Falls, Texas T8654
ECA/City o/ iYrchifa Falls Apraement Paqe 8 Decam6er 1, 2009
FOR CLIENT: City of YYfchita Falls
ATIN: Peggy Gahagan
1300 Seventh Street
WiClirfa Falis, TX 76301
The parties hereto have caused this Agreement to become effective by the application of the signatures
of their respective auCiorized representaWes set foRh below:
FOR CLIHNT: FOR EDWARDS CLAIMS ADMINISTRATION:
(Signature) (Slgnature)
(Title) (Trtle)
(Date) (Date)
WITNESS: VYITNESS:
ECA/Cl[y W Wlehlfe FWJs AgreemeM Page B Dacember 1, �08
ATfACHMENT A
INSURANCE REQUIREMENTS
Thitd Party Administrator shall procure and mairrtain for the durafron of the conh'act, insurance against
daims for injuries to persons or damages to properly which may arise from or in connection with the
perfortnance of the work hereunder by the contractor, his agerrts, representatives, employees or
subcontractors. The cost of such insurance shall be inGuded in the Conb�actors bid.
A. Minimum Scope of Insurance
Coverage shall be ffi least as broad as:
1. ISO Form Number GL 0002 (Ed 1R2) covering Comprehensive General Liability and ISO
Form Number GL 0404 covering Broad Form Comprehensive General Liability; or ISO
Commeraal General Liabitity coverage ("occurrence" form CG 0001). "Claims made" form is
u�ble except for professional liability.
2. Workers' Compensation insurance as required by the Labor Code of the State of Te�s,
inGuding Emp(oyers' Liabiliry Insurance.
3. Professional Liabil'rty.
B. Minimum Limits of Insurance
Contrador shall mairHain limits not less than:
1. Commeraal General Liability: $500,000 per occutte�e for bodily injury, personai injury and
property damage. $1,000,000 Aggregate Policy will inGude coverage for a) Premises -
Operations; b) Broad Form Contractual Liability; c) Products and Completed Operations; d)
Use of ContraGOrs and Subcontradors; e) Personal Injury; � Broad Form Property Damage.
2. Workers' Compensation and Employer's Liabitity: Workers' Compensation limits as required
by the Labor Code aF the State of Texas and Statutory Employers Liabiliiy Limits.
3. Professional Liabilit�r $500,000.
C. Dedudibles and Self-Insured Retentions
Any deductible or seSf-insured reternion must be deGared to and approved by the CITY.
D_ Other Insurance Provisions
The poficies are to contain, or be endorsed to contain the following provisions:
1. General Liabiliry.
a. The CITY, its officers, officials, employees, Boards and Commissions and volunteers are
to be added as "Additional Insured's" as respects liabilky arising out of adivities
pertormed by or on behalf of the vendor, products and completed operatlons of tt►e
vendor, premises owned, oxupied or used by the Contractor. The coverage shall cotitain
no speCial limitations on the sCOpe of protection aff�ded to the CITY, its officers, officials,
employees or volunteers. It is understood tliat the business auto policy under'Who is an
Insured" automatically provides liability coverage in favor of the CITY.
b. The contrador's insurance coverage shall be primary insurance as respects the CITY, its
officers, officials, employees and volunteers. Arry insurance or self-insurance maintained
by the CITY, its officials, employees or volunteers shall be excess of the coritractor's
insurance and shalf not contribute with it.
ECA/City af YWchlfa FWls Ag►eernent Pags 7 Deeem6w f, 2008
c. Any failure to comp[y with repating provisions of the policy shall not affect coverage
provided to the CFTY, its officers, officials, employees. Boards and Commissions or
volunteers.
d. The corrtractor's insurance shall apply separately to each insured against wha daim is
made or suit is brought, except with respect to the limits of the insured's liability.
2. Woricers' Compensation end Employer's Liability Coverage The insurer shall agree to waive
all rigMs of subrogation against the ClTY, its officers, offittials, employees and volurrteers for
losses arising from work perFormed by the coritrador for the CITY.
3. All Coverages. Each insurance policy required by this Gause shall be endorsed ta state that
coverage shall not be suspended, voided, canceled or non-renewed by either party, reduced
in coverage or in limits except after ten (10) days prior written notice by certified mail retum
receipt requested, has been given to the CITY.
E. Acceptability of Insurers
The CfTY prefers that Insurance be placed with insurers with an A.M. Best's rating of no less than
B+:VI, or, A or better by Standard 8 Poors. This requirement will be waived for workers'
compensation coverage only for those consultants whose workers' compensadon coverage is
placed with oomparties who parGapate in the State of Texas Workers' Compensation Assigned
Risk Pool. Professional Liability carciers will need to be approved by the Risk Manager.
F. Verification of Coverage
Contrador shall fumish the CITY with certificates of insurance effecdng c�verage required. The
certificates for each insurance policy are to be signed by a person authorized by that insurer to
bind coverage on its behaN. The certificates are to be on fortns approved by the CITY and are to
be received and approved by the CffY before work comme�. The CITY reserves the ri�t to
require complete, certified copies of all required insurance policies, at any time.
ECA/Cky of NRehlfa FaNs Aprednent �9e a , Decwnbar 1, Z008
A7TACHMENT B
ALLOCATED CLAIMS COSTS
Edwards Claims Administration acts as the third party claims adminisVation firm respor�sible for
adjudicating and managing the workers' compensation claims submitted by its dients. We do not charge
additional fees beyond our Gaims administration fees. Howevet, during the course of handling the files,
various outside parties may be utilized to manage the costs associated with a Gaim andlor to obtain
additional irrformation imperative to the appropriate investigati�on and handling of a daim. Fees for these
ancillary services are simply °passed through° and paid against the respective daims file being handled.
Allorated Gaims experues may indude the following:
• Attomey fees, vary by provider (current provider is Flahive, Ogden & Latson, whlch bills 5140lhr
forlegalrepreserrtaiion}
• Cost containment fees (presently with Starr Comprehensive Solutions; fees subjed to change 'rf
network or e-billing is imptemented, and/or jurisdictional requiremerrts change)
Bill audits: $10_00/ bill, with RN nurse review of each bi{I
$tO.OQ / bill plus $1.50 pef line for Hospital Bills
PPO fees: 26% of savings
Medical Nurse Rev'iewer: No Charge
Reconsiderations $8.00/ bill
Duplicate Bills: No Charge
Mandated Medical Bill EDI $1.50 f bill
eBill processing $2.00 ! bill for receipt
$2.00 / bill for electronic response to HCP
Preauthorization:
RN Level Only: $80 performed by registered nurse
Medical Director Level: $170.00, induding nurse irrtake/review
VVithdrawal: No Charge
MedicalNocational Case Mgmt: $75 per hour field case mgmt ($60lhr telephonic)
Peer Review Coordination: $350-650 (indudes nurse prep / phys. review}
Vocational Assessment: $650 flat
Job Site AssessmentS: $125/hour
. Index bureau fees (S1MB, ISO, etc.) —$8.95 per request
• Mandated Claims Electronic Data Interchange (EDI) -$2.50 per transaction
• Fees for Gaims-related medical opinions
• Independent medical examinations
. Witness fees
• Experf fees
• Witr�ess/e�ert travel expenses
• Extraordinary travel expenses incurred by Edwards Claims at the request of the City
• Legal Fees incurred for representation at hearings and/or trial praceedings (see FOL fees; no
charge for adjuster handling and/or representation)
• Court reporter fees
• Photographs
• Detective services, private investigative services
• Costs of obtaining public records (DWC records, police reports, etc.)
• Cost of checks — billed to GieM on pro-rata basis
• Banking fees — handled by Gient
ECA/Clry of WMhlta FaNs Agrear�ent Pape 9 Dacembv 1, 2009
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This Agcee:ment dated this 3rd day of November, 2009, by and between Edwards Claims Administration,
a Texas curporation (hereinafter referred to as Edwards Claims} and the City of Wichita Falls, (hereinafter
referred to as Client). The Client hereby agrees that Edwards Claims shall perForm services for and on
, behalf of C lient upon the terms and conditions set forth herein.
I. RELATIONSHIP - EDWARDS CLAIMS AND CLIENT
1. De :finitions
Acljust - process of investigation, evaluation, and disposition of claims alleging bodily injury as a
re:>ult of an on-the-job injury or incident.
AI ocated loss expense - expenses payable by the Client to third parties as a result of claims
services, but not including direct claims payments or fees paid to. Edwards Claims.
_ Cl�im - any incident that could, in Edwards Claims' judgement, result in financial loss to or
financial liability of the Client, and for which Edwards Claims has established a file.
Discretionary settlement authority - stated sum(s) of money set forth under this Agreement urider
wl�ich Edwards Claims shafl have full and sole discretion and final authority to adjust and make
cl�iim payments on behalf of the Client.
R�:serve - monetary evaluation of the Client's total financial exposure on any claim or incident as
e;,tablished by Edwards Claims.
Tliird party - any person, partnership, corporation, or other legal entity except Edwards Claims,
ernploy�es of Edwards Claims, the Client, or employees of the Client.
2: Nature of Contractual Relationshiq
Glient has elected to employ the administrative services of Edwards Claims relative to the
a��eration and maintenance of an individually or collectively self-insured workers' compensation
p�ngram. In retum for and in consideration of the fees set forth herein, Edwards Claims agrees to
f� mish services to Client in accordance with the provisions of this Agreement. Edwards Claims at
a!I tirnes shall be considered an independent contractor, and employees of Edwa�ds Claims shall
ir no event be considered employees of the Client. Edwards Claims reserves the right, in its sole
d scretion, to assign performance of activities under this Agreement to any of its personnel and to
! s��bcontract to third parties any part or all of Edwards Claims' ddties without the necessity of the
! Client's approval, provided, however, that any subcontracting by Edwards Claims shall not relieve
, Edwards Claims of its obligations to the Client under this Claims Service Agreement.
', 3. Term of Acareement
i This Agreement shall remain in effect from December 1, 2009, to November 30, 2012, at which
� time the Agreement may be renewed for an additional period by agreement of the parties. This
� P,greement may be terminated by either party upon 60 days written notice prior to anniversary or
upon mutual ag�eement by both parties at any time.
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ECA/City of �chita Falls Agreement Page 1 ��� Be¢embErrP; Z� �
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II. SERVICES TO BE PERFORMED BY EDWARDS CLAIMS
During the period or periods of this Agreement, Edwards Claims shall act for the Client as Administrator of
its workers' compensation program and resulting claims arising under the Texas Workers' Compensation
Act, and shall devote its best efforts in the conduct of its duties hereunder. Such duties shall include the
following:
1. Review, investigate, adjust, settle or resist all reported claims of occupational illnesses or injuries.
Any claim to be denied will be discussed with Client prior to denial.
2. Monitor medical treatment of injured employees and obtain appropriate medical reports.
3. Issue checks ar authorize payments of workers' compensation benefits and medical treatments
considered related, reasonable, and necessary.
4. Fumish all claims forms necessary for proper claims administration.
5. Negotiate settlements with claimants or their attomeys in accordance with discretionary
settlement authority provided by the Client.
6. ' Provide narrative reports on all serious claims and as needed by the Client.
7. Prepare and monitor files referred to defense counsel for disposition, discovery, and any legal
work.
8. Consult with the Client and defense attorneys on the cost impact and cost control strategy
available on claims.
9. Assist in the selection and aid in the supervision of attomeys retained to defend claims against
the Client.
10. Evaluate and reserve all claims.
11. Monitor claims for potential subrogation and direct and supervise efforts to pursue subrogation
recovery.
12. Audit medical, hospital, and miscellaneous invoices prior to approving for payment.
13. Provide moRthly, quarterly, and annual claims reports.
14. Develop and assist in the implementation of written procedures and instructions necessary to the
efficient operation of the Client's program. r
15. Provide reports required by excess insurers upon written direction from the Client.
16. Provide Client with current information on workers' compensation statutes, Texas Department of
Insurance, Department of Workers' Compensation rules, and any subject which may have effect
on the Client's program.
17. Assume ha�dling of al{ outstanding workers' compensation claims w6th accident dates prior to the
effective date of this Agreement, as requested by the Client.
18. Prepare and submit IRS form 1099 for all vendor payments made by Edwards Claims on behalf
of #he Client during each respective calendar year.
ECA/City of �chita Falls Agreement Page 2 December 1, 2009
, t
111. SERVICE FEES
In consideration for the claims services provided by Edwards Claims, Client shall pay Edwards Claims in
accordance with the fallowing fee schedule:
Indemnity Claims (other than medical only) $ 630.00
Medical Only Claims $ 90.00
Record Only Claims $ 20.00
This flat rate pricing applies for the duration bf this Agreement. Medical only claims will be converted to
indemnity claims when incurred reserves exceed $7,500. Any claim that remains open more than two
years from the date of receipt will be charged ta the Client at a rate of $300 per year. Upon termination or
non-renewal of this Agreement, Edwards Claims will continue to adjudicate existing claims at the rate of
$300 per year per open claim.
Edwards Claims will accept the handling of claims filed prior to December 1, 2009, under the following fee
schedule:
Indemnity Claims (other than medical only) $ 375.00
Medical Only Claims $ 75.00
These fee structures exclude allocated expenses defined as:
attorney fees, index bureau fees, EDI transmission fees, medical audit and/or cos# containment
fees, fees for claim related medical opinions, independent medical examinations, witness fees,
expert fees, witness/expert travel expenses, extraordinary trave! expenses incurred by Edwards
Claims at the request of the Client, fees incurred for representation at hearings and/or trial
proceedings, court reporter fees, transcript fees, photographs, detective services, the cost of
� obtaining public records, cost of checks and banking fees. Aitachment B provides a listing of
current aflocated expenses and related fees. Note that such fees are subject to change.
�
� Any change in federal, state, or local laws affecting claims handling, claims reporting, or medical cost
' containment activities may result in a modification of the handling fees outlined above.
; An annual minimum fee of $60,000 shall apply to this Agreement.
�
� IV. PAYMENT OF FEES
j
The Client will be billed at the beginning of each month for the prior month's claims activity in accordance
; with the fee schedule outlined in Section I11 above. Payment will be made by the Client within ten (10)
days of receipt of the bill. Auditing of annual billings will be completed within 60 days of the contract
; anniversary date.
;
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ti V. INSURANCE
z
; A. Insurance requirements are addressed in Attachment A. Prior to the commencement of any work
j under this contract, Edwards Claims shall furnish an original completed certificate(s) of insurance
� to the Client's Purchasing Agent, which shall be completed by an agent authorized to bind the
� named underwriter(s) and their company to the coverage, limits, and termination provisions
� shown thereon, and which shall furnish and contain all required information referenced or
i indicated thereon. The original certificate(s) must have the agent's original signature, include the
� signer's company affiliation, title and phone number, and be mailed directly from the agent to
' Client. The Client shall have no duty to pay or perform under this contract until such certificate
k shall have been delivered to the ClienYs Purchasing Agent.
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� ECA/City of �chita Falls Agreement Page 3 December 1, 2009
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B. The Client reserves the right to review the insurance requirements of this section during the
effect+ve period of this cqntract and any extension or renewal hereof and to modify insurance
coverage and their limits when deemed necessary and prudent by the ClienYs Purchasing Agent
based upon changes in statutory law, court decisions, or circumstances surrounding this
Contract, but in no instance will the Client allow modification whereupon the Client may incur
increased risk.
C. Edwards Claims' financial integrity is of interest to the Client, therefore, subject to Edwards
Claims' right to maintain reasonable deductibles in such amounts as are approved by the Client,
Edwards Claims shall obtain and maintain in full force and effect for the duration of this contract,
and any extension hereof, at Edwards Claims' sole expense, insurance coverage written by
companies authorized and admitted to do business in the State of Texas.
D. The Client shall be entitled, upon request and without expense, to receive copies of the policies
and all endorsements thereto as they apply to the limits required by the Client, and may make a
reasonable request for deletion, revision, or modification of particular policy terms, conditians,
limitations or exclusions (except where policy provisions are established by law or regulation
binding upon either of the parties hereto or the underwriter of any such policies). Upon such
request by the Client, Edwards Claims shall exercise reasonable efforts to accomplish such
changes in policy coverage, and shall pay the cost thereof.
E. Edwards Claims agrees that with respect to the above required insurance, all insurance contracts
and certificate(s) of insurance will contain the following required provisions.
I 1. Name the Client and its directors, officers, employees, agents and elected officials as
', additional insured with respects to the operations and activities of, or on behalf of, the
, named insured performed under contract with the Client, with the exception of the
� workers' compensation/employers' liability and the professional liability policies.
I 2. Edwards Claims' insurance shall be deemed primary with respect to any insurance or
; self-insurance carried by the Client for liability arising out of operations under the contract
; with the Client.
� 3. Provide for an endorsement that the "other insurance" clause shall not apply to the Client
� where the Client is an additional insured on the policy.
� 4. Workers' Compensation/Employers' liability policy will provide a waiver of Subrogation in
� favor of the Client.
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i F. Edwards Claims shall notify the Client in the event of any notice of cancellation of any notice of
! cancellation, non renewal or material change in coverage and shall give such notices not less
� than 10 days prior to the change, or 10 days for nonpayment of premium, which notice must be
j accompanied by a replacement Certificate of Insurance. All notices shall be given to the Client,
; by Certified mail, at the following address:
{
i Glient of Wichita Falls
! 1300 Seventh Street
� � Wichita Falls TX 76307
; Attn: Peggy Gahagan
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� G. If Edwards Claims fails to maintain the aforementioned insurance, or fails to secure and maintain
� the aforementioned endorsements, the Client may obtain such insurance and deduct and retain
E the amount of the premiums for such insurance from any sums due under the agreement,
� however, procuring of said insurance by the Client is an alternative to other remedies the Client
� may have, and is not the exclusive remedy for failure of Edwards Claims to maintain said
� insurance or secure such endorsement. In addition to any other remedies the Client may have
� upon Edwards Claims' failure to provide and maintain any insurance or policy endorsements to
the extent and within the time required, the Client shall have the right to order Edwards Claims to
ECA/City of �chita Fal/s Agreement Page 4 December 1, 2009
E
stop work hereunder, and/or withhold any payments(s) which become due to Edwards Claims
' hereunder until Edwards Claims demonstrates compliance with the requirements hereof.
', H. Nothing herein contained shall be construed as limiting in any way the extent to which Edwards
Claims may be held responsible for payments of damages to persons or property resulting from
Edwards Claims' or its sub�ontractors' performance of the work covered by this contract.
VI. GENERAL CONDITIONS AND INDEMNIFICATION
All claims and related files generated by Edwards Claims as a result of its activity under this program
including all files transferred to Edwards Claims from prior administrators shall remain at all times property
of the Client and following reasonable notice to Edwards Claims, ClieRt shall have the right to conduct an
; annual audit on Edwards Claims' premises of all Client files processed by Edwards Claims. Individuals
perForming such audit may be ClienYs personnel or other representatives designated for that purpose by
Client. Edwards Claims shall maintain active and inactive claim files for a reasonable period following
which at the option of Client they will be retumed to the Client or destroyed. Edwards Claims shall treat
; all of ClienYs files and other records generated under this program with complete confidentiality and no
; information related thereto shall be released by Edwards Claims to anyone without authorization of the
Clien#.
In the event of termination of this Agreement, Client shall have the option of requiring Edwards Claims to
return atl claim files to Client for further handling or alternatively to continue to handle all claims involving
accidents that occurred prior to termination of this Agreement to their final resolution with additional
compensation as outlined in Section III.
Edwards Claims' responsibility for the performance of activities described in Section II is conditioned upon
the ClienYs cooperation with Edwards Claims in all reasonable matters with respect to the activities of
Edwards Claims, including, but not limited to, responding to Edwards Claims' requests for information
promptly, meeting with Edwards Claims and/or third parties as may be needed, and making decisions on
matters which, as required by this Agreement, or in the professional opinion of Edwards Claims should be
made by Client.
The ownership of a►I systems created or utilized by Edwards Claims in performance of activities under this
Agreement shall belong to, and remain as property of Edwards Claims; the Client having no interest
therein. "Systems" as used herein shall include, but is not limited fo, computer programs, computer
equipment, formats, risk data record formats, procedures, documentation and internal reports of Edwards
Claims, but shall not include claim files returned to the Client pursuant to this Section, or any materials
delivered by Edwards Claims to the Client.
The services provided by Edwards Claims are not of a legal nature and Edwards Claims shail in no event
give, or be required to give, any legal opinion or provide any legal representative to the Client, nor may
any communication prepared by Edwards Claims be relied upon by the Client as a legal opinion or
interpretation. Edwards Claims shall in no event be considered as engaged in the practice of law.
' The terms of this Agreement between Edwards Claims and the Client shall be govemed by the State of
� Texas. Any adjudication by any court of competent jurisdiction which invalidates any part of this Claims
� Senrice Agreement shall not act to invalidate any other part thereof. All notices, requests, and other
communications from either party to the other shall be in writing and delivered either personally or by
� certified mail, return receipt requested. Any such notice, request or other communication shall be
deemed to have been given on the date of personal delivery or, if mailed, on the date of mailing. All such
� notices, requests or other communications shall be delivered to:
FOR Edwards Claims: Edwards Claims Administration
ATTN: Kim Edwards
1004 Marble Heights Drive
Marble Falls, Texas 78654
� ECA/City of �chita Fa/ls Agreement Page 5 December 1, 2009
(
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FOR CLIENT: City of Wichita Falls
ATTN: Peggy Gahagan
1300 Seventh Street
Wichita Falls, TX 76301
The parties hereto have caused this Agreement to become effective by the application of the signatures
of their respective authorized representatives set forth below:
NT: FOR EDWARDS CLAIMS ADMINISTRATION:
� �- �,Uv�, �-��--�W a���/I�
�g� ) (Signature)
/ � it•�. � ��• V �
(Title) (Title)
' �� � - o � � 1'� -OQI
(Date) (Date)
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; WITNESS: WITNESS:
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ECA/City of �chita Fal/s Agreement Page 6 December 1, 2009
ATTACHMENT A
INSURANCE REQUIREMENTS
', Third Party Administrator shall procure and maintain for the duration of the contract, insurance against
claims for injuries to persons or damages to property which may arise from or in connection with the
perFormance of the work hereunder by the contractor, his agents, representatives, employees or
subcontractors. The cost of such insurance shall be included in the Contractor's bid.
A. Minimum Scope of Insurance
, Coverage shall be at least as broad as:
, 1. ISO Form Number GL 0002 (Ed 1/72) covering Comprehensive General Liability and ISO
' Form Number GL 0404 covering Broad Form Comprehensive General Liability; or ISO
� Commercial General Liability coverage ('bccurrence" Form CG 0001). "Claims made" form is
unacceptable except for professional liability.
�
' 2. Workers' Compensation insurance as required by the Labor Code of the State of Texas,
; including Employers' Liability Insurance.
3. Professional Liability.
; B. Minimum Limits of Insurance
; Contractor shall maintain limits not less than:
i
1. Commercial General Liability: $500,000 per occurrence for bodily injury, personal injury and
; property damage. $1,000,000 Aggregate Policy will include coverage for a) Premises -
; Operations; b) Broad Form Contractual Liability; c) Products and Completed Operations; d)
; Use of Contractors and Subcontractors; e) Personal Injury; fl Broad Form Property Damage.
2. Workers' Compensation and Employer's Liability: Workers' Compensation limits as required
' by the Labor Code of the State of Texas and Statutory Employer's Liability Limits.
3. Professional Liability $500,000.
� C. Deductib�es and Self-Insured Retentions
i Any deductible or self-insured retention must be declared to and approved by the CITY.
;}
D. Other Insurance Provisions
� The policies are to contain, or be endorsed to contain the following provisions:
x 1. General Liability.
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� a. The CITY, its officers, officials, employees, Boards and Commissions and volunteers are
� to be added as "Additional Insured's" as respects liability arising out of activities
� performed by or on behalf of the vendor, products and completed operations of the
� vendor, premises owned, occupied or used by the Contractor. The coverage shall contain
� no special limitations on the scope of protection afforded to the CITY, its officers, officials,
� employees or volunteers. It is understood that the business auto policy under'Who is an
� Insured" automatically provides liability coverage in favor of the CITY.
b. The contractor's insurance coverage shall be primary insurance as respe�ts the CITY, its
officers, officials, employees and volunteers. Any insurance or self-insurance maintained
by the CITY, its officials, employees or volunteers shall be excess of the contracto�'s
insurance and shall not contribute with it.
ECA/City of �chita Falls Aqreement Page 7 December 1, 2009
. ,
c. Any failure to comply with reporting provisions of the policy shall not affect coverage
provided to the CITY, its officers, officials, employees, Boards and Commissions or
volunteers.
d. The contractor's insurance shall apply separately to each insured against who claim is
made or suit is brought, except with respect to the limits of the insured's liability.
, 2. Workers' Compensation and Employer's Liability Coverage The insurer shall agree to waive
all rights of subragation against the CITY, its officers, officials, employees and volunteers for
losses arising from work performed by the contractor for the CITY.
' 3. All Coverages. Each insurance policy required by this clause shall be endorsed to state that
coverage shall not be suspended, voided, canceled or non-renewed by either party, reduced
in coverage or in limits except after ten (10) days prior written notice by certified mail return
receipt requested, has been given to the CITY.
E. Acceptability of Insurers
The CITY prefers that Insurance be placed with insurers with an A.M. Best's rating of no less than
B+:VI, or, A or better by Standard & Poors. This requirement will be waived for workers'
compensation coverage only for those consultants whose workers' compensation coverage is
placed with companies who participate in the State of Texas Workers' Compensation Assigned
Risk Pool. Professional Liability carriers will need to be approved by the Risk Manager.
F. Verification of Coverage
Contractor shalf furnish the CITY with certificates of insurance effecting coverage required. The
certificates for each insurance policy are to be signed by a person authorized by th�t insurer to
bind coverage on its behalf. The certificates are to be on forms approved by the CITY and are to
be received and approved by the CITY before work commences. The CITY reserves the right to
require complete, certified copies of all required insuran�e policies, at any time.
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ECA/City of �chita Falls Agreement Page 8 December 1, 2009
, ATTACHMENT B
ALLOCATED CLAIMS COSTS
Edwards Claims Administration acts as the third party claims administration firm responsible for
adjudicating and managing the workers' compensation claims submitted by its clients. We do not charge
additional fees beyond our claims administration fees. However, during the course of handling the files,
various outside parties may be utilized to manage the costs associated with a claim and/or to obtain
additional information imperative to the appropriate investiga#ion and handling of a claim. Fees for these
ancillary services are simply "passed through" and paid against the respective claims file being handled.
Allocated claims expenses may include the following:
• Attorney fees, vary by provider (current provider is Flahive, Ogden & Latson, which bills $140/hr
for legal representation)
• Cost containment fees (presently with Starr Comprehensive Solutions; fees subject to change if
!, network or e-billing is implemented, and/or jurisdictional requirements change)
' Bill audits: $10.00 / bill, with RN nurse review of each bill
�
, $10.00 / bill plus $1.50 per line for Hospital Bills
; PPO fees: 26% of savings
Medical Nurse Reviewer. No Charge
' Reconsiderations $6.00 / bill
Duplicate Bills: No Charge
Mandated Medical Bill EDI $1.50 / bill
eBill processing $2.00 / bill for receipt
;
$2.00 / bill for electronic response to HCP
� Preauthorization:
RN Level Only: $80 performed by registered nurse
! Medical Director Level: $170.00, including nurse intake/review
�
Withdrawal: No Charge
; MedicalNocational Case Mgmt: $75 per hour fie�d case mgmt ($60/hr telephonic)
Peer Review Coordination: $350-650 (includes nurse prep / phys. review)
Vocational Assessment: $650 flat
' Job Site Assessments: $125/hour
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� Index bureau fees (SWIB, ISO, etc.) —$8.95 per request
� •
• Mandated Claims Electronic Data Interchange (EDI) -$2.50 per transaction
• Fees for claims-related medical opinions
; • Independent medical examinations
• Witness fees
• Expert fees
� • Witness/expert travel expenses
• Extraordinary travel expenses incurred by Edwards Claims at the request of the City
s • Legal Fees incurred for representation at hearings and/or trial proceedings (see FOL fees; no
� charge for adjuster handling and/or representation)
` • Court reporter fees
E • Photographs
• Detective services, private investigative services
� • Costs of obtaining public records (DWC records, police reports, etc.)
• Cost of checks — billed to client on pro-rata basis
• Banking fees — handled by client
ECA/City of �chita Falls Agreement Page 9 December 1, 2009
�
OP ID MO DATE (MM/DDIYYYY)
. ACORD CERTIFICATE OF LIABILITY INSURANCE EDWAR-6 09 so 09
. PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFlCATE
INSIIRICA HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P. O. Box 25928 ALTER THE COVE�iAGE AFFORDED BY THE POLICIES BELOW.
Oklahoma City OK 73125
Phone:800-880-0291 Fa�c:405-556-2332 INSURERSAFFORDINGCOVERAGE NAIC#
INSURED INSURERA: FECIETdl Insurance Co 2028i
WSURER B:
Edv�rards Ri sk Mana EAIEAt IIIC . INSURER C:
(SEE DESCRIPTION SECTIO�T)
I004 Marble Heights INSURER D:
Marble Falls TX 78654
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
, ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHEFi DOCUMENT W ITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OFi
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLA(MS.
' LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MIWDD DATE MM/DD � N LIMITS
GENERAL LIABILITY EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY PREMISES Ea occurence) $
CLAIMS MADE � OCCUR MED EXP (My one person) $
PERSONAL & ADV INJURY $
'I GENERALAGGREGATE $
GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPlOP AGG $
POLICY �E a LOG
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT $
- ANY AUTO (Ea accident)
ALL OWNED AUTOS BODILY INJURY
SCHEDULfD AUTOS (Per person) $
HIRED AUTOS BODILY INJURY
� (Per accident) $
NON-0WNED AUTOS
PROPERTY DAMAGE $
(Par accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
i
� ANY AUTO OTHER THAN � ACC $
i AUTO ONLY: qGG $
' EXCESSNMBRELLA LIAB�LITY EACH OCCURRENCE $
i OCCUR � CLAIMS MADE AC�iGREGATE $
I $
DEDUCTIBLE $
j RETENTION $ $
i
i WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY TORY LIMITS ER
i ANY PROPRIETOR/PARTNEWEXECUTIVE E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYE $
' if yes, describe under
•. SPECIAL PROVISIONS below E.L DISEASE - POLICY LIMIT $
� OTHER
; A PAOFESSIONAL 82106217 09/O1/09 09/Ol/10 ERRORS & $5,000,000
3 LIABILITY QMISSIONS
� DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVI310NS
RETENTION IS $25,000.
;
CERTIFICATE HOLDER CONTINUES TO READ: D/B/A EDWARDS CLAIM ADMINISTRATION
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i CERTIFICATE HOLDER CANCELLATION
6
� CITYWIC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Tt1E EXPIRATI
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR Tb MAIL 1 O DAYS WARTEI
CITY OF WICIiITA FALLS NOTICE TO THE CEIiTIFICATE HOLDER NAMED TO TNE LEFT, 6UT FAILURE TO DO SO SHAI
pE �'�'� IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
1300 SEVENTH STREET
WICHITA FALLS TX 76307 REPRESENTATIVES.
AUTHO RE ENTA VE
ACORD 25 (2001/08) � ACORD CORPORATION 19
. QcoRn CERTIFICATE OF LIABILITY INSURANCE OPID MO DATE(MNUDD/YYYI�
EDWAR-6 09 30 09
PRODUCER THIS CERTIFICATE IS ISSUED AS A MA7TER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
INSURICA HOLDER. THIS CERTiFICATE DOES NOT AMEND, EXTEND OR
P. O. Box 25 928 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Oklahoma City OK 73125
Phone:800-880-0291 Fax:405-556-2332 INSURERSAFFORDINGCOVERAGE NAIC#
INSURE� INSURERA Hartford Insurance Grou NA
INSURER B:
Edwards Risk Management, Inc.*
Jerry Edwards INSURER C:
1004 Marble Heights INSUfiERD:
Marble Falls TX 78654
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTW ITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT W ITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOW N MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE VE P DATE MMPDD T � LIMRS
GENERALLIABILRY EACHOCCURRENCE $ ZOOOOOO
A X COMMERCIALGENERALLIABILITY 3SSBMRP7S11 09/Ol/09 O9�OI.�ZO PREMISE�Ea�occurence) $ 300000
CLAIMS MADE � OCCUR MED IXP (My one person) $ 1 � � � �
PERSONAL&ADVINJURY $Z.00OOOO
GENERALAGGREGATE $ ZOOOOOO
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2 O OO O O O
POLICY PR � LOC
JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
ANY AUTO (Ea accident) �
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (Per person) $
HIRED AUTOS BODILY INJURY
NON-0WNED AUTOS (Per axident) $
�, PFOPERTYDAMAGE $
(Per accident)
GARAGELIABILITY AUTOONLY-EAACCIDEM' $
ANY AUTO OTHER THAN � ACC $
AUTO ONLY: AGG $
, EXCESS/UMBRELLALIABILITY EACHOCCURRENCE $ �.00OOOO
A OCCUR � CLAIMSMADE 3$SBNIRP7H11 O9�OZ�O� 09/01/10 AGGREGATE $ ZOOOOOO
$
i DEDUCTIBLE $
I X flETENTION $ $
� WORKERS COMPENSATION AND X TORY LIMITS ER
� EMPLOYERS' LIABILRY
I. A 38WECRW2609 08�28��9 �8�28��.� E.LEACHACCIDENT $�j��0��
ANY PROPRIETOR/PARTNER/EXECUTIVE
i OFFICER/MEMBERIXCLUDED? ELDISEASE-EAEMPLOYEE $ r JOOOOO
� If yes, describe under
SPECIALPFOVISIONSbelow E.LDISEASE-POLICVLIMIT $ r JOOOOO
� OTHER
�
I
� DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
j *CERTIFICATE HOLDER CONTINUES TO READ: THE CITY, ITS OFFICERS,
OFFICIALS, ENIl�LOYEES, BOARDS AND CONII�IISSIONS AND VOLUNTEERS. CERITIFICATE
! HOLDER IS ADDED AS ADDITIONAL INSDRED WITH RESPECTS TO THE GENERAL I�IAIBI,ITY
� IF AND WHEN REQUIRED BY WRITTEN CONTRACT SUBJECT TO POLICY TERMS, CONDITIONS
j AND LIMITATIONS. (SEE PAGE 2)
i CERTIFlCATE HOLDER CANCELLATION
�
� CITYWIC SHOULD ANY OF THE ABOVE OESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRAT4
� DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1 O DAYS WRITTED
� CITY OF WICHITA FALI,S* NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHAL
PEGGY GAHAGA'N IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, RS AGENTS OR
� 1300 SEVENTH STREET
� WICHITA FALLS TX 76307 REPRESENTATIVES.
� AUTHO HE �VE
ACORD 25 (2001/08) � ACORD CORPORATION 19
WAIVER OF SIIBROGATION IN FAVOR OF CERTIFICATE HOLDER SAS BEEN ENDORSED TO
TSE WORI�RS CO1�'ENSATION POLICY IF AND WHEN REQUIRED BY WRITTEN CONTRACT
SUBJECT TO POLICY TEItMS, CONDITIONS AND LIMITATIONS. THIS INSURANCE SHALL
' BE DEEMED PRIMARY AND NON-CONTRIBUTY OVER ANY OTHER COLLECTIBLE INSURANCE
IF AND WHEN REQUIRED BY WRITTEN CONTRACT SIIBJECT TO POLICY TERMS,
CONDITIONS AND LIMITATIONS.
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