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Jefferson County Alabama Bankrupt - DOC

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					       ATTENTION ALL OFFERORS

RETURN THE ENCLOSED PROPOSAL IN A SEALED
              ENVELOPE TO:

               ANNIE WARD,
          PURCHASING MANAGER
  716 RICHARD ARRINGTON JR. BLVD NORTH
                 ROOM 830
           BIRMINGHAM, AL 35203

   YOU MUST MARK ON THE ENVELOPE:

                RFP# 34-10
“ADMINISTER WORKERS’ COMPENSATION CLAIMS”

            RETURN BY 5:00 P.M. ON
              DECEMBER 11, 2009
          For questions concerning this RFP
       Contact: Deborah Scales, Principal Buyer
                Phone: (205) 325-5383
                 Email: scalesd@jccal.org


    No faxed or email submissions will be accepted
Jefferson County Commission                                                                         NOVEMBER 24, 2009
716 Richard Arrington Jr. Blvd North                                                                    RFP NO. 34.10
Room 830 Courthouse                                                                                      SHEET NO. 2
Birmingham Alabama 35203


                                              REQUEST FOR PROPOSAL

Sealed proposals, one (1) original and three (3) copies, marked "ADMINISTER WORKERS’ COMPENSATION
CLAIMS" will be received by the Purchasing Manager, Room 830 * 716 Richard Arrington Jr. Blvd N, Birmingham,
Alabama.

Proposals will be accepted until 5:00 P.M. central time (standard or daylight savings time, as applicable) on December
11, 2009. Proposals submitted after this date and time will not be considered.

Proposals will be publicly opened at 2:00 P.M. on December 14, 2009.

The County is not responsible for delays occasioned by the U.S. Postal Service, the internal mail delivery system of the
County, or any other means of delivery employed by the bidder. Similarly, the County is not responsible for, and will not
open, any bid/proposal responses, which are not received later than the date and time, indicated above. Late
bids/proposals will be retained in the bid/proposal file, unopened.

INTERVIEW PROSPECTIVE BIDDERS AFTER PROPOSAL SUBMISSION
It may be necessary to interview prospective bidders after proposal submission to clarify aspects of their proposal. The
County will notify prospective bidders regarding the interview.

TELEGRAPHIC/ELECTRONIC PROPOSAL RESPONSES
Proposal responses sent by electronic devices (i.e., facsimile machines and email) are not acceptable and will be rejected
upon receipt. Vendors will be expected to allow adequate time for delivery of their responses either by airfreight, postal
services, or by other means.

TERMS OF CONTRACT
Any contract resulting from this RFP will become effective upon bid award (or within 30 days of award notification,
approval of the County Commission) for one (1) year. The County, in its sole discretion, has the option to extend the
contract on the same terms and conditions applicable during the initial term, for up to two (2) consecutive, additional one-
year periods.

TELEPHONE INQUIRIES
Telephone inquires with questions regarding clarification of any and all specifications of the bid will not be accepted. All
questions will be written and faxed or e-mailed to Deborah Scales, Jefferson County Purchasing Department (fax 205-
325-5221) or (email scalesd@jccal.org) no later than the end of the business day five (5) days prior to the bid opening
date. Correspondence with individuals other than those listed herein will not be allowed.

INTERPRETATIONS AND ADDENDA
No interpretation or modification made to any respondent as to the meaning of the RFP shall be binding on the Jefferson
County Commission unless submitted in writing and distributed as an addendum by the Jefferson County Purchasing
Department. Interpretations and/or clarifications shall be requested in writing and directed to Deborah Scales,
Jefferson County Purchasing Division, 830 Courthouse, 716 Richard Arrington Jr. Blvd. North, Birmingham, AL
35203, (Fax 205 325-5221) or (email: scalesd@jccal.org). Verbal information obtained otherwise will not be
considered in awarding of contract. All addenda shall become part of the RFP.
Jefferson County Commission                                                                          NOVEMBER 24, 2009
716 Richard Arrington Jr. Blvd North                                                                     RFP NO. 34.10
Room 830 Courthouse                                                                                       SHEET NO. 3
Birmingham Alabama 35203


                                       REQUEST FOR PROPOSAL (Continued)


LANGUAGE, WORDS USED INTERCHANGEABLY
The word COUNTY refers to the JEFFERSON COUNTY COMMISSION and/or JEFFERSON COUNTY, ALABAMA
throughout this document. Similarly, RESPONDENT, VENDOR, and BIDDER refer to the person or company
submitting an offer to sell its goods or services to the COUNTY. The words PROPOSAL, QUOTATION, and BID are all
offers from the BIDDER. The County has established for the purposes of this RFP that the words SHALL, MUST or
WILL are equivalent in this RFP and indicate a mandatory requirement or condition, the material deviation from which
shall not be waived by the County. A deviation is material if, at the sole discretion of the County, the deficient response is
not in substantial accord with this RFP’s mandatory condition requirements. The words SHOULD and MAY are
equivalent in the RFP and indicate very desirable conditions or requirements but are permissive in nature. Deviation
from, or omission of, such a desirable condition or requirement will not in and of itself cause automatic rejection of a
proposal, but may result in being considered as not in the best interest of the County.

MINIMUM QUALIFED BIDDER
The following are the minimum qualifications for bidders:
    Documented ability to provide all the services listed in and required by this RFP.
    Documented experience and a good reputation for reliability and successful completion of services required in
        this RFP.
    Is authorized to conduct business in the State of Alabama and Jefferson County.
    Sufficient existing personnel qualified in providing the services to fulfill the requirements of this RFP.

INTRODUCTION
The purpose of this Request for Proposal is to establish a contract with a qualified provider that will provide Jefferson
County with experience and professional services to administer all Workers’ Compensation claims, to include
investigations, review of all claims for compensability, adjust claims, supervise litigation, provide reports, etc. The
approximate number of workers’ compensation claims processed by Jefferson County annually is 300 to 400.

INQUIRIES
Questions about this RFP should be directed in writing, via e-mail to Deborah Scales at the address shown below, no later
than the end of business December 4, 2009. Correspondence with individuals other than those listed herein will not be
allowed:
Deborah Scales
Principal Buyer
Jefferson County Commission
Room 830 Courthouse
716 Richard Arrington Jr. Blvd N
Birmingham, Alabama 35203
Phone: (205) 325-5383
E-Mail: scalesd@jccal.org
Jefferson County Commission                                                                            NOVEMBER 24, 2009
716 Richard Arrington Jr. Blvd North                                                                       RFP NO. 34.10
Room 830 Courthouse                                                                                         SHEET NO. 4
Birmingham Alabama 35203


                                       REQUEST FOR PROPOSAL (Continued)


INSTRUCTIONS
Proposals must be submitted in a sealed envelope (s) with the Request for Proposal number, title of proposal and Offeror’s
name and address indicated on the envelope(s). All proposals must be submitted in ink or typewritten. All vendors must
submit one original and three (3) copies of proposals. Proposals will be considered only from companies that have been
established for a minimum of three (3) years.

SCOPE OF CONTRACT

RESPONSIBILITIES OF SERVICE COMPANY
Provider must describe in detail in their proposal how they will fulfill the following requirements.

    1. To provide Jefferson County with those services as set forth in Paragraph 2 below (the “Basic Services”) with
       respect to any claim referred to Service Company that is made under any Exposures which involve an actual or
       alleged loss occurring during the term of this Contract. For the monetary considerations set forth in the Award,
       except that Allocated Loss Adjustment Expense, as defined in Article IV below, will be paid by Jefferson County
       in addition to the monetary considerations set forth in the Award.

    2. Basic Services to be rendered with respect to any claims described in this Article III, Paragraph 1 Above
       (“Claims”) shall be the following:

            A. To establish a file with respect to each claim

            B. To investigate all claims and to recommend the amount of loss reserve to be established with respect to
               each such claim

            C. To provide each claim file with a written chronology of all actions taken with respect to the underlying
               claim

            D. To furnish all claim forms necessary for proper claims administration

            E. To adjust, settle or resist all claims within the discretionary settlement authority limit of the Service
               Company as authorized by Jefferson County

            F. To adjust, settle or resist all claims in excess of the Authority Limit with the express prior approval of
               Jefferson County

            G. To supervise all litigation or other proceedings involving any claim and, where permitted, to attend any
               judicial or administrative hearing involving any claim

            H. To monitor all treatment programs recommended to a Claimant by any care provider

            I.   To furnish to Jefferson County and/or its designees on a monthly basis, a “Loss Run” and a “Loss Fund
                 Activity Report”
Jefferson County Commission                                                                     NOVEMBER 24, 2009
716 Richard Arrington Jr. Blvd North                                                                RFP NO. 34.10
Room 830 Courthouse                                                                                  SHEET NO. 5
Birmingham Alabama 35203


                                    REQUEST FOR PROPOSAL (Continued)


RESPONSIBILITIES OF SERVICE COMPANY (Continued)

          J. To provide to Jefferson County a monthly narrative status report on all claims reserved in excess of
             $50,000

          K. Work closely with client attorneys in reaching amicable settlements

          L. Compute and notify client of appropriate settlement amounts to be paid

          M. Work closely with client’s attorney in all litigation or other proceedings involving any
             claim

          N. Monitor and update online prescription service

          O. Implement medical protocol as needed or requested

          P. Access AlaMed, Workers’ Compensation Preferred Provider Network for additional savings

          Q. Medical Bill adjudication to PPO network fee schedule

          R. Bill review and medical bill adjudication to state fee schedule

          S. Review claims for over utilization of services

          T. Verify lost time with client and/or physician each week

          U. Issue indemnity checks each week and mail to employer or employee

          V. Issue medical checks each week and mail to provider

          W. Maintain escrow checking account and reconcile monthly

          X. Follow subrogation claims and recover any amounts due from third party

          Y. Subrogation

          Z. Furnish weekly check registers

          AA. Weekly invoices for claims fund reimbursement

          BB. Send Monthly check register

          CC. Assist in gathering information as needed for the actuary report
Jefferson County Commission                                                                         NOVEMBER 24, 2009
716 Richard Arrington Jr. Blvd North                                                                    RFP NO. 34.10
Room 830 Courthouse                                                                                      SHEET NO. 6
Birmingham Alabama 35203


                                      REQUEST FOR PROPOSAL (Continued)


RESPONSIBILITIES OF SERVICE COMPANY (Continued)

           DD. Report to excess carrier on all claims within the guidelines set forth by carrier

           EE. Quarterly loss runs reports to excess carrier

           FF. Customize analysis reports within 48 hours of request by client

           GG. Attend meetings called by client’s attorney and/or client

           HH. Provide storage of all closed claims prior to 2006

           II. Continue claims service of all open claims that occurred prior to 2006

           JJ. Make necessary filings with the Department of Industrial Relations with respect to claims

           KK. Send claimant a written letter of notification of all claims that have been denied

           LL. Serve as Account Designee and report client claims that are Medicare beneficiaries set based Medicare
           Secondary Payer Mandatory Reporting – Section 111 Guidelines for Reporting

   3. Jefferson County has the right to assume the control and handling of any claim at any time, and the selected
      Service Company agrees to deliver promptly any claim file to Jefferson County which it may request, but without
      any off-set or deduction from any of the fees or charges paid or payable by Jefferson County to Service Company
      under Article V below. The parties agree that all times prior to and after the cancellation of this Agreement all
      claim files are owned by and are the property of Jefferson County. Claim files are subject to review by Jefferson
      County and its employees and authorized agents during Service Company’s regular business hours, with
      reasonable prior notice.

   4. To exercise reasonable efforts to manage the services provided hereunder in such a way and in such manner as to
      ensure that every adjustor, claims investigator, appraiser and/or employee used by Service Company or
      subcontracted by Service Company will adjust and/or investigate every alleged claim or matter covered by this
      contract in accordance with this contract.

   5. To provide to Jefferson County, Certificates of Insurance evidencing adequate Errors and Omissions Insurance
      (Professional Liability Coverage). Successful Proposer is required to furnish evidence of insurance no later than
      seven (7) days after receipt of Purchase Order.

   6. To indemnify, defend and hold Jefferson County and Jefferson County’s directors, officers, attorneys, employees,
      agents and other representatives, wholly harmless from and against any and all damage, loss, costs and expenses
      whatsoever (including, without limitation, attorneys fees and litigation expenses) incurred by Jefferson County or
      by any of Jefferson County’s directors, officers, attorneys, employees, agents or other representatives, by reason
      of any negligent, grossly negligent or willful act or omission of Service Company(s) or of Service Company’s
      directors, officers, attorneys, employees , agents or other representatives, taken or omitted to be taken pursuant to
      this Agreement; provided, however, that Service Company shall have no obligation to indemnify anyone
Jefferson County Commission                                                                        NOVEMBER 24, 2009
716 Richard Arrington Jr. Blvd North                                                                   RFP NO. 34.10
Room 830 Courthouse                                                                                     SHEET NO. 7
Birmingham Alabama 35203


                                      REQUEST FOR PROPOSAL (Continued)


     RESPONSIBILITIES OF SERVICE COMPANY (Continued)

       pursuant hereto with respect to (i) any act or omission of Service Company or any of Service Company’s
       directors, officers, attorneys, employees, agents or other representatives taken or omitted to be taken at the
       direction of Jefferson County or any of Jefferson County’s directors, officers, attorneys, employees, agents or
       other representatives (ii) Service Company being name in litigation as the insurer of record, (iii) Service Company
       or Service Company’s directors, officers, attorney’s employees, agents or other representatives failure to settle a
       Claim that could have been settled within Service Company’s Authority Limit (so long as such failure to settle
       does not result from a negligent, grossly negligent or willful act, error or omission by Service Company or by any
       of Service Company’s directors, officers, attorneys, employee’s agents or other representatives) or (iv) Service
       Company or Service Company’s directors, officers attorney’s employees, agents or other representatives failure to
       pay any Claim or Allocated Loss Adjustment Expense on a timely basis due to Jefferson County or Jefferson
       County’s directors, officers, attorneys, employees, agents, or other representatives failure to comply with Article
       V, Paragraph 4. In the event Jefferson County or any of it’s directors, officers, attorneys, employees, agents or
       other representatives, is named as a defendant in any legal action or is named as a defendant in any legal action or
       proceeding in which a Claim indemnified hereunder is asserted, Service Company will assume, at Service
       Company’s expense, the defense of such action on behalf of Jefferson County and its directors, officers, attorneys,
       employees, agents and other representatives, as the case may be. Service Company has sole discretion to select
       the attorneys who will defend any such action, provided, however, that Service Company shall exercise such
       discretion reasonably. This indemnity shall survive termination of this Agreement.

7.     To exercise reasonable care in the selection of any Service Company(s), Adjusting Company, Adjuster, Claims
       Investigator or Appraiser it subcontracts its responsibilities hereunder, to ascertain that such subcontractors hold
       proper licenses for the work to be performed, and to warrant that it and its Adjusters, Claims Investigators and
       Appraisers hold proper licenses for the work to be performed and are resident in those states requiring residency,
       and in which it renders services hereunder.

8.     To issue checks from the “Company” bank account established for the payment of Jefferson’s County’s claims
       (the “Loss Fund Account”) to be funded by Jefferson County as set forth in Exhibit C, attached hereto and made a
       part hereof, for the payment by Services hereunder, and for deposit of recovery amounts, including, without
       limitation, subrogation, salvage and adjustment reimbursements from Claim and/or Allocated Loss Adjusted
       Expense amounts previously paid from such Loss Fund Account (“Recoveries”).

9.     To report directly to Jefferson County and to have the responsibility for reporting to specific excess insurer(s) or
       annual aggregate excess insurer(s) on notice of any Claims(s) that is/are or may be required to be reported or
       notice given to such excess insurer(s) under the terms and conditions of any such excess insurance policies
       available to Jefferson County. Service Company(s) will continue to handle Claims once Jefferson County’s self –
       insurance retention, either specific or annual aggregate, has been exceeded if mutually agreed to by Jefferson
       County and excess insurer(s), under the terms and conditions of any such excess insurance policies available to
       Jefferson County. Service Company(s) will continue to handle Claims once Jefferson County’s self-insurance
       retention, either specific or annual aggregate, has been exceeded if mutually agreed to by Jefferson County and
       excess insurer(s), if there is no controversy as to coverage, liability, and damages between Jefferson County and
       its excess insurer(s).
Jefferson County Commission                                                                        NOVEMBER 24, 2009
716 Richard Arrington Jr. Blvd North                                                                   RFP NO. 34.10
Room 830 Courthouse                                                                                     SHEET NO. 8
Birmingham Alabama 35203


                                       REQUEST FOR PROPOSAL (Continued)


RESPONSIBILITIES OF SERVICE COMPANY (Continued)

ALLOCATED LOSS ADJUSTMENT EXPENSE
  1. The term “Allocated Loss Adjustment Expense” shall mean such of the following items of expense incurred or
     authorized by Service Company as may be reasonable and necessary in connection with its provision of the Basic
     Services:

       A.      Medical examination of claimants, including the reasonable and necessary transportation expenses of
               claimants

       B.      Reports from attending or examining physicians

       C.      Attorney fees and disbursements

       D.      Court reporter services and transcripts

       E.      Stenographic service and transcripts

       F.      Witness attendance fees

       G.      Court costs

       H.      Appeals bonds

       I.      Printing costs related to trials and appeals

       J.      Testimony, opinions, appraisals, reports, surveys and analyses of professionals and experts

       K.      Trial and hearing attendance fees

       L.      Reports from government agencies or branches

       M.      Credit Bureau reports

       N.      Private investigators

       O.      Photographs

       P.      Medical or vocational rehabilitation

       Q.      Medical costs containment services, i.e., utilization review, pre-admission authorization, hospital bill
               audit, provider bill audit and medical case management incurred at the request of Jefferson County
Jefferson County Commission                                                                           NOVEMBER 24, 2009
716 Richard Arrington Jr. Blvd North                                                                      RFP NO. 34.10
Room 830 Courthouse                                                                                        SHEET NO. 9
Birmingham Alabama 35203


                                        REQUEST FOR PROPOSAL (Continued)


ALLOCATED LOSS ADJUSTMENT EXPENSE (Continued)

        R.       Extraordinary Claim investigation and/or travel expense incurred at the request of Jefferson County

        S.       Any similar service related to the investigation and defense of a particular Claim, or the protection of and
                 collection of the subrogation rights of Jefferson County, for which Jefferson County shall have given
                 prior approval

        T.       Indemnity payments to employee claimants made on behalf of County”

RESPONSIBILITIES OF JEFFERSON COUNTY

   1.        To pay to Service Company the fees prescribed in Article II. If Jefferson County fails to pay Service
             Company the fees prescribed in Article II and/or in accordance with the time frames set forth therein, Service
             Company will notify Jefferson County and if Jefferson County does not cure such failure within ten (10) days
             of such notice, Service Company may terminate this Agreement immediately, notwithstanding the sixty (60)
             days prior written notice set forth in Article VI. In the event of such immediate Agreement termination, the
             termination option as set forth in Article VI, Paragraph 1, shall apply. In the event said fees prescribed in
             Article II are not paid within fifteen (15) days from receipt of billing there shall be added a surcharge of 10%
             to the billing on the services fees.

   2.        To pay all Allocated Loss Adjustment Expense, as defined in Article IV, in addition to the Claim service fee
             to be paid to Service Company(s) as prescribed in Article II.

   3.        To pay all benefits provided to a claimant under the Alabama Workers’ Compensation Statute, which have
             been identified as due and payable by “The Service Company” with the appropriate amount of said payment
             to be made by “The Service Company” within the applicable time frame as set out by the Workers’
             Compensation Statute, the Alabama Department of Industrial Relations Administrative Rulings and
             Guidelines and as set out by the Judicial Rulings of the Alabama Court of Civil Appeals and the Alabama
             Supreme Court.

TERMINATION

   1.   If this Agreement is terminated or not renewed, Jefferson County shall exercise one of the following options:

   A.        Jefferson County may require Service Company to conclude the handling of all open and closed Claims
             occurring during the term of this Contract, up until the effective date of termination whether reported before
             or after the term of this Contract subject, however, to the terms, conditions and limitations of this Contract.

   B.        Jefferson County may require Service Company to return all open and/or closed Claim files. Such return of
             open and/or closed Claim files shall not result in any expense or reduction in per claimant fees for all flat rate
             claims referred to Service Company prior to the effective date of termination, or time and expense fees
             incurred on time and expense Claims prior to the effective date of termination. The costs and expenses
             incurred by Service Company in returning such files will be billed, with documentation showing such costs,
Jefferson County Commission                                                                           NOVEMBER 24, 2009
716 Richard Arrington Jr. Blvd North                                                                      RFP NO. 34.10
Room 830 Courthouse                                                                                       SHEET NO. 10
Birmingham Alabama 35203


                                        REQUEST FOR PROPOSAL (Continued)


TERMINATION (Continued)

        to Jefferson County by Service Company. Such billing will be paid by lien to Service Company within thirty (30)
        days of billing.

    2. This contract may be terminated by either Jefferson County or Service Company with or without cause and for
       any reason whatsoever upon thirty (30) days prior written notice.

    3. Notwithstanding the provisions of Paragraphs 1 and 2 of this Article VI, this Contract may be terminated
       immediately by Jefferson County (i) if rendered or becomes insolvent, (ii) if unable to pay debts as they come
       due, (iii) if adjudicated a bankrupt, or files, or becomes subject to a petition of any insolvency, creditors or
       bankruptcy law or (iv) if Jefferson County has a receiver, liquidator or trustee of substantially all its assets
       appointed by a court of competent jurisdiction. In the event of immediate Agreement termination by Jefferson
       County, Jefferson County shall have the right to exercise its options upon termination as set forth in Paragraph 1
       of this Article VI.

GOVERNING LAW
This contract shall be governed by, and its provisions construed in accordance with, the laws of the State of Alabama.

INVALID PROVISIONS
In the event any provision of this contract shall be held to be invalid, unenforceable or in conflict with applicable law,
then the validity of the other provisions of this contract shall not be deemed to be adversely affected but shall remain in
full force and effect.

EXCLUSIVITY
This is an exclusive contract between the Service Company and Jefferson County to the extent that the Service
Company(s) shall be assigned all claims and/or losses as defined pursuant to Exhibit A and the Service Company shall
provide services under this contract, except as may be otherwise provided herein.

AMENDMENT AND WAIVER
No amendment or waiver of any provision of this contract and on consent to any departure here from, shall be effective or
binding unless and until set forth in a writing signed by each party and then any such waiver or consent shall be effective
only in the specific instance and for the specific purpose for which it is given. No notice or any other communication
given by one party hereto to the other party shall be construed to constitute approval or ratification by the other party of
any matter contained or referred to in such notice, unless the same is consented to by the other party in writing.

ENTIRE AGREEMENT
This contract, together with the exhibits attached hereto, constitutes the entire contract between the parties relating to the
subject matter hereof, and there exist no other written or oral understanding, agreements or assurances with respect to
such matters except as are set forth herein. Unless expressly stated, this contract confers no rights on any person or
business entity that is not a party hereto.
Jefferson County Commission                                                                          NOVEMBER 24, 2009
716 Richard Arrington Jr. Blvd North                                                                     RFP NO. 34.10
Room 830 Courthouse                                                                                      SHEET NO. 11
Birmingham Alabama 35203



                                       REQUEST FOR PROPOSAL (Continued)


NOTICES
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 communications
shall be addressed as follows:
If to Service Company:
Company Name             _______________________________________________
Company Address          _______________________________________________
City, State, Zip Code _______________________________________________
Attn: President

If to Jefferson County:
Jefferson County Commission
Room 610A* 716 Richard Arrington Jr. Blvd. N
Birmingham, AL 35203
Attn: Demetruis J. Taylor

ASSIGNMENT
Neither party may assign its rights or obligations under this contract without prior written consent of the other party.

BINDING EFFECT
This contract shall be binding upon and insure to the benefit of each party hereto and their respective permitted successors
and permitted assigns.

CANCELLATION
Failure to deliver as specified and in accordance with the RFP submitted, including promised delivery will constitute
sufficient grounds for cancellation of the order at the option of the County Commission.

TAX
Jefferson County is exempt from all tax. Provided however, bidder shall be responsible for payment of all sales, use,
lease, ad valorem and any other tax that may be levied or assessed by reason of this transaction.

GUARANTEE
Proposer certifies by submitting RFP, that he is fully aware of the conditions of service purpose for which item(s)
included in this RFP are to be purchased, and that his offering will meet these requirements of service and purpose to the
satisfaction of the Jefferson County Commission and its Agent.

The award will be made on all or none basis. Bidder will quote on all items.
Jefferson County Commission                                                                         NOVEMBER 24, 2009
716 Richard Arrington Jr. Blvd North                                                                    RFP NO. 34.10
Room 830 Courthouse                                                                                     SHEET NO. 12
Birmingham Alabama 35203


                                       REQUEST FOR PROPOSAL (Continued)


CONFIDENTIAL OR PROPRIETARY INFORMATION
If a bidder’s proposal contains material noted or marked as confidential and/or proprietary that, in the County’s sole
opinion, meets the disclosure exemption requirements of the Alabama Public Records Law, then that information will not
be disclosed pursuant to a request for public documents. If the County does not consider such material to be exempt from
disclosure under the Alabama Public Records Law, the material will be made available to the public, regardless of the
notations or markings. If a bidder is unsure if its confidential and/or proprietary material meets the disclosure exemption
requirements of the Alabama Public Records Law, then it should not include such information in the proposal.

PUBLIC DISCLOSURE
Subject to applicable law or regulations, the content of each Bidder’s Proposal shall become public information upon the
effective date of any resulting contract.

NEGOTIATIONS
Jefferson County reserves the right to enter into contract negotiations with the selected bidder. If the County and the
selected bidder cannot negotiate a successful contract, the County may terminate negotiations and begin negotiation with
the next selected bidder. This process will continue until a contract has been executed or all proposals have been rejected.
No bidder shall have any rights against the County arising from such negotiations.

AWARD
The Jefferson County Commission expressly reserves the right to reject any or all bids, or parts of bids, or to re-bid and to
make the award or awards as the best interest of the County appears.

CONTRACT
A fully executed Contract between the most responsive bidder and the County shall be implemented prior to successful
Contractor beginning work.

INVOICING
All invoices must agree with the purchase order in description and price and include the following information: 1)
Purchase Order Number; 2) Ship-to Department name and address.
In order to ensure prompt payment, ALL ORIGINAL INVOICES* MUST BE SENT TO:
     Jefferson County Commission
     Finance Department
     Room 820, Courthouse
     716 Richard Arrington Jr. Blvd, North
     Birmingham, AL 35203

*If invoice does not agree with purchase order, credits or a corrected invoice will be required in order for the County to
process payment. Invoices that do not reference an authorized Purchase Order will be returned to the vendor.
Jefferson County Commission                                                                       NOVEMBER 24, 2009
716 Richard Arrington Jr. Blvd North                                                                  RFP NO. 34.10
Room 830 Courthouse                                                                                   SHEET NO. 13
Birmingham Alabama 35203

                                      REQUEST FOR PROPOSAL (Continued)

THIRD-PARTY “REMIT-TO”
If Bidder has a third-party “remit-to” company, that information must appear on the Bidder’s response. Jefferson County
will send payment to the company designated by Bidder on its response, but will not be responsible for resolving payment
issues, should the Bidder change payment processing companies after a payment has been mailed or without forty-five
(45) days written notification to the Purchasing and Accounting division of Jefferson County.

NON- DISCRIMINATION POLICY
The Jefferson County Commission is strongly committed to equal opportunity in solicitation of ITB’s and RFP’s. The
County encourages bidders and proposers to share this commitment. Each bidder submitting a proposal agrees not to
refuse to hire, discharge, promote, demote, or to otherwise discriminate against any person otherwise qualified solely
because of race, creed, sex, national origin or disability.

INSURANCE
The successful bidder will maintain such insurance as will protect him and the County from claim under Workmen's
Compensation Acts, and from claims for damage and/or personal injury, including death, which may arise from operations
under this contract. Insurance will be written by companies authorized to do business in Jefferson County, Alabama and
shall include Jefferson County, Alabama as Added Additional Insured By Endorsement including a thirty (30)
day(s) written cancellation notice. Evidence of insurance will be furnished to the Purchasing agent not later than seven
(7) day(s) after Purchase Order/contract date. Successful bidder is also required to include the bid number on the evidence
of insurance.

                                              Insurance Minimum Coverage:
Contracting party shall file the following insurance coverage and limits of liability with the County's Human Resource
Department and Purchasing Department before beginning work with the County.
       General Liability:
       $1,000,000 - Bodily injury and property damage combined occurrence
       $1,000,000 - Bodily injury and property damage combined aggregate
       $1,000,000 - Personal injury aggregate
       Comprehensive Form including Premises/Operation, Products/Completed Operations, Contractual, Independent
       contractors, Broad Form property damage and personal injury.
       Automobile Liability:
       $1,000,000 - Bodily injury and property damage combined coverage
       Any automobile including hired and non-owned vehicles
       Workers Compensation and Employers Liability:
       $100,000 - Limit each occurrence
       Umbrella Coverage:
       $1,000,000 - Each occurrence
       $1,000,000 - Aggregate
       Added Additional Insured By Endorsement:
       Jefferson County, Alabama
       30 day(s) written cancellation notice
       Under Description of Operations/Locations/Vehicles/Exclusions Added by
       Endorsement/Special Provisions enter the BID/RFP Number, Project Number or Purchase
       Order Number Covered by The Certificate of Insurance

Proposer is required to maintain a minimum of $1,000,000 in ERRORS & OMMISSION (E&O) insurance to
protect the County from claims which may arise from operations under this contract.
Jefferson County Commission                                                                         NOVEMBER 24, 2009
716 Richard Arrington Jr. Blvd North                                                                    RFP NO. 34.10
Room 830 Courthouse                                                                                     SHEET NO. 14
Birmingham Alabama 35203


                                       REQUEST FOR PROPOSAL (Continued)


HOLD HARMLESS AND INDEMNIFICATION
Contracting party agrees to indemnify, hold harmless and defend Jefferson County, Alabama, its elected officers and
employees (hereinafter referred to in this paragraph collectively as “County”), from and against any and all loss expense
or damage, including court cost and attorney’s fees, for liability claimed against or imposed upon County because of
bodily injury, death or property damage, real or personal, including loss of use thereof arising out of or as a consequence
of the breach of any duty or obligations of the contracting party included in this agreement, negligent acts, errors or
omissions, including engineering and/or professional error, fault, mistake or negligence of Integrator, its employees,
agents, representatives, or subcontractors, their employees, agents or representatives in connections with or incident to the
performance of this agreement, or arising out of Worker’s Compensation claims, Unemployment Compensation claims, or
Unemployment Disability compensation claims of employees of company and/or its subcontractors or claims under
similar such laws or obligations. Company obligation under this Section shall not extend to any liability caused by the
sole negligence of the County, or its employees. Before beginning work, contract party shall file with the County a
certificate from his insurer showing the amounts of insurance carried and the risk covered thereby. Liability insurance
coverage must be no less than $1,000,000. During performance the company must effect and maintain insurance from a
company licensed to do business in the State of Alabama. Coverage required includes 1) Comprehensive General
Liability; 2) Comprehensive Automobile Liability; 3) Worker’s Compensation and Employer’s Liability.

REQUIREMENTS

1.      Workers Compensation Claims- The Service Company is required to provide the following
        adjustment work for all workers compensation claims for the fees contained in Exhibit B to this Agreement.

2.      The following services are:
           1. Administration of all claims
           2. Review of all claims for compensability
           3. Compute and notify client of appropriate temporary total benefits to be paid.
           4. Compute and notify client of appropriate settlement amounts to be paid.
           5. Notify client (Human Resources and County Attorney) of final settlement amount
           6. Provide client a quarterly by-name report of all claims that have been settled
           7. Adjudicate all medical bills to the State Fee Schedule or the AlaMed Fee Schedule as appropriate
           8. Necessary filings with the Department of Industrial Relations
           9. Subrogation reviews
           10. Coordinate defense litigation with in-house legal department
           11. Implement new laws
           12. Consult and testify before legislative bodies
           13. Prepare loss data
           14. Prepare monthly statistical reports for Jefferson County and a quarterly statistical report to excess carrier
                of the state division of Workers’ Compensation, if requested
           15. Provide client a yearly report of the number of the number of compensation claims, medical claims and
                open claims
           16. Send an introductory letter to all loss-time claimants explaining Workers’ Compensation benefits and
                employee’s rights and responsibilities under the Alabama Workers’ Compensation Act
Jefferson County Commission                                                                        NOVEMBER 24, 2009
716 Richard Arrington Jr. Blvd North                                                                   RFP NO. 34.10
Room 830 Courthouse                                                                                    SHEET NO. 15
Birmingham Alabama 35203



                                            PROPOSAL PRICE SHEET
                                   (Offeror must use this form. Fill in all spaces.)



SCHEDULE OF CLAIMS SERVICE FEES AND EXPENSES

   A.      Injuries occurring on December 1, 2009 through November 30, 2010

           The Service Company is required to administer all Workers’ Compensation Claims during the
           aforementioned time period. Jefferson County will consider paying a flat ANNUAL fee.

           Please fill in your fees below:

           1st year    $ ____________________

           2nd year    $ ____________________

           3rd year    $ ____________________


   B.      The Service Company will administer carry over claims on a per file basis as follows:

        Lost time              $_____________ per claim

        Medical Only           $ _____________ per claim

        Input Fee              $ _____________ per claim
Jefferson County Commission                                                                           NOVEMBER 24, 2009
716 Richard Arrington Jr. Blvd North                                                                      RFP NO. 34.10
Room 830 Courthouse                                                                                       SHEET NO. 16
Birmingham Alabama 35203


                                        REQUEST FOR PROPOSAL (Continued)


Non-Collusion Affidavit

I, ___________________________________________________, an authorized agent/representative of

________________________________attest that the proposal is not made in the interest of, or on behalf of, any

undisclosed person, partnership, company, association, organization, or corporation; that the Proposal is genuine and

not collusive or sham; that the Offeror has not directly or indirectly induced or solicited any other Offeror to put in a

false or sham RFP, and has not directly or indirectly colluded, conspired, connived or agreed with any Offeror or

anyone else to put in a sham RFP, or than anyone shall refrain from proposing; that the Offeror has not in any manner,

directly or indirectly sought by agreement, communication or conference with anyone to fix the RFP of the Offeror or

any other Offeror, to fix any overhead profit, or cost element of the RFP price or of that of any Offeror, or to secure

any advantage against the public body awarding the contract of anyone interested in the proposed contract; that all

statements contained in the RFP are true; and further, that the Offeror has not, directly or indirectly submitted his/her

RFP price or any breakdown thereof or the contents thereof, of divulged information or data relative thereto, or paid,

and will not pay any fee to any corporation, partnership, company, association, organization, RFP depository, or to any

member or agent thereof, to effectuate a collusive or sham RFP.


I, the undersigned, hereby certify that I have read and understand this Non- Collusion Affidavit and guarantee complete

compliance with all the terms, conditions and stipulations.


Subscribed and Sworn to                                    BY: ___________________________________
Before me this ________ day                                Authorized Signature of Offeror   Date
of ___________ 20____.
                                                           _____________________________________
                                                           Print or Type Name of Offeror
___________________________________
Notary Public of
My Commission expires
Jefferson County Commission                                                                         NOVEMBER 24, 2009
716 Richard Arrington Jr. Blvd North                                                                    RFP NO. 34.10
Room 830 Courthouse                                                                                     SHEET NO. 17
Birmingham Alabama 35203


                                       REQUEST FOR PROPOSAL (Continued)

SIGNATURE PAGE
The Jefferson County Commission, or its Agent, shall have the right to waive any informality or irregularity. Under
certain limited conditions, the Purchasing Department may apply a local preference option in determining the low bid for
purchases of personal property.

All provisions of this Invitation are accepted by bidder as part of any contract or purchase resulting therefrom.

Please specify terms of payment below;

Date: _______Company Name: _______________________ Web Address: __________________
Terms: _______Address:________________________________________City:______________
County: _______________State: _____Zip: ____________Phone: (_____) ____________________

If Jefferson County Business Licenses were issued to your company for the past twelve (12) months, please list numbers:
_____________________________________________.

Vendor's Federal I.D. Number: ____________________________

I certify that ___________________________ has ___ has not ___ been in operation for five years at
         (Company Name)                          (Check one)
location(s) zoned for the type of business conducted by my company at the address stated above.

                                                                                        ______________________________
                                                                                                   (Authorized Signature)
                                                                                        ______________________________
                                                                                                            (Print Name)
                                                                                        ______________________________
                                                                                                        (E-Mail Address)

Toll Free Phone: ____________________ Fax Number: _________________________________

Return original bid in sealed envelope. Authorized signature of bidder must be in ink.

Bids received in our office after the specified date and hour will not be considered.

INDICATE THE FOLLOWING ADDRESSES IF DIFFERENT FROM ABOVE:
1. BID AWARD NOTICE ADDRESS

2. PURCHASE ORDER ADDRESS

3. REMITTANCE ADDRESS (AND NAME IF DIFFERENT THAN ABOVE)

				
DOCUMENT INFO
Description: Jefferson County Alabama Bankrupt document sample