Waiver of Subrogation for Workers Comp by etd25282

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                  SPRING BRANCH INDEPENDENT SCHOOL DISTRICT
                        Duncan F. Klussmann, Ed.D., Superintendent of Schools

                                    PURCHASING DEPARTMENT
                        1031 Witte Road, Building E, Houston, Texas 77055-6016
                              Phone 713/365-5223 Fax 713/365-5214


                                                          Date:            February 9, 2007 ______


                         NOTICE TO PROPOSERS
The SPRING BRANCH IINDEPENDENT SCHOOL DISTRICT, herein after referred to as SBISD, is
accepting sealed proposals as specified in this document. Sealed proposals will be received at the
                                                                           nd
office of the Director of Purchasing, SBISD, 1031 Witte Road, Building E (2 Floor), Houston, Texas
77055-6016 until:
                                                 ANNUAL CONTRACT FOR
                                                 WORKERS‟ COMPENSATION PROGRAM AND
MARCH 21, 2007 @ 2:00 PM                 FOR     WORKERS‟ COMPENSATION EXCESS INSURANCE



Proposals will be publicly opened and read immediately following the deadline for receiving the proposals at
                                 nd
1031 Witte Road, Building E (2 Floor). Any questions pertaining to the proposal procedure should be
addressed to the Bid Specialist at 713/365-5223, extension 2326. Any questions pertaining to the proposal
specifications should be directed to the Director of Purchasing at 713/365-5223, extension 2325.

       PROPOSAL ENVELOPES SHALL BE PLAINLY MARKED
        SEALED PROPOSAL FOR:                                      PROPOSAL NO. __8314P

        ANNUAL CONTRACT FOR WORKERS‟ COMPENSATION PROGRAM
        AND WORKERS‟COMPENSATION EXCESS INSURANCE

        DO NOT OPEN UNTIL:_____MARCH 21, 2007 @ 2:00 PM                                               _


Any proposal received later than the specified time, whether delivered in person or mailed, shall be
disqualified.

The evaluation criteria specified herein will be used to determine which of the proposals provide the best
quality for SBISD at the most economical cost. SBISD reserves the right to request post-proposal
modifications, including best and final offers. SBISD reserves the right to accept or reject any or all
proposals, to waive all technicalities, and to accept the proposal(s) that is determined to be the most
favorable to SBISD. Recognizing that there are important considerations other than price, SBISD may not
necessarily award to the lowest Proposer.

Proposals must be effective for ninety (90) days following deadline for the receipt of proposals.




Barbara A. Robillard




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                                       SC O PE O F PRO PO S AL

Scope of Services Requested
The Spring Branch Independent School District is accepting proposals for the following services for its
Workers' Compensation Program:

Insurance Coverages Requested
The Spring Branch Independent School District wishes to examine the following options for its Workers'
Compensation and Excess (Stop-Loss) Insurance Programs:

Insured: Spring Branch Independent School District. Coverage shall apply to all employees of the
Spring Branch Independent School District.

Invitation: SBISD requests proposals from qualified Carriers, Third Party Administrators, and Excess
Carriers for services listed below. Invitees may propose on only option one, option two or all three of the
options listed below.

Option - 1
      A Guaranteed Cost Program – (fully insured program): to include all aspects of services and
       excess insurance and other costs associated with a Workers' Compensation program to include,
       for example: cost of insurance premiums, claims administration, litigation management, medical
       cost containment, utilization services, loss prevention services, return to work program features,
       etc.

Option - II
      A Self-Insured Program: to include all aspects of services and costs associated with a Workers‟
       Compensation program to include, for example: administration of the overall program, claims
       administration, litigation management, medical cost containment, utilization services, loss
       prevention services, return to work features, etc.

Option III
      Excess and Employers liability Insurance Coverage

        A quote for an aggregate stop loss insurance, at various retention level options, as stated in the
        Proposal Quotation Forms.

        Limits/Coverages: Statutory Workers Compensation and Employers liability $1,000,000

        Proposals on any or all options:
        Self Insured Retention (SIR)                      $250,000
        Self Insured Retention (SIR)                      $300,000
        Self Insured Retention (SIR)                      $350,000


Policy Period
The policy shall commence as described below, with the option to renew annually for an additional two
(2) years, if the renewal is agreed to in writing by both parties.

                                       July 1, 2007 – June 30, 2008

It is the intention of the District to remain in the program for a period of three (3) years. Therefore, a
three-year rate guarantee will be given favorable consideration. If a three (3) -year rate guarantee
cannot be provided, indicate the maximum guaranteed rate increase which may be anticipated, and the
basis on which the increase will be based upon renewal. In the event the District neither has renewed
this contract nor secured alternative proposals from another carrier, TPA and/or service provider, on or
before the initial termination date, this proposal as approved and awarded shall continue upon mutual
agreement on a month-to-month basis.


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Pre-Proposal Conference
A pre-proposal conference will be held on February 27, 2007 at 10:30 a.m. in the office of the
                                                             nd
SBISD Purchasing Department, 1031 Witte Road, Building E, 2 Floor, Houston, Texas 77055.

Non-Attestation to RFP
Due care and diligence has been exercised in the preparation of the RFP, and all information contained
herein is believed to be substantially correct. However, the responsibility for determining the full extent
of the services required, the exposure to risk, and verification of all information herein shall rest solely
with those making proposals. Neither the District nor its representative shall be responsible for any error
or omissions in this RFP.




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1.0.0   GENERAL TERMS AND CONDITIONS FOR PROPOSALS

1.1.0   APPLICABILITY – These conditions are applicable and form a part of the contract documents in
        each equipment and/or service contract and a part of the terms of each purchase order for items
        of equipment and/or service included in the specifications and proposal forms issued herewith.

1.2.0   WITHDRAWAL OF PROPOSALS will not be allowed for a period of 90 days following the
        proposal opening.

1.3.0   SPECIFICATIONS may be those developed by the Using Department or by the Manufacturer to
        represent items of regularly manufactured products.

        1.3.1   DISTRICT SPECIFICATIONS have been developed by the Using Department to show
                minimal standards as to the usage, materials, and contents based on their needs.

        1.3.2   MANUFACTURER’S SPECIFICATIONS (Design Guide), Whenever an article in this
                proposal is defined by description as either a proprietary product or by using the name
                of a manufacturer, the Proposer is encouraged to offer an item which is equal in quality,
                durability and in full compliance with our Specifications. If the term “equivalent, alternate
                or equal” is not inserted it shall be implied. The specified article or material shall be
                understood as descriptive, not restrictive.

1.4.0   QUESTIONS concerning this proposal shall be addressed to the Director of Purchasing and
        Contracts, SBISD.

1.5.0   PROPOSALS SHALL BE SUBMITTED ON THESE FORMS. Deviations to any Conditions
        and/or Specifications shall be conspicuously noted in writing by the Proposer and shall be
        included with the proposal.

1.6.0   SEALED PROPOSALS ONLY ARE ACCEPTABLE. FAXED PROPOSALS will not be
        accepted by SBISD since the fax process does not provide for the delivery of a sealed proposal.

1.7.0   REQUIRED ADDENDA will be issued by SBISD Purchasing Department to all those known to
        have received a complete set of proposal documents.

1.8.0   QUANTITIES REQUIRED are substantially correct. The District reserves the right to purchase
        additional quantities above that stated at the same unit price unless otherwise specified by the
        Proposer.

1.9.0   DELIVERIES required in this proposal shall be freight prepaid F.O.B. destination and proposal
        prices shall include all freight and delivery charges. For shipments designated on the purchase
        order to the SBISD Central Warehouse, delivery hours are 7:00 a.m. to 3:00 p.m. NO
        DELIVERIES WILL BE ACCEPTED AFTER 3:00 P.M.

1.10.0 WARRANTY CONDITIONS for all supplies and/or equipment shall be considered
       manufacturer‟s minimum standard warranty unless otherwise agreed to in writing. Proposer
       shall be an authorized dealer, distributor or manufacturer for the product. All equipment
       proposals shall be new unless clearly stated in writing.




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1.0.0   GENERAL TERMS AND CONDITIONS FOR PROPOSALS, continued

1.11.0 SAMPLES, when called for, shall be submitted with the proposal per instructions set forth in the
       Special Terms and Conditions.

        1.11.1 ADDITIONAL SAMPLES needed for a proposal to be evaluated properly shall be
               delivered within (5) working days from the time the vendor is notified by the Purchasing
               Department.

        1.11.2 SAMPLE ITEMS from the successful Proposer may be retained for the purpose of
               determining that the quality and workmanship of the delivered items are comparable to
               the sample.

1.12.0 THOSE WHO DO NOT PROPOSE are requested to notify the SBISD Purchasing Department in
       writing if they wish to receive future proposals. Failure to do so may result in their being deleted
       from our prospective Proposer list.

1.13.0 EVALUATION OF PROPOSALS takes into account the following considerations: price, quality,
       suitability for the intended use, probability of continuous availability, vendor‟s service, safety
       record, and date of proposed delivery and placement. It is not the policy of the SBISD to
       purchase on the basis of low proposals alone.

1.14.0 DISCLOSURES               By signing this proposal, a Proposer affirms that he/she has not given,
       offered to give, nor intends to give at any time hereafter any economic opportunity, future
       employment, gift, loan, gratuity, special discount, trip, favor or service to a public servant in
       connection with the proposal submitted.

        1.14.1 PROPOSER SHALL NOTE any and all relationships that might be a conflict of interest
               and include such information with the proposal.

        1.14.2 By signing this proposal, a Proposer affirms that, to the best of his/her knowledge, the
               proposal has been arrived at independently, and is submitted without collusion with
               anyone to obtain information or gain any favoritism that would in any way limit
               competition or give them an unfair advantage over other Proposers in the award of this
               proposal.

1.15.0 FUNDING OUT CLAUSE. Any contract for the acquisition, including lease, of real or personal
       property is a commitment of the District‟s current revenue only:

        1.      The District retains the continuing right to terminate the contract at the expiration of
               each budget period during the term of the contract.

        2.      The contract is conditioned on a best efforts attempt by the District to obtain and
               appropriate funds for payment of the contract.”

1.16.0 ALL CONTRACTS AND AGREEMENTS between Merchants and SBISD shall strictly adhere to
       the statutes as set forth in the Uniform Commercial Code as last amended in 2002 by the
       American Law Institute in the National Conference of Commissioners on Uniform State Laws.
       Reference: Uniform Commercial Code, 2001 Official Text, or latest.

1.17.0 CONTRACTS FOR PURCHASE will be put into effect by means of a purchase order(s)
       executed by the Executive Administrator of Purchasing and Contracts after proposals have been
       awarded.

         1.17.1 Any additional agreements/contracts to be signed by SBISD shall be included with the
                proposal.



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1.0.0   GENERAL TERMS AND CONDITIONS FOR PROPOSALS, continued

        1.17.2 Prices for all goods and/or services shall be negotiated to a firm amount for the duration
               of this contract or as agreed to in terms of time frame.

        1.17.3 Tax Exemption: SBISD is exempt from payment of taxes under Chapter 20,
               Title 122A, Revised Civil Statutes of Texas, for the purchase of tangible personal
               property.

1.18.0 ASSIGNMENTS AND SUBCONTRACTING: No part of this order may be assigned or
       subcontracted without the prior written approval of SBISD. Payment can only be made to the
       Supplier named in this order.

1.19.0 TERMINATION OF CONTRACT. It is understood that the District retains the option to terminate
       this Agreement for any reason at the end of each contract year without pecuniary risk or penalty
       or at any point during the contract term with evidence of just cause. The District agrees that it
       will provide written notice of termination no later than thirty (30) days prior to the end of the
       contract year or for just cause. The termination will become effective and this Agreement shall
       terminate thirty (30) days following written notification of intent.

1.20.0 CONFIDENTIAL INFORMATION OR TRADE SECRETS (Government Code, Article 252.049).
        If any of the information is considered to be confidential or a trade secret belonging to the
       Proposer and, if released would give advantage to a competitor or Proposer, that information
       should be filed with the proposal in a separate envelope marked “CONFIDENTIAL – DO NOT
       DUPLICATE WITHOUT PERMISSION”.

1.21.0 VENDOR NON-PERFORMANCE. If at any time, the vendor fails to fulfill or abide by the terms and
       conditions or specifications of the contract, SBISD reserves the right to:

        1)       purchase on the open market and charge the vendor the difference between contract price
                 and actual purchase price, or

        2)       deduct such charges from existing invoice totals currently due, or

        3)       Cancel within thirty (30) days written notification of intent and remove the vendor from the
                 active proposal file for a period of time not less than one (1) year.

        4)       Re-bid the service/product.

        5)       Award to next lower responsible Proposer, if accepted by same.

1.22.0 OTHER REQUIREMENTS. Any problems or discrepancies that are not covered by the above
       requirements should be directed to the Executive Administrator of Purchasing and Contracts for a
       determination or clarification prior to any action taken on said problem or discrepancy. If the
       Contractor fails to make such request, no excuse will thereafter be entertained for failure to carry out
       the work in a satisfactory manner.

1.23.0 PROPOSAL DOCUMENTS. Proposals shall be submitted by the Proposers in triplicate; one (1)
       original and two (2) copies, marked as such.




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                             CHECKLIST OF ENCLOSURES

Following checklist of enclosures is provided for guidance purposes. It is the
responsibility of the Proposers to review the entire RFP to ensure that all the items
requested are enclosed.

1.     Proposal Forms
2.     General Information on the Organization
3.     Insurance Company‟s A.M. Best rating
4.     Certificates of Insurance
5.     Applicable Licenses
6.     Audited Financial Statements
7.     Enclosures as per Conditions Provision of the RFP
8.     Transition Plan
9.     A copy of sample policy and/or contract
10.    Market Request Form
11.    Responses to Questionnaire
12.    General Forms
13.    Claims Manual (if available)
14.    Company Brochures
15.    Reports




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                        GENERAL INFORMATION AND TERMS




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                                 GENERAL INFORMATION AND TERMS

Background
The Spring Branch Independent School District is a moderately large sized District with an employee
workforce of approximately 4,500 and an automated substitute calling system which has enrolled
approximately 875 substitutes who are on-call per District need. The District has a student enrollment of
approximately 32,600. There are 32 elementary schools, 9 middle schools, 6 high schools, 2 special
campuses and 4 site facilities, covering approximately 44 square miles. The workforce is comprised of
teachers, nurses, administrators, clerical, custodians, cafeteria food service staff, bus drivers, mechanics,
and maintenance employees. Additional claims information regarding the District is provided in the
Underwriting Section of the Request for Proposal (RFP).

Philosophy
It is of importance to the District to provide its injured employees a quality benefits delivery program that
will control and direct workers‟ compensation claims, ensure good employee relations, promote reduction
in litigation, and contain claims costs. The District‟s goal is directed toward the highest professional level
of responsive claims handing. In an effort to maintain control, this should include regular on-going
communication with injured workers, from the inception to disposition of the claim. The District is
interested in providing a workers' compensation program which will coordinate and manage on the job
injuries/illness, return to work program with the providers of its medical and disability benefits. The
purpose is to provide employees with quality medical care, and a coordinated return to work program for
on and off the job injuries/illness. It shall be the responsibility of the company(ies) proposing this type of
plan to be in compliance with all federal, state, and Texas Department of Insurance Workers'
Compensation rules, regulations and laws. The District is committed to providing all statutory benefits
covered under the workers‟ compensation law and maintain control over costs, legally and practically.

Contents of the Proposal
The Request for Proposal contains general terms and conditions, information, questionnaires, exhibits,
proposal forms, and underwriting information. These specifications are not intended to be restrictive.
Proposers shall present their most competitive coverage and pricing, and may include alternative
proposals. Explain, in detail, each nonconforming area and provide pertinent documentation that will
define proposer‟s position. If plan includes special advantages, explain each area, and identify them in
the proposal.

Proposal Forms and Questionnaire
Forms in this package shall be completed and returned with the proposal by U. S. Mail or other method of
delivery on or by March 21, 2007 at 2:00 p.m. Proposer shall answer each question. Use additional
pages if necessary, maintaining proper identification of items.

Information on Your Organization
Submit general information about your organization. Comment in detail on any potential changes
anticipated in the organization structure or ownership. The District requires that if there are any changes
made in your organizations which may affect the proposal submitted or the contract to be entered with the
District, it shall be incumbent upon the new organization to comply and meet with the terms of the
proposal submitted and/or negotiated.

Confidential Information
The District is subject to the Open Records Act, therefore, to preserve any information as confidential,
mark that particular information by stamping the page or sections as such, as the full proposal may not be
handled as confidential. (See 1.20.0)




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Reservation of Rights
The District reserves the right to accept or reject any or all proposals, accept renewal terms or waive any
and all informalities not advantageous to the District. Recognizing important factors beyond
rates/premium cost/charges are to be taken into consideration, the District will not be bound to accept the
lowest cost proposal.

Responsibility
The District does not accept any financial responsibility of any costs incurred by Company(ies) for the
purposes of preparing a response to the proposal, travel involved, or other associated costs in relation to
the proposal.

Obligations
The Company shall at all times observe and comply with existing and future Federal, State, Local and
Municipal laws, rules and regulations of the contract, or any of its provisions and/or services being
offered.

Non-Attestation to RFP
Due care and diligence has been exercised in the preparation of the RFP, and all information contained
herein is believed to be substantially correct. However, the responsibility for determining the full extent of
the services required, the exposure to risk, and verification of all information herein shall rest solely with
those making proposals. Neither the District nor its representative shall be responsible for any error or
omissions in this RFP.

Non-Waiver Endorsement
Each Company submitting a proposal shall acknowledge that the District has made a reasonable attempt
to provide the Companies with relevant information on premium costs, underwriting, claims, and other
data contained herein. Companies submitting proposals shall acknowledge and waive any right of denial
of coverage or avoidance of the policy provisions based upon any expressed or implied warranty or
representation that any of the premium costs, underwriting, loss information, etc., provided discloses all
exposures or data known to exist.

Contact and Negotiations with Proposers
As a part of the evaluation process, the District reserves the right to contact any Company, in order to
clarify, verify and/or request information with regard to any proposal content. A specific contact person,
with telephone and fax numbers, shall be named on the signature sheet for the purposes outlined above.
 The District reserves the right to accept a proposal without any discussion or negotiation with Companies
submitting proposals.

Firmness of Proposal
Proposals shall be firm and effective ninety (90) days after date of submission. Rejection or withdrawal
after offer is accepted shall constitute a breach of contract. Once proposal is delivered, Companies must
observe notice provisions as stated herein.

Termination of Contract
The District reserves the right to terminate this agreement upon failure of Company to perform per terms
of this proposal, failure to perform per negotiated terms and conditions, or failure to comply with usual and
customary practices of the industry and upon breach of any laws, rules or regulations. The District
reserves the right to terminate the contract at any time for cause. Sixty (60) days advance termination
notice will be given in writing to the Company(ies). Company(ies) shall provide the District with ninety
(90) days written notice to terminate the contract.




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Insurance Requirements
The Company shall maintain and provide proof of insurance during the term of this contract, and any
extensions thereto. Certificates of insurance of the following types of coverage‟s and limits shall be
enclosed with the proposal.

Coverage                                                           Limits
Workers' Compensation and Employers Liability               Workers' Compensation. - Statutory
                                                            Educators Liability $1,000,000

Commercial General Liability Policy- to include             $1,000,000 Combined Single Limit (CSL)
coverage for Premises Operation, Independent                for Bodily Injury and Property Damage
Contractor, Products and Completed Operations,
Contractual Liability, Personal Injury, Medical
Payments.

Automobile Liability Insurance                              $500,000 CSL
to include owned/leased, hired, and
non-owned vehicles.

Employee Fidelity/Faithful Performance                      $1,000,000
Coverage-including loss to the District arising
from Contractor‟s officers or employees

Professional Liability                                      $1,000,000

Upon award of the contract, the District shall be entitled to receive, without expense to the District, copies
of all policies and endorsements thereto. The District reserves the right to make any reasonable request
for deletion, revision or modification of particular policy terms, conditions, 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 request by the District, the Company shall exercise
reasonable efforts to accomplish such changes in policy coverage, and shall pay the costs incurred.

The Proposer agrees with respect to the above mentioned insurance, that the certificate of insurance
shall contain the following provisions:

       Name Spring Branch ISD and its officers, employees, and elected representatives as additional
        insured (as the interest of each insured may appear), to applicable coverage.
       Furnish thirty (30) days notice of material change.
       Provide for an endorsement that the “other insurance” clause shall not apply to the District where
        District is an additional insured on the policy.
       The Company agrees to waive subrogation rights against the District, its officers and employees
        for injuries, including death, property damage, or any other loss to the extent same may be
        covered by the proceeds of insurance.
       Furnish to SBISD within fifteen (15) days notice of any carrier “ratings” change.

Hold Harmless and Indemnity Agreement
Successful Proposer shall indemnify, defend and hold the District, its Board of Trustees, officers,
employees and authorized representatives harmless from any and all claims, demands, allegations,
lawsuits, action of any type/description for personal injury, death and/or property damage arising from any
cause or sustained by any person/persons/organization on account of any negligent
act/error/omission/fault of the successful Proposer, or any of its agents, employees, subcontractors, or
suppliers in the execution of, or performance under any contract which may result from award of the
Proposal. Successful Proposer shall pay all sums of money, judgement with costs, which may be
obtained against the District and participating entities.


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Rates and Premiums
Rates/Premium charges proposed shall be total, including all losses, loss adjustments, reinsurance, other
company expenses, standard acquisition expense factors and all state premium taxes.

Costs of services shall be itemized and invoiced to the District. Premiums shall be firm for the duration of
this contract and stated in proposal package as such. Premiums shall be all inclusive. Additional
charges of any kind shall be identified by item and related costs or agree to forfeit the rights to payment

Proposers are requested to provide a breakdown of the net premium costs and any commissions/fees to
be paid to the agent(s)/broker(s) by the insurance company. Illustrate the services, which will be made
available to the District, for the fees/commissions paid.

Payment Terms
Payments of premiums for excess insurance may be on an annual basis, and the Third Party
Administrator (TPA) Services on monthly basis and fully-insured on a quarterly basis. The proposer‟s
may state cash flow terms.

Financial Rating
Insurance Companies shall have a rating of A+, A, or A- as defined in the current edition of A.M. Best's,
which shall be maintained throughout the term of the contract. If during the contract period the rating of
the Company is lowered, it is the responsibility of the Insurance Company/Agent to notify the District.

Financial Statements
Current audited financial statements, or evidence of financial stability, shall be included with the proposal.

Client List
A client list shall be completed on the forms provided.

Sample Policy
A sample policy of proposed coverage and endorsements, summarizing policy exclusions and policy
enhancements, shall be included in the proposal.

Renewal Information
Renewal information shall be furnished to the District no later than ninety (90) days prior to the plan year‟s
anniversary date.




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Selection and Evaluation Criteria
The Spring Branch Independent School District recognizes the fact that there are important
considerations involved other than the rates/charges, and will not be bound to accept the lowest cost
proposal. The proposals will be evaluated and selected based upon, but not limited to, the following
criteria:

   Applicable to Insurance Companies : scope of insurance coverage‟s, extent of proposed services,
    financial stability, premium costs, deductible/retention amounts, specific and aggregate stop loss
    levels proposed.
   Ability to comply with the requested proposals and/or acceptable alternative proposals submitted.
   Capability to structure plan design provisions to meet the District‟s objectives and goals.
   Assurance of an acceptable transition plan for a July 1, 2007 start date.
   Methodology and resources applied to fulfill the scope of services, staffing and organization.
   Demonstrated capability in providing localized services (Houston,Texas).
   Commitment by the senior management executives to the District‟s needs for services requested.
   Flexibility and responsiveness to the District‟s needs, injured employees, physicians, and regulatory
    bodies.
   Claims adjusting philosophy, integration of services and claims investigation ability.
   Competency in providing quality assessment procedures such as effective and accountable methods
    of delivering medical cost management services, utilization services, occupational health networks or
    services.
   Financial stability and experience in providing proposed requested services to other clients and
    government entities (specifically School Districts).
   Knowledge and experience in providing services, specifically in workers‟ compensation programs.
    Claims competency to include processing ability, along with accuracy and efficiency.
   Experience and qualification of key management, supervisory personnel, adjusters, and other staff
    who are to be assigned to the District‟s account.
   Accounting/Auditing procedures of the Companies (checks and balances).
   Funding and cash flow arrangements proposed. The evaluation of cost calculations will not take into
    consideration the initial first year annual costs, but future costs for the following two or more years.
   Premium rate/cost guarantees for current and future renewal periods. Cost evaluations will consider
    service charges in relation to positive ultimate impact the services will yield to the total final costs.
    Proposers are encouraged to illustrate how their services, through experience, management and
    strategies, will enable the District to keep costs stable and/or lower.
   Sample claims kit, claims manual, quality of communication materials, action plan, management
    reports submitted and/or as negotiated.
   Automated systems capabilities, employer online ability to monitor claim activity and management
    reporting capabilities and costs of this to the District.




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Conditions
The Company submitting proposals shall confirm and state the company‟s position for each of the
following conditions, as applicable to the proposal being submitted.
The Company shall:

                    Conditions                            Response to Condition Compliance
                                                       Yes          No          N/A

Include a copy of all forms, policies, materials,
attachments, and reports of services being offered.
State the size, location and experience of
professional staff, specifically those servicing the
District‟s account, and enclose resumes.
The District reserves the right to
approve/disapprove any individual who may be
selected to service the District account.
Management personnel shall be willing to work with
the District‟s plan administrator(s) in the
preparation of any documents that may assist in
the smooth operation, administration of the plans.
Submit additional information at the request of the
District after the submission date, without changing
the terms and conditions of the proposal.
Provide the District reasonable rights to perform
audits by the District‟s personnel and/or an outside
firm of consultants/auditors to investigate the
District‟s claims administration and services, and
evaluate performance of the company, and agree
to provide full cooperation during this process.
Performance of these functions shall be conducted
with notification to the Company per customary
industry standards.
Senior Management executives to agree and
provide commitment to hold meetings as necessary
to discuss any additional future commitments and
improvements that may be required.
Not collude in any manner or engage in any
practice or activity with any other organization or
entity, which may restrict or eliminate competition
and thereby not result in the best proposal being
submitted to the District. Violation of these
instructions will cause the proposal to be rejected
by the District. (This does not preclude joint
ventures or sub-contracts, which are legal and
customary in the industry practice).
Handle the overall account responsibility for each
part of the service by one main contact
representative.
Upon selection furnish copy(ies) of documents to
prove that the Company is licensed to conduct
business in the State of Texas.




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                     Conditions                             Response to Condition Compliance
                                                         Yes          No          N/A

Provide a description of the quality controls
currently in place. The description should include
the approach to frequency of internal claims audit
controls.
Provide the District with various options regarding
handling of open claims at the termination or
expiration of the contract. (State this clearly in the
proposal, and include procedures and costs for
handling run off of claims)
The Carrier shall have mainframe database for
claims entry and data collection. The District
should have on line access to the claims data for
review of claims information, and not for making
any modifications or input of data.
Provide additional data that is considered pertinent
and useful in evaluating the proposal.




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Claims Management Plan
Include a claims management plan illustrating how Proposer's company will handle new claims and
provide services requested in this proposal. An outline of the plan is provided below for guidance
purposes. Proposers are not restricted to this format. Proposers may add to this format.

   Claims Administration - the plan should include but not be limited to:
     Data entry
     Coding
     Setting up files from notice of injury
     Assignment of the files
     Determination of compensability
     Setting of reserves
     Diary systems
     Supervisory controls
     Investigation process
     Payments of medical, indemnity, expenses, and other related charges
     Benefits Review Conference (BRC), Contested Case Hearing (CCH), appeals, and legal defense
        of claims
     Coordination with Medical Providers
     Coordination with Medical Cost Containment
     Compliance with Division of Workers' Compensation Commission (DWC) rules, regulations,
        filings etc.
     Training and education provided to staff
     Interaction with the client, and client involvement
     Cost control strategies

   Special Presentations
     Pre-hearing conferences
     Special formal hearings
     Special Board filings
     Court appearances

   Surveillance Services
    Reports on claims suspected to be fraudulent, exaggerated or suspicious.

   Risk Management Information Systems
     Standard reports
     Ad hoc reports
     On -line capabilities

   Workers' Compensation Medical Cost Management Services
     Medical bill review
     Hospital bill review
     Utilization review
     Case management-telephonic and on site
     Pre-authorization, concurrent and reconsideration process
     Peer review
     Return-to-work coordination with parties involved
     Rehabilitation services
     Health Network Providers

   Banking Procedures and Controls


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Underwriting Information
The underwriting information is included in the proposal under the Section listed as “Underwriting
Information”.


Request for Additional Information
Requests for additional information must be directed to the District‟s Purchasing Department. Requests
shall be submitted in writing, and may be sent via fax or electronic mail, no later than March 2, 2007 by
noon to:

                          Director of Purchasing
                          Purchasing Department
                                                        nd
                          1031 Witte Road, Building E (2 Floor)
                          Houston, Texas 77055-6016
                          Telephone No. (713) 365-5223 extension, 2326
                          Fax:     (713) 365-5216
                          E-mail: alice.mcpherson@springbrancisd.com

Addenda to Proposal
The District reserves the right to revise and amend the specifications prior to the date set for the opening.
Proposers are to send their requests for additional information or clarification, in writing, to the Purchasing
Department via fax (713/365-5216). Revisions, additions, or amendments, if any, will be made by issuing an
addendum. If addenda are issued, a good faith effort will be made to send the addenda issued to the parties who
have been furnished a copy of the RFP. No addenda will be issued later than March 7, 2007 except for an
addendum withdrawing the RFP or one that includes postponement of the date for the receipt of proposals The
District, however, does not hold responsibility of furnishing copies of addenda to each and every interested party.

It is the responsibility of each Company, prior to submitting the proposal, to contact the Purchasing Department to
determine if addenda were issued and, if so, to obtain such addenda for attachment to the Proposal.




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Pre-Proposal Conference
A pre-proposal conference will be held at February 27, 2007 at 10:30 a.m. in the office of the
                                                              nd
SBISD Purchasing Department, 1031 Witte Road, Building E, 2 Floor, Houston, Texas 77055.

Proposal Submission
The Spring Branch Independent School District will receive proposals. Proposals shall be submitted to
the District by the following date, time and place:

Date:                    March 21, 2007
Time:                    2:00 p.m.

Place:                   Director of Purchasing
                         Purchasing Department
                                                       nd
                         1031 Witte Road, Building E (2 Floor)
                         Houston, Texas 77055-6016
                         E-mail: alice.mcpherson@springbranchisd.com

Marked:                  Request for Proposal for:
                         Annual Contract for Workers' Compensation Program and Workers‟
                         Compensation Excess Insurance, Proposal No. 8314P
                         Due: March 21, 2007 at 2:00 p.m.

The District will not be responsible for missing, lost or late mail. The District will not accept any proposals
via facsimile. PROPOSALS RECEIVED AFTER 2:00 PM ON THE ABOVE DATE SPECIFIED WILL NOT
BE CONSIDERED.

Originals
The recommended vendor will be responsible for submitting to SBISD, prior to commencing contract, a
signed original proposal and two (2) copies to the Director of Purchasing and Contracts. The
recommended vendor shall be available to attend the April 23, 2007 Board of Trustees meeting to support
SBISD in answering questions and clarifying information that may be requested by the Board.




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                     SPECIFIC INFORMATION AND TERMS




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                            SPECIFIC INFORMATION AND TERMS
Safety and Loss Control
The District has a Safety and Loss Control Section, which conducts the function of loss control/risk
prevention. Following is an outline of safety and loss control program activities:

   Pre-employment physical exams for bus drivers only. (To meet with Department of Transportation
    (DOT) physical examination requirements.)
   Fleet Safety Training Program
   Supervisory Training
   Return-to-Work Program
   Physical Hazard Inspections
   Accident Review Committee to review fleet accidents
   Fire Safety Prevention Program
   Near missed reporting procedures
   Prohibitive Substance and Drug Testing

Insurance Coverage
Information relating to the current coverage is provided under the Underwriting Information Section of this
Proposal.

Insurance Coverages Requested
The Spring Branch Independent School District wishes to examine the following options for its Workers'
Compensation and Excess Insurance/Employers Liability Program:

Insured: Spring Branch Independent School District. Coverage shall apply to all employees of the
Spring Branch Independent School District.

Option - I

       A Guaranteed Cost Program – (fully insured program): to include all aspects of services and
        excess insurance and other costs associated with a Workers' Compensation program to include,
        for example: cost of insurance premiums, claims administration, litigation management, medical
        cost containment, utilization services, loss prevention services, return to work program features,
        etc.

Option - II
      A Self-Insured Program: to include all aspects of services and costs associated with a Workers‟
       Compensation program to include, for example: administration of the overall program, claims
       administration, litigation management, medical cost containment, utilization services, loss
       prevention services, return to work features, etc.

Option - III

       Excess and Employers liability Insurance Coverage

        A quote for an aggregate stop loss insurance, at various retention level options, as stated in the
        Proposal Quotation Forms.

        Limits/Coverages: Statutory Workers Compensation and Employers liability $1,000,000

        Proposals on any or all options:
        Self Insured Retention (SIR)                      $250,000
        Self Insured Retention (SIR)                      $300,000
        Self Insured Retention (SIR)                      $350,000
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Aggregate Stop-Loss
Aggregate limit on annual basis as a percentage of manual premium or audited payroll.

Alternate Proposals
The District will review any alternate proposals submitted.

Policy Period
The policy shall commence as described below, with the option to renew annually for an additional two (2)
years, if the renewal is agreed to in writing by both parties.

                                      July 1, 2007 – June 30, 2008

It is the intention of the District to remain in the program for a period of three (3) years. Therefore, a
three-year rate guarantee will be given favorable consideration. If a three (3) -year rate guarantee cannot
be provided, indicate the maximum guaranteed rate increase which may be anticipated, and the basis on
which the increase will be based upon renewal. In the event the District neither has renewed this contract
nor secured alternative proposals from another carrier, service provider, on or before the initial
termination date, this proposal as approved and awarded shall continue upon mutual agreement on a
month-to-month basis.

Minimum Claims Administration Standards
And Scope of Services
The TPA or Carrier shall provide the claims administration services for workers' compensation program.
In performance of services, the TPA or Carrier shall comply with all applicable Federal, State and local
laws, rules and regulations. All files, records and databases will be the property of the District and subject
to review and audit at any time.

The services considered essential for handling the Texas Workers' compensation claims include, but are
not limited to, those listed below.

Claims Administrator will:

   Administer on behalf of the District, the workers' compensation program in accordance with the
    Workers' Compensation Act and the rules of the Division of Workers' Compensation.

   Examine all reports of job-related injuries or illnesses and determine whether the claims are
    compensable under the Act.

   Assign cases to a licensed Workers' Compensation (WC) adjuster on the day of receipt/notification of
    the Injury Report.

   Provide assistance to the District with investigation of all accidents and keep the District advised and
    informed. Claims to be investigated in such a manner that claims benefits (or controverted claims)
    are filed and paid within the time frame established by the Texas Workers Compensation Act, and the
    Rules promulgated by the DWC. Adjusters must have the ability to conduct on-site investigations in a
    timely and frequent manner as needed.

   Prepare and file job related Initial Injury Reports, such as DWC-1, Contested Case Hearing (CCH)
    forms, Benefits Review Conference (BRCs), and Required Medical Examination (RME) requests, and
    any other legally required forms, reports, documents, and papers on behalf of the District with the
    Division of Workers‟ Compensation within the mandated time limits.

   Maintain prompt contact - three-point contact within 24 hours with the injured employee, employer,
    physician, following assignment of the claim.

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   Maintain personal prompt contact – with injured employee in serious cases, and whenever necessary,
    including follow up contact.

   Contact claimant and/or witnesses on lost-time injuries, as needed or requested by employer.

   Obtain statements from the claimant, physician and witnesses or the claim file should reflect
    reason(s) for its omission. The statements should include, but not be limited to the following:
                        Description of the accident
                        Nature of Injury
                        Identification of witnesses (names, addresses, telephone number etc.)
                        Name of treating physician

   Create and maintain a physical file within 48 hours of receipt of the claim. Establish claims handling
    information such as diary dates of adjuster and supervisor (each claim to be reviewed at least every
    thirty (30) days or more frequently where needed). Maintain documents of each review in the claims
    file. Set up reserves, and any other pertinent information.

   Document statements, contact with witnesses, claimants, doctors and other investigations.

   Date stamp in-bound correspondence the day it is received. Match correspondence with the file and
    distribute it to responsible party within 24-48 hours of receipt, and take appropriate action. Outbound
    correspondence will, in all cases be sent promptly, in accordance with general professional
    standards. Phone calls will be returned promptly, and those requiring written response will be
    responded to without undue delay.

   Estimate initial appropriate reserves at the time a file is set up. All files must have reserves to extend
    through the life of the claim. Although all necessary facts may not be available at the outset of a
    claim, reserves should be adjusted when medical information or investigation indicates the existing
    reserve is inadequate. Reserves should consider following minimum criteria: extent and seriousness
    of injury, facts as determined by investigations, projected income benefits to be paid, projected
    temporary, impairment or supplemental income benefits, etc., potential costs of outside experts, and
    any other related expenses.

   Verify and determine all claims data, salary information and compensable wages. Submit all Injury
    Reports and Wage Statements and any other reports in compliance with DWC requirements.

   Review and determine all medical bills submitted for injury claimed, within the DWC mandated rates,
    and not previously paid. Payments to be issued to providers (physicians, hospitals, and others) for
    appropriate and compensable medical services to District employees. This includes monitoring
    medical reports for appropriate levels of improvements and appropriateness of treatment as well as
    extent of injury.

   Evaluate and coordinate activities with medical cost management regarding propriety of medical
    treatment and costs of payment of medical, prescription and other related benefits and expenses to
    insure that treatment provided is consistent with the injury, is reasonable and necessary, not
    excessive or duplicated.

   Obtain medical reports, guide employee to the Occupational Network (with the knowledge and
    consent of the injured employee), coordinate case management activities, obtain peer reviews, and
    use RME whenever necessary.

   To facilitate Return-to-Work program, coordinate activities with the physician, employee, and the
    District‟s representative ensuring compliance of the program with applicable rules, regulations and
    laws.

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   Process wage replacement benefits promptly in compliance with DWC payment schedules within
    mandated time frames.

   Issue payments on any settlements, claims expenses, and legal fees as required for each claim.

   Review approvals of all medical treatment requested by claimant or claimants treating physician in
    accordance with law.

   Notify the District of any Contested Case Hearings, and Benefit Review Conferences, and provide
    appropriate reports, and updates.

   Designate and maintain a person in Austin, Texas (Travis County) as its representative to the DWC to
    act as agent for receiving notices from the Commission.

   Provide assistance in assigning attorneys in litigated cases in preparing for hearings and/or trial,
    including the preparation of interrogatories and requests for production, and all hearings and trials
    with assigned legal counsel attending.

   Attend DWC hearings, Appeals, Trials, etc.

   Obtain prior approval from the District for services of persons or firms outside its organization
    engaged for special work in connection with the investigation of claims, special medical case
    management of claims, or rehabilitation of alternate duty services.

   Identify, investigate and pursue subrogation claims involving third party negligence, which can be
    subrogated for incurred expenses, and consult with and advise the District in writing of any and all
    recoveries or proposed settlements.

   Meet with District staff on a regular basis, as determined following award of the contract, or earlier as
    claim warrants to discuss the status of open claims, and other related issues. Open communication
    and dialogue is an important criterion.

   Report claims as per requirements of the excess insurance policy to the Excess Carrier.

   Provide monthly reports summarizing losses by department, and the District as a whole. Reports
    must utilize the District‟s established occupation, departmental, and location codes. (Include copies
    of all available reports for review with the proposal).

   Provide monthly check register detailing financial activity including payments issued, payee, amount
    of check, check number, type of payment, claim number and date of service.

   Computer system must be capable of producing ad hoc reports as requested by the District.

   Maintain a hard-copy claim file for each reported claim. The files shall be made available to the
    District‟s authorized personnel at all times for inspection. Each file shall contain all data pertinent to
    the claim to support its disposition.

   Store and maintain closed files. No file is to be destroyed without written approval of the District.

   Enter all Employers‟ First Report of Injury into the computer system. All such entries to be performed
    within 24 hours.




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   Maintain information on each assigned case, and all required claims information in computer system
    and preserve claims file on every reported claim (such files shall contain all data pertinent to
    supporting disposition of the claims). All data is to be entered promptly and timely. A hard copy of
    electronic media is to be created within 48 hours of receipt.

   Prepare, mail and maintain necessary correspondence to claimants, DWC, medical providers, legal
    counsel and other appropriate parties with EDI capability to DWC.

   Be willing to undergo periodic unscheduled audits for purpose of inspecting and reviewing claims
    handling procedures, financial control measures, etc., and cooperate fully with the auditors by making
    available to the District, or its designated representatives, any and all records or other necessary
    information.

   Provide bill review, utilization review (prospective, concurrent, retrospective, pre-certification), peer
    review, pre-authorization, case management, vocational and rehabilitation evaluation, discharge
    planning, case management, return to work program, identification of catastrophic illnesses or injury,
    and other workers compensation medical cost management related services. The services offered
    must be in compliance with Texas Workers Compensation Act, rules and regulations.

   Correspondence date stamped, sorted and checked for auditing, utilization review etc. service‟s and
    assigned to staff promptly.

   Check all medical bills, including hospital bills for DWC fee guidelines or special discounts (PPO)
    arranged with providers.

   Monthly and fiscal reports must be received outlining gross billings, number of bills audited, number
    of bills paid and disputed, cost of audit, net amount and percentage of savings, the ratio of return on
    amount billed.

   Provide any other ad hoc reports or any other information as requested by the District.

   Electronically transfer required information to DWC per DWC EDI requirements and other involved
    parties.

   Maintain contact with physicians, injured employees, and adjusters, and provide information to the
    parties promptly as requested and/or required.

   Provide services through experienced, qualified, licensed professional staff. Services of a Medical
    Director may be needed from time to time basis. The Case Managers should have appropriate
    required designations. Any contractors used are requested to provide detailed information on their
    ability to serve the District and the qualifications and experience of their staff, including numbers and
    types of staff.

   Vocational evaluation for job analysis and return to work programs performed by properly certified
    vocational staff.

   Approach to containing workers‟ compensation costs must be comprehensive, fair, and in compliance
    with Texas Workers Compensation Act rules, regulations etc.

   Case management program should use pro-active approach, and coordinate activities with the claims
    adjusters, and District staff.

   Facilitate and coordinate the District‟s Return-to Work program activities with injured worker,
    physician, claim‟s adjuster, employer and/or any other related party.
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   Case managers and utilization review staff must be available to treating physicians during normal
    working hours. Treating physicians will receive timely notification of decisions.

   All analysis and recommendations, reviews, provided by case managers, pre-authorization etc. must
    be properly documented in the files. Documentation must show due diligence and reasonableness
    for any recommendations made, should these be challenged through administrative or judicial
    channels.

   The Company will be responsible for monitoring of appropriateness of treatment, necessity and
    continuation of medical treatment in relation to on the job injury/illness.

   Utilization review will include review of excessive costs of medical treatment, days of hospitalization,
    hospital bill screening.

   Screen charges for any overlapping dates of service or any unrelated fees, upcoding, unbundling, a
    provider may submit.

   Have the ability to interface claims handling, utilization review and bill auditing timely and with
    knowledge of the others actions.

   Furnish copies of all memorandum/notices etc. by the DWC regarding rule changes, and revisions to
    the law.

   Obtain pre-approval from the District for use of subcontractor for any services.

   Surveillance should be considered, only following authorization from the District where length of
    temporary disability or extent of disability is questioned. The District reserves the right to require
    surveillance on any claim. Outside investigator services will be employed where necessary but
    direction and control will be exercised over the investigator‟s activities.

   The successful proposer shall be able to provide loss control services per DWC rules for fully insured
    workers‟ compensation programs or if a self-insured proposer is awarded, on an hourly or flat fee
    basis, with any other expenses clearly outlined and defined. The loss control services shall include
    but not be limited to: ability to analyze losses for trends, frequency and severity, conducting on-site
    safety inspections of all facilities, audit of existing safety programs and procedures, review of hazard
    communication program, blood-borne pathogen program, assisting with the development or
    enhancement of programs and manuals, safety communication and education and serving as a loss
    prevention resource for the client.




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                                   QUESTIONNAIRE
_____________________________________________________________________




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  QUESTIONNAIRE

  The following questionnaire shall be answered as part of the proposal by each appropriate party with
  answers in the same order as questions stated below. Mark questions N/A if not applicable.


                                     GENERAL QUESTIONS


   1) Where is your nearest claims office and will this be the office where SBISD claims are handled?

   2) Will your company provide a representative at DWC hearings and conferences? Attorney or
      Adjuster and at what level?

   3) Is subrogation handled by an adjuster or attorney? In-house or contracted out?

   4) What is your average case load per adjuster? What percentage is medical only and what
      percentage is indemnity?

   5) Under what circumstances if any would you use contracted services? Please indicate what
      services are included in-house and what are contracted? Please include, claims handling, case
      management, medical cost containment, loss prevention and legal counsel.

   6) Define the cost and under what circumstances the administrator will handle run-off claims in the
      event of termination of the contract?

   7) Are the fees quoted for claims investigation and management for the life of the claim? If not then
      please explain what it covers and what additional fees can be expected.




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INSURANCE COMPANIES

Rates/Premiums
 Is policy/contract written on a three (3)-year basis with rates guaranteed for first, second, and third
   year?

   Are premiums adjusted annually based upon increase/decrease in payroll, losses? Provide brief
    explanation.

Additional Coverages
 List additional endorsements that broaden coverage or eliminate any of the exclusions.

   Would insurer consider waiving defense and settlement requirements in favor of the District? How
    and to what extent?

SERVICE PROVIDERS
The following General Questions are to be answered by applicable vendors of services. Proposers shall
review the following questions, and answer accordingly. If a question does not apply, mark as “N/A.”

Banking/Funding - Claims Fund Accounts

   Describe the banking arrangements for fund transfers and claim payments Company will require.
    Can this procedure or process be modified to accommodate the client?

   State bank reconciliation systems available and how often are these used.

   Does Company have bank transfer capability whereby drafts can be issued and the account
    replenished daily/weekly/monthly?

   Describe financial safeguards used to prevent fraud, duplicate/excessive payments.

   How are credits handled on the billings to the client‟s account?




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                             COST PROPOSAL FORMS
   ______________________________________________________________________________




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COMPANY INSURANCE POLICY INFORMATION

Provide the following information, by marking an “X” in the column, if coverage is provided for the benefit
stated by your policy.

                   Coverage for Exposures                                         Response

State Name of the Company

A.M. Best Rating

Maximum Limit of Liability                                          Yes                     No
 Workers' Compensation Statutory                                   _________             _________
 Employers Liability (E.L.) $1,000,000                             _________             _________

Excess Insurance                                                                 Premium
 Retention Level
                       $150,000                                     __________              __________
                       $200,000                                     __________              __________
                       $250,000                                     __________              __________
                       $300,000                                     __________              __________
                       Other ___________.
Fully Insured                                                       __________              __________
 Deductible          None                                          __________              __________
                      $10,000                                       __________              __________
                      Other ___________.
                                                                    __________              __________
   E.L. - Bodily Injury – $100,000 each accident                   __________              __________
                            -$500,000 disease policy limit          __________              __________
                             -$100,000 disease each employee        __________              __________
                             -Other Limits – state

Aggregate Excess Insurance
 Loss Fund Percentage 80%                                          __________              __________
Specify minimum loss fund for liability period                      __________              __________
State Benefits Payable:
     Named State – Texas                                           __________              __________
     Other States Coverage (All States and U.S. Territories        __________              __________
          and possessions, except the monopolistic state funds)–
          If yes, benefit amount payable.
Voluntary Compensation (WC000311A)                                  __________            __________
For all individuals that do not fall under statutory provisions
Premium Computations enclosed, indicating credits etc.              __________            __________

Date of Occurrence for Occupation Disease (O.D.) Claims)
  Last day of last exposure is during policy period                __________            __________
  Date Employee ceases work as a result of the O.D.                __________            __________
  Date established by Texas W.C. Act
                                                                    __________            __________




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Accident
 Accident                                                        __________        __________
 Accident or series of related events having a common            __________        __________
   source of causation.

Limit of Liability (W.C. & E.L.)

   Applies to each accident or occurrence                        __________        __________
   Applies to each employee for disease                          __________        __________
   Separate limits apply for WC and E.L                          __________        __________
   A maximum limit applies for combined WC and EL per            __________        __________
    accident or disease.
   Applies any loss within the SIR to aggregate coverage after   __________        __________
    satisfying an aggregate Loss Retention Level.
    An aggregate applies for all diseases.                        __________        __________

Application of Retention

   Applicable for each accident or occurrence                    __________        __________
   Applies to each employee for occupational disease.            __________        __________

Payment of Claims

   Prorated between Insured and Insurer in proportion to         __________        __________
    claimants in applying retention.
   Counted same as payments to claimants in applying             __________        __________
    retention.

Payment for Defense Cost if Insurer Participate in Defense
 Insurer bears expense
 Prorated same as other defense costs                            __________        __________
 No provision                                                    __________        __________
                                                                  __________        __________
Claims that must be reported:

   Claims likely to involve Insurers                             __________        __________
   Claims that exceed 50% of retention                           __________        __________
   Injury involving:
    - Fatality                                                    __________        __________
    - Amputation of major extremity                               __________        __________
    - Serious burn                                                __________        __________
    - Serious head or brain injury                                __________        __________
    - Spinal cord injury                                          __________        __________
    - Permanent total disability                                  __________        __________
    - Disability likely to exceed one year                        __________        __________
    - Serious injury to two or more employees                     __________        __________
    - Reopening of any case that may involve insurer.             __________        __________

Late Reporting Penalty:                                           __________        __________
    - Claim denial                                                __________        __________
    - Penalty assessed


Provision for Change of Administrator
 Policy cancellation                                             __________       __________
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 Service Organization must be acceptable                      __________       __________
 No provision                                                 __________       __________
Timing of Loss Payments
 WC - periodically as paid by the insured but not more        __________      __________
   often than monthly.
   EL – within 30 days after submission of proof of loss       __________      __________
 Within a “reasonable” time after receipt of proof of loss.
 Periodically
 Not specified                                                __________      __________
 Loss settlement provision allows for insurers lump sump      __________      __________
   settlement                                                  __________      __________

Application of Subrogation Recoveries
 Insurer reimbursed first, remainder to insured. Recovery     __________      __________
   expenses prorated based on amount recovered by each
   party.
 Recovery loss recovery expenses applied to insurer first,    __________      __________
   then insured.                                               __________      __________
 Company is subrogated to all rights of recovery
 Insured may subtract up to 25% of recovery for recovery      __________      __________
   expenses before applying remainder to reduce aggregate
   retention.
Arbitration Provision
 Arbitration in Texas by arbitrators chosen by each party     __________      __________
   and a third arbitrator chosen by the two arbitrators.
 No provision other than insured must first comply with all
   policy conditions.                                          __________      __________
 No provision
                                                               __________      __________
Cancellation Notice
 The District to give 30 days notice                          __________      __________
 Insurance Company to give 90 days notice. If not, state
   the period.                                                 __________      __________
 Each party must give notice as specified in the policy
   declarations,                                               __________      __________

Notice of Occurrence Endorsement
 Agree that the knowledge of an accident by an agent or       __________      __________
   employee of the SBISD will not in itself constitute
   knowledge of the insured, unless the designated
   representative (to be advised) has received such notice.

Exclusions
 Workers Compensation
   - Punitive Damages                                          __________      __________
   - Fines and Penalties for violation of statutes or          __________      __________
       regulations or due to fellow employee suits.
Exclusions
   - Amounts paid in excess of WC law benefits due to          __________      __________
       misconduct or violation of law by insured
   - Liability under federal Act.                              __________      __________

Employers Liability
    - Liability assumed under contract                      __________          __________
    - Injury or death of any employee employed in violation
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       of law                                                  __________       __________
   -   Loss with respect to which entity comprising the        __________       __________
       insured has any other insurance in force
   -   Intentional bodily injury                               __________      __________
   -   Damage from discharge, coercion, or discrimination of   __________      __________
       an employee in violation of law.
   -   Damages arising out of operation where the insured      __________      __________
       has not complied or has violated or rejected any WC
       law.
   -   Fines or penalties                                      __________      __________

Renewal Guarantees
 Second Year                                                  __________      __________
 Third Year                                                   __________      __________




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     ______________________________________________

                   PROPOSAL FORMS
    ________________________________________________




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                                         PROPOSAL FORM
Excess Workers' Compensation
and Employers Liability Insurance

Furnish quotes on any or all items listed in accordance with specifications at premium options shown
below. Attach additional sheets if including alternatives. Provide quotes on three-year rate guarantees
as requested in the proposal.

OPTION I- SPECIFIC STOP LOSS WITH AGGREGATE STOP LOSS
Benefits -: W.C. - Statutory. Employers Liability -$1,000,000

Retention               Specific Stop Loss               Aggregate       Rate/$100
(Per occurrence)        Premium                          Stop-Loss       Payroll

$250,000 SIR            $___________            $__________              $__________
$300,000 SIR            $___________            $ __________             $__________
$350,000 SIR            $___________            $ __________             $__________

OPTION II- SPECIFIC STOP LOSS ONLY
Benefits -: W.C. - Statutory. Employers Liability -$1,000,000

Retention                       Specific Stop-Loss               Rate/$100
(Per occurrence)                Premium                          Payroll

$250,000 SIR                    $__________                      $__________
$300,000 SIR                    $__________                      $__________
$350,000 SIR                    $__________                      $__________

OPTION III
Alternative Quote:
Limits: Workers' Compensation: ______________            Employers Liability _____________

Stop-Loss Retention:    Specific: _____________ Aggregate: ___________
Stop-Loss Premium:      Specific: _____________ Aggregate: ___________Rate: ________

Premium Payment Plan
Summary:
Major Departures from Specifications:




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                                               LOSS PREVENTION

All expenses that are to be paid by the Spring Branch Independent School District must be identified.


                                                  Entity Providing       Manner and Cost in Which
                Service                                Service           Service is Billed

    Loss Control Services

    If there is any variance or
    deviation to the cost of
    services listed above, please
    list these below




     If there is a charge for travel or mileage, please indicate.




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                                CLAIMS INVESTIGATION AND MANAGEMENT


                                                  Entity Providing            Manner and Cost in Which
                Service                                Service                Service is Billed

    Indemnity Claims

    Medical Only Claims

    Record Only Claims

    Run off claims

    Subrogation Investigation and
    Recovery Services

    Attorney Representation- List
    up to 3 Firms




                                         __________________________           __________________________
    Attending DWC Hearings &
    Conferences

    Representative to the DWC in
    Austin

    On-site Claims Investigations
    with Recorded Statements



     If there is a charge for mileage or travel, please indicate.

     If there is any variance or deviation to the cost of services listed above, please list them below:




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                                         MEDICAL COST CONTAINMENT


                                                  Entity Providing               Manner and Cost in Which
                Service                                Service                   Service is Billed

    Pre-authorization for Specific
    Treatment

    Concurrent/Retrospective              __________________________
    Review (if different)

    Utilization Review



    Physician Peer Review
    Coordination

    Nurse Case Management
    (Telephonic)

    Nurse Case Manager (on site)

    Hospital Bill Audit

    Medical Bill Audit

    Preferred Provider Organization

    and Discount

    Additional Services that may be
    provided



     If there is a charge for mileage or travel, please indicate so above.

     If there is any variance or deviation to the cost of services listed above, please list them below:




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                                                 ADMINISTRATION


                                          Entity Providing           Manner in Which            Estimated
                 Service                  Service                    Service is Billed          Annual Cost

    Annual Fee for Administration
    of the Plan

    Generating IS Reports

    Issuing Payments

    (per line item or per
    transaction?)

    Additional Services

    On-line connectivity (license
    fees, system maintenance,
    training, installation)

    Conversion of loss history from
    Previous TPA or Carrier

    Run offs



     If there is any variance or deviation to the cost of services listed above, please list them below:




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                   MARKET ASSIGNMENT AND GENERAL FORMS

_____________________________________________________________________




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                                            MARKET REQUEST FORM
         (Not applicable to Director Writers, TPAs, Medical Management Companies)

         Name of Authorized Person:

         Signature

         Date:

         Name of the Agency/Co.:

         Address:

         City/State

         Telephone:

         Fax No.

List markets in order of preference:

Name of the Company                           Premium              Loss             Reason for
                                              Volume               Ratio            Selection

-----------------------------------------     ------------------   --------------   ------------------

-----------------------------------------     ------------------   --------------   -------------------

-----------------------------------------     ------------------   --------------   -------------------

-----------------------------------------     ------------------   --------------   -------------------


Fax to:Barbara A. Robillard
             Director of Purchasing
             1031 Witte Road, Building E (2nd Floor)
             Fax No.: 713/ 365-5216,
             Telephone: 713/365-5223 X 2326

Market Request to be sent February 20, 2007. Notification of Assignment will be made by
noon on February 22, 2007. Additional assignments may be requested and made after
that date so long as they are not in conflict with prior assignment.




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                  SPRING BRANCH INDEPENDENT SCHOOL DISTRICT
                           REQUEST FOR INFORMATION
                                AGENT/BROKER


       Name of the Agency/Co.:

       Address:

       City/State

       Telephone:


       Fax No.

       Principal/Account Executive:

       Assistant:


       No. of Public Sector Accounts:

       No. of Total Accounts:

       Premium Volume Written:

       Compensation: Fees/Commissions: (State Amount):

       Services to be provided:




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                 SPRING BRANCH INDEPENDENT SCHOOL DISTRICT
                            ACCOUNT EXECUTIVE
                              TO BE ASSIGNED


       Name:

       Title:

       Experience:

       Organization                 Dates                 Position

       _________________            _____________         ________________

       _________________            _____________         ________________

       _________________            _____________         ________________


       Designation/Licenses

       ________________________________________________________

       ________________________________________________________

       Areas of Expertise:

       ________________________________________________________


       No. Of Clients Currently Serviced: ____________________________

       Type of Clients Serviced:    __________________________________

       ________________________________________________________




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                SPRING BRANCH INDEPENDENT SCHOOL DISTRICT

                             CERTIFICATE OF AUTHORITY
                              REQUEST FOR PROPOSAL




The undersigned is authorized to execute this proposal on behalf of:




_________________________________________________
Name of the Organization



_________________________________________________
Name the services being proposed



This proposal shall remain firm through: ________________________________



_________________________________________________
Signature

_________________________________________________
Title


_________________________________________________
Printed Name




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                            AUTHENTICATION CERTIFICATE
                              REQUEST FOR PROPOSAL

Name, address, and telephone number of person who is authorized for preparation of
this document:


__________________________________________
Name (Type/Print)
__________________________________________
Name of the Company
__________________________________________
Street Name
__________________________________________
City
__________________________________________
State                 Zip Code
__________________________________________
Phone No.
__________________________________________
Fax

The Proposer understands and agrees that the District reserves the right to evaluate the
qualifications of all Proposers and to disqualify any of the Proposers based upon that
evaluation.

The Proposer certifies that responses to the forgoing Proposal and Questionnaire do
not contain untrue statements of a material fact, or omit or mislead any material fact
necessary to evaluate the proposal submitted.

By:    __________________________________________
       Name (Type/Print)
Title: __________________________________________

Date: __________________________________________




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                                     FELONY CONVICTION NOTICE

                  th
State of Texas 74 Legislative Session of 1995, Chapter 260, Section 76, added Education Code, Section
44.034, Notification of Criminal History of Contractor:

Subsection (a) states “a person or business entity that enters into a contract with a school district must
give advance notice to the district if the person or an owner or operator of the business entity has been
convicted of a felony. The notice must include a general description of the conduct resulting in the
conviction of a felony”.

Subsection (b) states “a school district may terminate a contract with a person or business entity if the
district determines that the person or business entity failed to give notice as required by Subsection (a) or
misrepresented the conduct resulting in the conviction. The district must compensate the person or
business entity for services performed before the termination of the contract”.

Subsection (c) states “This section does not apply to a Publicly-Held Corporation”.



I, the undersigned agent for the firm named below, certify that the information concerning notification of
felony convictions has been reviewed by me and the following information furnished is true to the best of
my knowledge.

Vendor‟s Name:



Authorized Company Official‟s Name (Printed):



A.      My firm is not owned or operated by anyone who has been convicted of a felony.
        Signature of Company Official:



B.      My firm is owned or operated by the following individual(s) who has/have been convicted of a
        felony:
        Details of Conviction(s):




C.      My firm is a publicly held corporation; therefore, this reporting requirement is not applicable.
        Signature of Company Official:




Signature of Company Official:

Date:

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                                      CERTIFICATE OF RESIDENCY


The State of Texas has passed a law concerning non-resident contractors. This law can be found in
Texas Government Code under Chapter 2252, Subchapter A.
http://www.capitol.state.tx.us/statutes/go/go0225200.html#go001.2252.001. This law makes it necessary
for the SBISD to determine the residency of its bidders. In part, this law reads as follows:

“Section: 2252.001
(3)     „Non-resident bidder‟ refers to a person who is not a resident.

(4)      „Resident bidder‟ refers to a person whose principal place of business is in this state, including a
         contractor whose ultimate parent company or majority owner has its principal place of business in this
         state.

Section: 2252.002
        A governmental entity may not award a governmental contract to a nonresident bidder unless the
        nonresident underbids the lowest proposal submitted by a responsible resident bidder by an amount
        that is not less than the amount by which a resident bidder would be required to underbid the
        nonresident bidder to obtain a comparable contract in the state in which the nonresident‟s principal
        place of business is located.”



I certify that
                                           (Name of Company Bidding)

is, under Section: 2252.001 (3) and (4), a

                   Resident Bidder                             Non-resident Bidder


My or Our principal place of business under Section: 2252.001 (3) and (4), is in the city of

                                                    in the state of                                    .


                                  Signature of Authorized Company Representative


                                                   Print Name


                                  Title                                              Date




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DISCLOSURE: CONFLICT OF INTEREST STATEMENT

       SPRING BRANCH INDEPENDENT SCHOOL DISTRICT – PURCHASING
                            DEPARTMENT

Notice to Vendors: Conflict of Interest Questionnaire Required by Chapter 176 of the
                   Texas Local Government Code

Effective January 1, 2006, any person or entity who contracts of seeks to contract with
SBISD for the sale or purchase of property, goods, or services (as well as agents of
such persons) (hereafter referred to as Vendors) are required to file a Conflict of Interest
Questionnaire with the District. Each covered person or entity who seeks to or who
contracts with SBISD is responsible for complying with any applicable disclosure
requirements. SBISD will post the completed questionnaires on its website.

The Conflict of Interest Questionnaire must be filed:

       No later than the seventh business day after the date that the Vendor begins
       contract discussions or negotiations with the government entity, or submits to the
       entity an application, response to a request for proposal or bid, correspondence,
       or other writing related to a potential agreement with the entity.

       The Vendor also shall file an updated questionnaire not later than September 1
       of each year in which a covered transaction is pending, and the seventh business
       day after the date of an event that would make a statement in the questionnaire
       incomplete or inaccurate.

Note: A Vendor is not required to file an update questionnaire if the person had filed an
updated statement on or after June 1, but before September 1 of the year.


The Conflict of Interest Questionnaire may be downloaded from the SBISD website at
http://www.springbranchisd.com/alpha.htm

Click on “Disclosures”
Select: the Word or PDF icon to left of “DisclosureConflictStmt”.

Completed form should be sent to:

       Spring Branch Independent School District
       Attn: Purchasing Department
       1031 Witte Road, Building E
       Houston, Texas 77055-6016
       Phone: 713.365.5223



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       DISCLOSURE: CONFLICT OF INTEREST STATEMENT, continued

  CONFLIC T OF INTEREST QUESTIONN AIRE                                                                        FORM        CIQ
  For vendor or other person doing business with local governmental entity

  This questionnaire is being filed in accordance with chapter 176 o f the Local                       OFFICE USE ONLY
  Government Code by a person doing business with the governmental entity.                           Date Received

  By law this questionnaire must be filed with the records administrator of the
  local government not later than the 7th business day after the date the person
  becomes aware of facts that require the statement to be filed. See Section
  176.006, Local Government Code.
  A person commits an offense if the person violates Section 176.006, Local
  Government Code. An offense under this section is a Class C misdemeanor.
  Name of person doing business with local governmental entity.




         Check this box if you are filing an update to a previously filed questionnaire.

         (The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than
         September 1 of the year for which an activity described in Section 176.006(a), Local Government Code, is pending and not
         later than the 7th business day after the date the originally filed questionnaire becomes incomplete or inaccurate.)



  Name each employee or contractor of the local governmental entity who makes recommendations to a local government
  officer of the governmental entity with respect to expenditures of money AND describe the affiliation or business relationship.




  Name each local government officer who appoints or employs local government officers of the governmental entity for
  which this questionnaire is filed AND describe the affiliation or business relationship.




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                                                                                                                                     Adopted 11/02/2005




  DISCLOSURE: CONFLICT OF INTEREST STATEMENT, continued

  CONFLIC T OF INTEREST QUESTIONN AIRE                                                                                  FORM          CIQ
  For vendor or other person doing business with local governmental entity                                                      Page 2


  Name of local government officer with whom filer has affiliation or business relationship. (Complete this section only if
  the answer to A, B, or C is YES.)

  This section, item 5 including subparts A, B, C & D, must be completed for each officer with whom the filer has affiliation or other
  relationship. Attach additional pages to this Form CIQ as necessary.



   A.    Is the local government officer named in this section receiving or likely to receive taxable income from the filer of the
        questionnaire?

                          Yes                   No




   B.    Is the filer of the questionnaire receiving or likely to receive taxable income from or at the direction of the local government
        officer named in this section AND the taxable income is not from the local governmental entity?

                          Yes                   No




   C.    Is the filer of this questionnaire affiliated with a corporation or other business entity that the local government officer serves
        as an officer or director, or holds an ownership of 10 percent or more?

                          Yes                   No




   D.    Describe each affiliation or business relationship.




    Signature of person doing business with the governmental entity                                               Date
                                                                                                                                       Adopted 11/02/05



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                                    NO PROPOSAL NOTIFICATION

                       SPRING BRANCH INDEPENDENT SCHOOL DISTRICT
                                      Purchasing Department
                       1031 Witte Road Building E, Houston, Texas 77055-6016


SBISD is interested in receiving competitive pricing on all items it proposals. We place significant
value on quality vendors and we also desire to keep your firm as a Proposer and a supplier of
materials, equipment and/or services; therefore, it is important for us to determine why you are
not proposing on this contract item. We will analyze your response and attempt to determine if
future changes are necessary in our specification development and procedures.

I/WE DID NOT SUBMIT A PROPOSAL FOR THE FOLLOWING REASONS:
(Please place an X by one or more of the reasons listed below.)

1.     Do not supply the requested product/service.

2.     Quantities offered or scope of job is TOO SMALL to be supplied by my company.

3.     Quantities offered or scope of job is TOO LARGE to be supplied by my company.

4.     Specifications are “too tight” or appear to be written around a proprietary product. (Please elaborate
       on this item.)

5.     Cannot proposal against MANUFACTURER on this item.

6.     Cannot proposal against JOBBER on this item.

7.     Time frame for proposing was too short. (Please elaborate on your primary reason for this
       judgment.)

8.     Other




IF YOU DID NOT PROPOSE and wish to remain on the SBISD bid list for this item, please indicate:

               I wish to remain on the bid list.

               I do not wish to remain on the bid list.



               VENDOR SIGNATURE                                                    DATE


               PRINTED NAME, TITLE                                                 PROPOSAL NO.


               COMPANY NAME                                                    A/C - PHONE NO.


ADDRESS       CITY            STATE         ZIP                   A/C - FACSIMILE NO.
ANNUAL CONTRACT FOR WORKERS‟ COMPENSATION – 03/07
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                                                                          Page 52 of 55




                                       REFERENCES

Provide references for three (3) current Texas clients, preferably school districts or large
organizations.

Current Clients

1.   Name of the Organization and Address           _____________________________

                                                    _____________________________

                                                    _____________________________

     Name of the Contact Person:                    _____________________________
     Telephone Number:                              _____________________________

     List Services Provided:                        _____________________________
     Number of Employees:                           _____________________________

2.   Name of the Organization and Address           _____________________________

                                                    _____________________________

                                                    _____________________________

     Name of the Contact Person:                    _____________________________
     Telephone Number:                              _____________________________

     List Services provided:                        _____________________________
     Number of Employees:                           _____________________________

3.   Name of the Organization and Address           _____________________________

                                                    _____________________________

                                                    _____________________________

     Name of the Contact Person:                    _____________________________
     Telephone Number:                              _____________________________

     List Services provided:                        _____________________________
     Number of Employees:                           _____________________________




ANNUAL CONTRACT FOR WORKERS‟ COMPENSATION – 03/07
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                                                                                 Page 53 of 55

Provide references for three (3) former clients who have left your organization during the last two (2)
years.

Former Clients

1.    Name of the Organization and Address               _____________________________

                                                         _____________________________

                                                         _____________________________

      Name of the Contact Person:                        _____________________________
      Telephone Number:                                  _____________________________

      List Services provided:                            _____________________________
      Number of Employees:                               _____________________________



2.    Name of the Organization and Address               _____________________________

                                                         _____________________________

                                                         _____________________________

      Name of the Contact Person:                        _____________________________
      Telephone Number:                                  _____________________________

      List Services provided:                            _____________________________
      Number of Employees:                               _____________________________


3.    Name of the Organization and Address               _____________________________

                                                         _____________________________

                                                         _____________________________

      Name of the Contact Person:                        _____________________________
      Telephone Number:                                  _____________________________

      List Services provided:                            _____________________________
      Number of Employees                                _____________________________




ANNUAL CONTRACT FOR WORKERS‟ COMPENSATION – 03/07
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                                                                          Page 54 of 55




     SBISD LOSS RUN INFORMATION




ANNUAL CONTRACT FOR WORKERS‟ COMPENSATION – 03/07
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                                                                                      Page 55 of 55
   I.          SBISD Underwriting Information

                                           Payroll Information
  Class Code          Class Description     9/1/06-08/31/07        9/1/05-08/31/06       09/01/04-08/31/05
                                           Estimated Gross          Actual Gross           Actual Gross
                                                 payroll          Payroll (includes      Payroll (includes
                                               (including             overtime)              overtime)
                                               overtime)
     8868              Professional       $170,013,710.73 $165,754,358.16 $162,169,236.80
     7380              Bus Drivers         $3,942,965.29   $3,828,121.64   $3,827,560.69
     9101               All others         $14,438,294.85 $14,215,522.18 $14,661,067.51

     Total                                $188,394,970.87 $183,798,001.98 $180,657,865.00

                                  Claims History
                                 As of 12/31/2006
 Fund Year          M/O and                 Paid                  Incurred
                   Indemnity


 2001/02               256                $792,963                $797,490
  2002/03              285                $856,534                $860,485
 2003/04               281                $1,066,288              $1,293,133
 2004/05               248                $832,426                $937,641
 2005/06               247                $670,386                $969,584
2006/2007*              88                 $46,828                $239,038
*Partial Year

                                  Claims $30,000 or Greater
                               For Period 09/01/2001-08/31/2005
                                       As of 12/31/2006
               Comp          Medical       Other     Total Paid          Total           #
                                         Expense                       Incurred       Claims
2001       $104,437        $145,789        $6,447   $256,673        $261,200              5
2002        $90,310        $352,934        $1,340   $444,585        $448,531              6
2003       $162,174        $501,742        $4,123   $668,039        $885,253             10
2004       $110,630        $343,711        $3,698   $458,039        $552,914              9
2005        $70,661        $160,258        $2,876   $233,795        $362,176              7
Totals     $538,212                       $18,484   $2,061,131      $2,510,074           37
                         $1,504,434

        Year           Premiums Paid for               Run-Off claims             EMF
                    Fully Funded program
                       Includes stop loss
    03-04                  $1,535,720                    $74,670.57               0.94
    04-05                  $1,542,026                    $61,475.68               1.12
    05-06                  $1,119,498                    $42,145.59               0.85
    06-07*                  $1,299,538*                  $40,000.00*              0.85
*Approximate for partial year




ANNUAL CONTRACT FOR WORKERS‟ COMPENSATION – 03/07
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