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Workers' Compensation Claims Administrative Services Agreement Addendum Copyrighted December 17, 2018 City of Dubuque Consent Items # 16. ITEM TITLE: Workers' Compensation Claims Administrative Services Agreement Addendum SUMMARY: City Manager recommending approval of an Addendum to the Agreement between the City of Dubuque and Alternative Service Concepts for services related to the administration of the City's Workers' Compensation Program. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Approve ATTACHMENTS: Description Type Workers Compensation Claims Administrative Services City Manager Memo Agreement Amendment Addendum-NNM Memo Staff Memo Staff Memo Addendum Two Supporting Documentation Claims Service Contract Supporting Documentation Insurance Schedule J Supporting Documentation THE CITY OF Dubuque � AIFA�erlwGh UB E '�� III► Masterpiece on the Mississippi Z°°'�w'2 7A13 2017 TO: The Honorable Mayor and City Council Members FROM: Michael C. Van Milligen, City Manager SUBJECT: Approval of an Addendum to the Workers Compensation Claims Administrative Services Agreement DATE: December 11 , 2018 Personnel Manager Randy Peck recommends City Council approval of an Addendum to the Agreement between the City of Dubuque and Alternative Service Concepts for services related to the administration of the City's Workers Compensation Program. The Addendum extends the current agreement from January 1 , 2019 to February 28, 2019 to give the City time to review proposals for the third-party administration of the Workers' Compensation Program. I concur with the recommendation and respectfully request Mayor and City Council approval. �� Mic ael C. Van Milligen �� MCVM:jh Attachment cc: Crenna Brumwell, City Attorney Teri Goodmann, Assistant City Manager Cori Burbach, Assistant City Manager Randy Peck, Personnel Manager � �� '�T��IT��' __ _ ___ �� _. _ �,�.�.��::� �� _ _ �� ,�� . . � . . ��.� �� 1'O: Michael C. Van Milligen, City Manager FROM: Randy Peck, Personnel Manager � SUBJECT: Approval of an Addendum to the Workers Compensation Claims Administrative Services Agreement DATE: December 11, 2018 I received the attached Addendum to the Agreement between the City of Dubuque and Alternative Service Concepts (ASC) for services related to the administration of the City's Workers Compensation Program. The Addendum extends the current Agreement and is in effect from January 1, 2019, to February 28, 2019. The reason for the extension of the current agreement is that we are in the process of reviewing proposals for the third-party administration of our Worker's Compensation Program and there is a possibility that we will be changing third-party administrators over the next few months. I request that the City Council pass a motion approving the Addendum and authorize you to sign the Addendum. RP/alk ASC Alternative Service Concepts1 LLC ADDENDUM TWO It is hereby understood and agreed that this Addendum attach to and become a part of the Claims Service Contract which took effect on October 1, 2017 between ALTERNATIVE SERVICE CONCEPTS, LLC ("ASC") and CITY OF DUBUQUE, IOWA ("Client"), as though fully repeated and set herein and serve· to extend the Contract period through February 28, 2019. HClient" agrees to pay "ASC" a fee of Three Thousand, Nine Hundred and Eighty Dollars ($3,980.00) for the administration of Workers' Compensation claims for January 1, 2019-February 28, 2019. All other terms, conditions, and agreements contained in said Contract remain in full force and effect. IN WITNESS WHEREOF, ''ASC" and "Client" have caused this Addendum to be executed by the person authorized to act in their respective names. ALTERNATIVE SERVICE CONCEPTS, LLC WITNESS: J'..2atb cUetfkb BY: ---=~~_,,_:67___.,~~~·=--<. __ TITLE: ---"'{1_,.::;_{J,~, {>_. ---- CITY OF DUBUQUE, IOWA WITNESS:~ BY: ~ I Michael C. Van Milligen TITLE: City Manager DATE: JJ/17)1; ~~-7~....._-7~~~~--~- DubuqueAddTwo/1017 Page 1 07269 � �. . � .� � �� i �.Iterr��iv�e�ervic��onc�pts, ��C � CLAIMS SERVICE CONTRACT THIS AGREEMENT is made and entered into with an effective date of Qctober 1, 2017 befiween ALTERNATIVE 9ERVICE CONCEPTS, LLC, formed in Delaware, with principal offices at 2501 McGavock Pike, Suite 802, P.O. Box 305148 Nashville, Tennessee 37214-1213, hereinafter referred to as "ASC", and CITY OF DUBUQUE, IOWA with principal offices in Dubuque, lowa, hereinafter referred to as "Client", '�� JI!lTNESS: �! WHER�AS, "ASC' is in the claims service business; and I WHEREAS, "Client" desires fio contract with "ASC" as its claims service company to service the workers' compensation ciaims of "Client's" arising oufi of their facilities located in Dubuque, lowa. N0111/, TMEREFOR�, "ASC" and "Client" contract as follows; "ASC" AGREE�: 1. (a) Ta review ail claims and/or losses reported during the term of this Contract � which involve workers' compensation clairns againsfi "Cli�nt". (b) To investigate, adjust, settle or resist all such losses and/or claims wifihin the agreed payment aufihority limit of Two Thousand Five Nundred Dollars ($2,500). (c) To investigate, adJust, settle or resist all such losses and/or ciaims as are in excess of the agrsed payment authority limit of Two Thousand Five Hundred Dollars ($2,500) only u�ith specific prior approval of"Client", (d) To reporf excess claims to "Client's" excess carrier only if "Client"fulfilis its obligations �mder "Client Agrees" Secfiion, 4c, 2, To furnish �II claim forms necessary for proper claims administration. 3, To establish claim and/or loss files for each reported claim and/or loss, Such files shall be the exclusive property of "Client". Such files are available for review by "Clienfi" at any reasanable time, with notice. 4, To m�int�in adequate Automobile Liability, Errors and Omissions, Fidelity Bond, General Liability, and Workers' Compensation insurance coverage and to maintain insurance as set forth in the attached Insurance Schedule for Profession�l Services. 5, To indemnify, clefend and hold harmless "Client" with respect to any claims asserted as � resulfi of any errors, omissions, torts, intentional tor�s or ofiher negligence on the Dubuque/1017 f'age 1 07269 , , , �� Alt�r��t6v�Se�vac� �onr�pt�, ��C par� of "ASC" and/or its employees, unless the compiained of actions of "ASC" were taken at the specific direction of"Client", . "CLIENT" AGREES: ' 1. To make funds available that "ASC' may draw from at any time and from time to ' time for ciaim and/or loss payrnents and for associated allocated expense within the I payment authorify limit of Two Thousand Five Hundred Dollars ($2,500) and for claim and/or loss payments in excess of the payment aufihority limit of Two Thousand Five Hundred Dollars ($2,500) with the prior approval of"Client". 2. To pay "ASC"fees in accordance with the Fee Schedule attached ta this Contracfi. 3, To pay "ASC" within thirty (30) days of fihe effective date of all invoices. All past due invoices are subject to an interesfi penalty of one and one-half percent (1 1/2%) per month, In the event "ASC" brings any action or praceeding to recov�r any parfi or all of an outstanding indebtedness, "ASC" shaii b� entifiled to recover as additional damages any re�sonable attorney fees not to exceed twenty percent (20%) of the outstanding indebtedness. 4, (a) To pay all Allocated Loss Expenses in addition to the claim s�rvice fee to be paid to "ASC' as prescribed in this Contract. (b) "Allocated Loss Expenses" shali include but not be limited to attorneys' fees; experts' fees (i,e. engineering, physicians, chemists, etc.); fees far independent medlcal examin�tions; witnesses' fees witnesses' travel expenses; court reporters' fees; transcript fees; the cost of obtaining public records; commercial photogr�phers' fees; automobile appraisal or property appraisal fees; medical cost containment services, such as utilization review, provider bill audifi, preadmission authorizafiion, hospital bill audit, �nd medical case managemenfi; all outside expense items; extraordinary travel expenses incurred by "ASC" at the request of "Client"; and any other similar fee, cost or expenses �ssociated with the inVesfiigation, negotiation, settlement or defense of any cl�im hereunder or as required fior the collection of subrog�tion on behalf of"Client". (c) To provide "ASC" with carnplete copies of ail excess poficies which apply to the claims reported during the Contract period. 5. To relinquish authority to "AS�° in �II matters relating to claims service within the agrEed payment �uthority limit of Two Thousand Five Hundrecf Doll�rs ($2,500), Dubuque/1017 Page 2 07269 . ' �� ' , �Alte��liv� ��rv��;e C��c�pts, ��.� 6. To indemnify, defend and hoid harmless "ASC" with respect to any ciaims asserted as a resuit of any errors, omissions, fiorts, intentional fiorts, or other negligence on the part of the "City" and/or its employees, unless the complained of acfiions of "City" were taken at the specific direction of"ASC", "ASC" AND "CLIENT" MUTUALLY AGREE AS FOLLOWS: . 1. (a) The term of this Contracfi is continuous from its effective date for one (1) year. This Contract may be fierminated by either ",�SC" or "Client" with cause by providing sixty (60) days' prior written nofiice by certified mail. (b) In the event thafi this Contract terminates or expires for any reason "Client" shall have the option; (i) to have "ASC' handle open files which h�ve b�en repor�ed for an ; �dditional fee bas�d on our prevailing annual rate per file. , (ii) to have "ASC' return the files to the ciient, i I � � 2. This Contract cavers Ciaim Service for"Client" in the United States of Arnerica. ; �I� 3. In th� event any one or more of the provisions of this Confiracfi shail be defiermined to i I be invalid or unenforceable by any court or other appropriate authority, the � remainder af this Contract shall confiinue in full force and effect, as if said invalid and unenforceable portion h�d nofi been included in this Contract. 4. This Contract shall be construed and interpreted in accordance with the laws of fihe state of lowa. � 5. This Contract represents the entire understanding of "ASC" and "Clienfi" and ( supersedes all prior oral and written communications between "ASC" and "Client" as I to the subject matter. Neither this Contract nor an � y provisions of ifi may be amended, modified or w�ived except in writing signed by a duly aufihorized i representative of"ASC' and "Client". ' 6, The failure or delay of either "ASC" or "Client" to take action with respect to any failure of the other p�rty to observe or per�orm any of the terms or provisions of this Contract, or with respect fo any def�ult here�inder by such other party, shall not be � construed as a waiver or operate as � waiver of �ny rights or remedies of either i i "ASC" or "Clienfi" or operate to deprive either "ASC' or "Client" af its right to institute �nd maintain any action or proceeding which it may deem necess�ry to protect, assert or enforce any such ri�hfis or rernedies, Dubuque/9017 P��e 3 072G9 , ' �� ' , . ,A9teYn��tiv� 5��v�ce�oo��cepts, �.L� 7. To not employ a person who has been employed by the other party at any time during the term of this Contract, unless the person to be empioyed shall not have been employed by the other party during the lmmediately preceding six (6) months or unless the hiring party shall have the other pa►�y's prior written consent. This provision shall survive the terminafiion of this Contract for a perlod of one (1) year. 8. During the term of this Contract, "ASC" will store closed files for a period of three (3) years from the date of closure, the date of the last payment of benefits, or the retention requirements of "Client's" carrier. The storage cost is included in the adminis�r�tive fees. After the three (3) year period, files will �ither be returned to "Client" or destroy�d if permitted by Statufie. 9. "ASC" will query �nd firansmit information under MMSEA requirements to CMS. 9N VVITNE�S l�/HER�OF, "ASC' and "Client" have caused this Contracfi to be III executed by fihe person authorized to act 1n fiheir respective names. . 'i ALTERfVATIVE SERVICE CONCE S, LLC . WITNESS: r �_ BY: TITLE: U��.L ►/�Sr,�� DATE: l� �� - ., .� CITY OF DUBUQUE, IOWA ,,'� �,�"' G=-�-~�„4....,.�,.�W.. WITNEus'-��'-'r-;�- �..r.-;�'';' � BY: (� � � � Nlic�iael C, Van Nlilligen TITLE: City Manager DATE: ��/ ,,� Dubuque/1017 P�ge 4 07269 ,� ' �� ; , /�Ifier��ive�ervice ��nr,epis, l.L� ' Alternative Service Concepts, LL� City of Dubuque, lowa October 1, 20�7 - October 1, 20'18 ; Two-Year Claims Handling ; New Claims ! � , � ; o , I i Workers' Compensation ( MedicalOnly 4 $17'0 $ 680 � Indemnity 20 $780 $15,600 � I Litigation fee TBQ $300 � base feo � Run-In Claims I Indemnity TBp �q,5p ___ i Medical �nly TBD $50 ___ ( Incident Reports� TBD $40 .__ Catastrophic Claims2 TBD --- --- i i Estimated Minimum Claims Fee $16,280 I � MMSEA-Annual Transmission Faes(Includes query& submissions) $ 2,100 AccountAdministration Foe $ 3,000 Systems Fee $ 2,500 � I Minimum & Deposit Claims Fee $23,880 i Claims will be handled for twa years from the date th�e loss is reported fio ,4SC with no additional per claim fee, Any claim remaining open after 24 months will be subject to an annual maintenance fee of$450,00 � ASC will handle the number of claims indicated for the minimum claims fee. If fihe f�e for I the actual number of claims is more than the minimum cl�ims fee, ASC will invoice the i client for the difference. � I The account adrninistrafion fee will be 7.5% of the cl�ims fee or $3,000, whichever is ! greater. The administration fee includes; s Account Setup � � New Claim Setup i i �Recorrlet!lrr clalttts sy.sterra orrly, �YlrtsE Ge,s��ecifled as "Ilicide��t"nt tr'sne of repoy�ti�ig, � �Cnt�rstrophlc clait��s—fljiy evettt reszelting i��10 0��ti�ore clrztmr�nts/szif'fr".�:es fvill Ge tr�etated tas ra crztrrstf�ophe � njirl Gidlcrl th��trotc«l per cl«in�rrcte,f'of�t{te fu�st T 0 c/riim«nts/.srrff7.ties a�id any clrainr/si�f'fix over�10 rnill Ge billed rat�per clair�t rrite of�'3SO�ef�clr�irr�. � Dubuque/1017 Pa�e 5 �7269 � I ° ' ��N I � � ; • �1l��n�liv� S�rvice��►r,e�t�, �.�C • Client Meetings (F'requency to be Determined) • Excess Reporting + State Repor�ing � • Storage Fees At the conclusion of the contract, the following opfiions are available for continued handling of open claims; � • Negotiated annual fee per claim • Claims returned to client Subroqation Pursuit and R�covery All parties will automatically be placed on notice if fihe potential for subrogation exists. Pursuit of subrogation wiil be per�ormed afi the client's requesfi, Pursuit of recover fee is 15% af recovery, y Additional Services and Fees3 ; Client Data Transrnission....................... .,..,,,.,,,,,,,,.,,,,,,,,,,,,,,�2,500 Per Release ' ............. , C�rrier Data Transmission.................................................................$400 Per Release � State-Mandated EDI ................................................................�...,.....$3 Per Repart/Biil I Computer Compatible Ch�cks & Electronic Transfers.......................At Cost � ; Data Conversion From Prior Administrator,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,At Cost � On-Line Access (One User) ' Additional Users ...........................................................................No Charg� ' ......................................$60 Per User Per ; Reports Produced by Clienfi.............................................��.......�....�..�Month I ', Report�s Produced by ASC.................................................................No Charge i � .$50 Per Copy ' Systems Training .............................................................................T&E ($85 Per Hour) � I Customized Programming ................................................................T&E ($IHour) I � Actuarial Data Requests........................................................... .$50 Per H r I I ,......, ou � TravelOver 100 Miles.......... .............................................................T&E 85 ' Outside Investigation ....................................................................... �$ Per Hour) � .T&E $85 Per Hour) Medical Cost M�naqement� ; Fee Scheduling.......................................................................28% of Savings � I �r0 Usagc.............................................................................30% of Savings � i Invoicinq and Pavment Terms � ; Fees will be invoiced annually. Fees are payable upon receipt of the invoice. "ASC" i reserves the right to charge 1'/2% per month or the maximum legal rate on unpaid I balances after 30 days, � Allocateci Exp�nses i ; Allocated expenses wili be charged fia the claim file and include fees for: � I • l.egai services � Professional photographs � • Medic�l records • Experts' / rehabilitation services s Index Burea�i repor�ing • Accident reconstruction 1 fts��er1uire�l o��requcsted, 1Llost services r�r•e.optional. �F��ici�ag for^�a�Xdltio�inl jti�eiiagc�rl c�a��e services ls rivatlaUle iipar�i rer�arest. � Dubuqu�/1017 I'aga 6 07269 '�. : , d�9�V� , • �e��rs�a�iu�,��vac� Go�c�pts, 9�L� a Architects, contractors 0 Engineers, chemists s Police, fire, coroner, weather reports • Expert wifiness stafiements � Surveillance • Official documents and transcripfis • Extraordinary travel at client's requ�sfi • Court reporters s Independent medical examinations, • Managed care MRis, etc. Workers' Comaensation Definitions (for billina purpases on per claim fee contractsl Medical On/y Claims- Work-related claims that require medical treatment oniy. • Subrogation not required • Invesfiigation sufficient to determine claim fiype and compensability � Lost d�y� do not exceed statutory waifiing period � No loss notices, captioned reports, client meetings, or settlement authority required • Payments do not exceed $2,500 • Two-poinfi contacfi made Indemnity Claims - Work-related claims that involve disability or payment of inedical and ofiher expenses in excess of $2,500. Claims that require investigation for subrog�tion and settlement negafiiations. � ', All claims, regardless of type, will be investigated, evaluated, and adjudicated in � i accordance with state statutory requiremenfis and corporate guidelines. ' ALTERtV/�T'IVE SERVIGE CONC . T LL.0 �______------�'"� WITNESS: /��GJ �.C�'�� BY: � � ,- TITLE; �� I��n� DATE: 1��17 C1TY O�' DUBUQUE, IOWA r' ' %----.�;.� �� WITNESS:.-,�' -�%�<l.`��/!'-/ BY; �`"`� , . .�-. � M'ichael C, Van Nlilligen TITLE; City NIa ager � � + / `" DATE: I i i ��l ��! , , Dubuque/1017 P�ge 7 07269 City of Dubuquo Insurance Requlrements for Professional Services INSURANCE SCHEDULE J � Alternative Services Concepts,LLC 1� shall furnish a slgned cerfiflcate of insurance to ll�e City of Dubuque, lowa for the coverage required in Exhibit I prior to commencing work and at the end of the proJect if the ferm of wor{<is longer th�n 60 clays, Contracfors presenfing annual certificates shall present a certificate at the end of each project with the final billln�, Each certificate shall be prepared on lhe most current AC�RD form approved by the lowa Departmenf of Insurance or an equivalent approved by fhe Flnance Direcfor, Each certificatQ shall Include a statement under Description of Operafions as to why the certificafe was(ssued� Eg; Project# or ProJect Location af or construction of 2. All pollcies of Insurance required hereunder shall be�vith an insurer authorized to do business In lowa and all insurers shall liave a rating of A or better In the current A,M, Best's R�ting Gulde, 3, �ach certlficate shall be furnished to the Personnel p�partment of fhe Cify of Dubuque, 4. Failure ta provide coverage requfred by fhis Insurance Schedule shall not be deemed a waiver of these requirements by the City of Dubuque. F�Ilure to obfain or maintain the requlred Insurance shall be considered a m�terlal breach of this agreement, 5, Contractors shall require all subconsultants and sub-subconsultants to obtain and maintain cluring fhs performance of worl<Insurance for the coverages described ln this Insurance Schedule and shall obt�in certificates of Insurances from �II such subconsultants and sub-subconsultants. Contractors agree that they shall be Ilable for th� failure of a subcansultant and sub- subconsuitant to obtain and maintaln such coverages, The City may request a copy of such �� certificates from the Confractor. 6. All required endorsements shall be attached to certlficate of insurance, f. 7, Whenever a specific ISO forrn fs listed, required the current odition of the form must be used, or an equlvalenf form may be substituted if approved by the Finance Dlroctor and subJect to the contractor ldontlfying �nd listing ln writing all deviations and exclusions from fhe ISO form, B, Contr�ctors shall be required to carry the minimum coverage/limits, or greafer if roqufred by law or ofher legal agreement, in Exhibif I. If the contractor's limits of liability are higher than the required minimum limits then fhe provider's limits shall be this agreement's required limits, I I� I I I i � Paga 1 of 4 Schec{ula J Profession�l Services July 2017 City of Dubuque fnsurance Requirements far Professional Servlces (NSUF�ANCC SCHEDULE J (continued) �xnib�t.i A) COMMERCIAL GEN�RAL LIABILITY General Aggregate Limit $2,000,000 Products-Completed Operations Aggregafe Limif $1,000,000 • Personal ancl Adverlising Injury Limit $1,000,000 Each Occurr�nce $1,000,000 Fire Damage Limit(any one occurrence) $50,000 Medical Payments $5,000 1) Coverage shall be writfen on an occurrence, not cla(ms made, form, The general Ilability coverage shall be written in accord wlth ISO form CG0001 or business owners form BP0002,All devlaflons from the standard ISO commercial general liability form CG 0001,or business own�rs form BP 0002, shall be clearly (dentifled, 2) Include ISO endorsement farm CG 25 04"Designafed Location(s) General Aggregate Limit"or CG 25 03"besignated Construction ProjecE(s)General Aggregate Limit"as appropriate, � ' 3) Include endorsement indicating that coverage is primary and non-contributory, 4) Include Preservation of Governmental Immunities Endorsement. (Sample attached). 5) include an endorsement fhat deletes any fellow employee excluslon, 6) Include addltional insured endorsement for; ' The City of Dubuque, (ncluding all its elected and appointed officials, all Its ''� employees and volunfeers, �II Its boards, commisslons and/or aufhorities and their board members, employoes and volunteers. Use ISO form CG 2026, 7) Policy shall Include Waiver of Right to Recover from Others endorsemont. ' B) AUTOMOBILE LIABILITY �I Combined Single l.lmit $1,000,000 I�'i C) WORKERS' COMPENSATION & EMPLOYERS LIABILITY I Statutory benefits covering all employees in)ured on the job by accident or disease as prescribed by lowa Code Chapfer 85 as amended, Covera�e� Statufory—Skafe of lowa Coverage B Employers Llability Each Accident $100,000 Each Employee-Disaaso $100,000 Policy Lirrit-Disease $500,000 Policy shall include Waiver of Right to Recover from Others endorsement, Nonelection of VVorl<ers' Compensation or Employers' Liability Coverage under lo�,va Code sec, 87,22 _yes _fonn aftached � Page 2 of 4 Sch�dul� J Professionai Seivices July 2017 City of Dubuque Insurance Requirements for Professional Servfces INSURANCE SCHEDULE J (continued) ; D) UMBRELLAIEXCESS LIAB1l,iTY �1,000,000 Umbrella/excess liability coverage musf be af Isast following form with fhe underlying policies included herein, E) PROFESSIONAI. LIABILITY $1,000,000 Provide evidence of coverage for 5 years after complecion of proJect. F) CYBER LIABILITY $1,000,000 X yes _no Coverage for First and Third Party liability including but not limited to lost data and � restoration, loss of income�ncl cyber breach of information, �I � I � �'�,� '�. �� P�ge 3 ef 4 Schedule J Profassional Services July 2017 City of Dubuqua Insurance Requirements for Professfonal Services �, PRESE�VATfON OF G�VERNMENT/�L IMMUNITI�S �NDORSEMENT 1. Nonwalver of Governmental Immunitv The insurer expressly agrees and states that the purchase of this policy and fhe including of the City of Dubuque, lowa as an Additlonal Insured does not waive any of the defenses of governmental (mmunity available fo the City of Dubuque, lowa under Code of lowa Section 670,4 as it Is now exists and as it may be amendeci from time to time, 2, Cla(ms Cov�raae, The Insurer furfher agrees fhat this policy of Insurance shall cover only those claims not subJect to the defense of governmenfal immunity under the Code of lowa Section 670.4 as it i now exisks and as it may be amencled from ffine to time. Those claims not subJect to Code of lowa Sectfon �70,4 shall be covered by tlie terms and conditions of fhis (nsurance policy, . 3, Assertion of Government Immunitv The City of Dubuque, Iowa shall be responsible for asserting � any defense of governmenfal Immunity, and may do so at any time and shall do so upon the timely written ; request of the insurer, . i 4, Non-Denial of Coveraae The Insurer shali not deny cover�ge under this policy and the insurer � shall not deny any of the righls and benefifs accruing to the City of Dubuque, lowa under this policy for reasons of governmental immunity unless and until a court of competent Jurisdiction has ruled in favor of � the defense(s) of governmental Immunity asserted by the City of Dubuque, lowa, ; No Other Chanqe In Policv The above preservat(on of governmental fmmunities shall not otherwise � ' change or alter tho coverage avaflable under the poficy, I ', � � I `� � � � � I � � � � I (DEPARTMENT MANAGER; �ILL IN ALL BLANKS AND CHECK BOXES) )� p��`�°f`� Scnedul� J Profession�l ServicLs Jub�2017 I (