Preferred Health Choices -Administrative Services Agreement Amendment VIII Copyrighted
June 19, 2017
City of Dubuque Consent Items # 7.
ITEM TITLE: Preferred Health Choices -Administrative Services
Agreement Amendment V111
SUMMARY: City Manager recommending approval of an amendment to
the Administrative Services Agreement with Preferred
Health Choices to provide run-out administration services
through June 30, 2018.
SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Approve
ATTACHMENTS:
Description Type
Preferred Health Choices Amendment to Administrative City Manager Memo
Services Agreement-MVM Memo
Staff Memo Staff Memo
Amendment VII I-Administrative Services Agreement Supporting Documentation
THE CITY OF Dubuque
fta B E I 11p y
Masterpiece 012 the Mississippi 2007.2012«2013
TO: The Honorable Mayor and City Council Members
FROM: Michael C. Van Milligen, City Manager
SUBJECT: Amendment VIII —Administrative Services Agreement with Preferred
Health Choices
DATE: June 12, 2017
On July 1, 2017, Wellmark will be the City's third party administrator for the medical
plan. Due to the change, the City will need to retain Preferred Health Choices to
provide administrative services for medical plan run out claims received after July 1,
2017 but incurred prior to July 1, 2017. Health Choices proposes a one-time fee of$21
per contract per month for three months. The anticipated cost, based on 580 contracts,
is $36,540. The services provided will include payment of claims received after July 1,
2017, but incurred prior to July 1, 2017; any claims adjustments (over/under paid
claims), refunds or corrected claims on claims occurred prior to July 1, 2017; and
responding to participant and provider inquiries regarding these claims.
Personnel Manager Randy Peck recommends City Council approval of an amendment
to the Administrative Services Agreement with Preferred Health Choices to provide run
out administration services through June 30, 2018.
1 concur with the recommendation and respectfully request Mayor and City Council
approval.
1 r
MicIfael C. Van Milligen
MCVM:jh
Attachment
cc: Crenna Brumwell, City Attorney
Teri Goodmann, Assistant City Manager
Randy Peck, Personnel Manager
THE CITY OF Dubuque
bcftd
NI-AmeHea City
1i rY
Masterpiece on the Mississippi 2007.2012.2013
TO: Michael C. Van Milligen, City Manager
FROM: Randy Peck, Personnel Manager
SUBJECT: Amendment VIII - Administrative Services Agreement with Preferred
Health Choices
DATE: May 26, 2017
On July 1, 2017, Wellmark will be the City's third party administrator for the medical
plan. Due to the change, we will need to retain Preferred Health Choices to provide
administrative services for medical plan run out claims received after July 1, 2017 but
incurred prior to July 1, 2017. Health Choices proposes a one-time fee of$21 per
contract per month for three months. The anticipated cost, based on 580 contracts, is
$36,540. The services provided will include payment of claims received after July 1,
2017, but incurred prior to July 1, 2017; any claims adjustments (over/under paid
claims), refunds or corrected claims on claims occurred prior to July 1, 2017; and
responding to participant and provider inquiries regarding these claims.
Preferred Health Choices will provide run out administration services through June 30,
2018. 1 recommend approval of the amendment to the Administrative Service
Agreement with Preferred Health Choices. The amendment has been reviewed by
Senior Counsel Barry Lindahl and he finds the terms acceptable. The requested action
is for the City Council to pass a motion approving Amendment VIII to the Administrative
Services Agreement with Preferred Health Choices.
RP:alk
1HEALTH CHOICES
May 25, 2017
Mr. Randy Peck
City Personnel Manager
City of Dubuque
50 W 1311 St.
Dubuque, IA 52001
Re: Run-Out Fee
Dear Randy:
In follow-up to our phone conversation, Health Choices will propose a one-time fee of$63 per
employee covered. (Calculated as: $21.00 per employee (as of 6/2017) covered times 3 months
of anticipated claims volume). Health Choices shall provide administrative services for the City
of Dubuque Employee Medical Plan for all run-out claims received after 7/1/2017, but incurred
prior to that date; any claims adjustments (over/under paid claims), refunds or corrected claims
on claims incurred prior to 7/1/2017, as well as respond to participant and provider inquiries
regarding said claims. Health Choices will provide run-out administration through 6/30/2018.
This fee is our normal run-out fee and intended to cover our cost for the provision of services.
Please advise at your earliest convenience but no later than June 9 in regard to the decision to
purchase run-out services from Health Choices, so that we can plan accordingly. I have
included an Amendment to the existing Administrative Services Agreement (which terminates
6/30/2017), if you would like to formalize the provision for these services in that manner.
Sincerely,
�'ane{z
Karen Hoffmann
Director of Operations
Enclosure
Amendment VIII
Administrative Service Agreement
Whereas, the City of Dubuque and Preferred Health Choices, have agreed to an Administrative
Service Agreement dated July 1, 1999 and as amended.
Effective June 1, 2017 said agreement is hereby amended as follows:
Attachment D Compensation to Health Choices is hereby amended to add Exceptions and
Additions as follows:
"Exceptions and Additions: Run -Out Fees for claims incurred prior to 7/1/2017
The run -out fee for Health Choices administration is a one-time fee of $63 per employee covered as of
6/2017. (Calculated as: $21,00 per employee covered times 3 months of anticipated claims
volume). Health Choices shall provide administrative services for the City of Dubuque Employee
Medical Plan for all run -out claims received after 7/1/2017 but incurred prior; any claims adjustments
(over/under paid claims), refunds or corrected claims on claims incurred prior to 7/1/2017, as well as
respond to participant and provider inquiries regarding said claims. Health Choices will provide run -out
administration through 6/30/2018."
Accepted on behalf of the City of Dubuqu
Signed:
Dated:
Michael C. Van Milligen, City Manager
Accepted on behalf of Preferred Health Choice
Signed:
Zach Keeling, Chief Operating Officer
Dated:
C: \ Users \al(oppes\App Data \ LocalWicrosoft\WindowATemporary Internet Files\Content,OutloolAYLFE074Y \City of Dubuque Administrative
Services Amendment VIII.docx
Administrative Service Agreement
This Agreement, made and, entered into effective the 1st day of July, 1999 (the "Effective Date"), by and
between the City of Dubugiie'(hereinafter referred to as "Purchaser"), and HMS Preferred Health Choices,
Inc., a corporation organized under the laws of the State of Iowa (hereinafter "Health Choices"), .
WHEREAS, Purchaser desires to offer a preferred provider health care plan providing certain broad service
benefits (hereafter "Covered Services") to its qualifying eligible employees and/or beneficiaries, and their
dependents (hereafter "Covered Persons");
WHEREAS, Purchaser desires to purchase certain administrative and provider contracting services for
operation of its preferred provider health care plan from Health Choices;
WHEREAS, a description of the preferred provider health care plan (hereafter "the plan"), is attached hereto
as Attachment A.
NOW THEREFORE, in consideration of the promises and mutual covenants contained herein, it is hereby
agreed by and between the parties as follows:
I. Services and Compensation
1.1 Administrative Services. Health Choices shall perform for Purchaser the administrative services set
forth in Attachment B hereto ("Administrative Services") for the operation of the Plan. Health Choices shall
perform these services in accordance with the reasonable exercise of its business judgment and all applicable
statutory and regulatory requirements.. Purchaser shall at all times retain ultimate control over the assets and
operations of the Plan and final responsibility for the obligations of the Plan imposed by law. Health Choices
shall perform the functions described in this Agreement in accordance with such policies, directives, and
controlling documents of the Plan as are provided to Health Choices by Purchaser:
1.2 Provider Contracting Services. Health Choices shall arrange, through contracts ("Provider Contracting
Services") with physicians, hospitals and other health care providers or entities contracting on behalf of such
providers, for the availability in the service area described in the Plan of Covered Services fromhealth care
providers ("Contracting Providers") to Covered Persons, on the preferred provider terms described in
Attachment C hereto. Health Choices shall provide Purchaser with a list of Contracting Providers (including
names, addresses, telephone numbers, and, when applicable, respective specialties), which list may be
revised by Health Choices from time to time. Purchaser shall be responsible for compensating Contracting
Providers for Covered Services in accordance with Attachment C. Purchaser shall make adequate funds
available for payment of such amounts on its behalf by Health Choices. Purchaser acknowledges that Medical
Associates Clinic, P.C. and Mercy Health Center, Inc., affiliated companies of Health Choices, shall be
Contracting Providers under this Agreement.
1.3 Providers as Third Party Beneficiaries. Purchaser acknowledges and agrees that, with respect to its
obligations to pay Contracting Providers as provided in Section 1.2, such providers of health care services to
Covered Persons shall be intended third party beneficiaries of that obligation.
1.4 Health Choices. Purchaser shall pay Health Choices monthly as a fee for the Administrative Services
and Provider Contracting Services it provides the amount specified in Attachment D hereof in the manner
described therein.
1.5 List of Covered Persons. Purchaser will provide Health Choices with a list of Covered Persons who are
eligible to receive benefits under the Plan and Health Choices may rely upon such list in performing its duties
hereunder. Purchaser will notify Health Choices of any additions, changes, deletions or modifications to the
list of Covered Persons as they occur. Purchaser shall hold Health Choices harmless for any inaccuracy in
such information.
1.6 Promotion of the Plan. Purchaser agrees to be responsible for offering the Plan to eligible persons.
Purchaser offers two plans, an HMO plan and an Indemnity plan. When the HMO plan is chosen, incentives
in the design of the plan have been adopted by Purchaser to utilize contracting providers. The Indemnity plan
offered has no such incentives.
H: adm in\agree\HMSC i ly.agr
Agreement, Health Choices shall hold them harmless for all judgements, awards, settlements and costs
(including attorneys' fees) which they incur or pay in connection therewith if the Court rendering the judgement
or agency making the award determines that the liability underlying the judgement or award (or attorneys' fees
with respect thereto) was caused by the sole negligence of Health Choices.
1.13 Legal Defense. The defense, including legal fees and costs, together with the amount of any
judgement, of any legal action arising out of a claim for benefits under the Plan, shall be the responsibility of
the Purchaser; and shall not be an obligation of Health Choices. Health'Choices shall, however, cooperate
with Purchaser by furnishing such material or information as it has available in connection with the defense
of any such action.
1.14 Expenses. Health Choices will not be considered the insurer, guarantor or underwriter of the liability
of the Purchaser to -provide benefits for the Purchaser's Covered Persons: Purchaser will' be responsible for
all expenses incident to the operation of the -Plan, except as may be specifically assumed by Health Choices
under this Agreement. Purchaser shall in a timely fashion provide adequate funds to Health Choices to permit
its payment of claims and other expenses when due.
1.15 Standard and Character of Performance. Health Choices shall use customary and reasonable care
and proper diligence in the performance of its services under this Agreement. It is understood and agreed
by the parties that the terms "customary and reasonable care and proper diligence" and "negligence" do not
make Health Choices a guarantor of the' correctness of all claim payments and other services performed
under this Agreement, but refer to the usual business practice standards and conduct in such business.
1.16 Incorrect Payments, If any payment is made hereunder to or for an ineligible employee or dependent,
or if itis determined that more or less than the correct amount has been paid by Health Choices, Health
Choices shall attempt to recover the payment made to or for the ineligible person or the amount of the.
overpayment, but Health Choices shall not be required to initiate court proceedings to recover any incorrect
payment. Health Choices agrees to investigate all questionable claims or payments referred to it by
Purchaser, to report to Purchaser the results, and to attempt to collect any payments improperly paid. If
Health Choices' is unsuccessful in its attempts to recover any improper payment, it shall so notify Purchaser
in order that Purchaser may take such actions as it shall deem appropriate to collect such amount, or in the
event the error was a result of Health Choices' negligence, willful misconduct or failure to use customary
reasonable and proper care In claims processing or payment, Health Choices shall indemnify Purchaser.
1.17 Reliance on Communications. In all matters pertaining to the performance of services. under this
Agreement, Health Choices, when it acts in good faith, may rely upon any notice, resolution, instruction,
direction, order, certificate, opinion, letter, telegram or other document believed by it to be genuine and
authorized by Purchaser. If the Plan is amended, Health Choices shall not be required to act in accordance
with any amendment until it receives written notice thereof and until such amendment is approved by any
insurance carrier providing excess or stop -loss insurance or reinsurance on behalf of the Plan.
1.18 Proprietary Information. Purchaser acknowledges that Health Choices, in providing services under
this Agreement, will by necessity divulge to and provide Purchaser with confidential proprietary plans,
programs, formulae, methods and other products and information ("Proprietary Material") relating to the
business services and activities of Health Choices or its contractors, including Proprietary Materia! developed
in the course of providing services hereunder. Purchaser agrees that, during the term of this Agreement and
thereafter, Proprietary Material shall remain the property of Health Choices or its contractors and Purchaser
shall maintain the confidentiality of such Proprietary Material and shall not use, divulge, furnish or make
accessible such Proprietary Material to anyone other than is necessary for the Plan's operations, unless
otherwise required by the Iowa Public Records Act, Iowa Code Ch.22 (1995).
II. Term and Termination of Agreement
2.1 Effective Date. The Effective Date of this Agreement shall be the date first written above, and it shall
continue in effect thereafter for an initial term of one year and from year to year thereafter, subject to the
termination provisions set forth below.
2.2 Termination of Anniversary Date. Either party may terminate this Agreement effective on any
anniversary date by written notice at least sixty (Gb) days prior to such anniversary date.
H; admin\agreell-IMSCily. agr
3.6 Third Party Rights. This Agreement is entered into by and between the parties hereto and for their
benefit. Except as specifically provided herein, there is no intent by either party to create or establish third
party beneficiary status or rights in any Covered Person, subcontractor, or other third party to this Agreement,
and no such third party shall have any. right to enforce any right or enjoy any benefit created or established
under this Agreement.
3.7 Assessments. The Purchaser will pay Health -Choices within a reasonable time after assessment any
tax or charge assessed against Health Choices which may be incurred by reason of an imposition of or
change in any charges imposed on Health Choices by any public body, exclusive of Federal or State Income
Taxes, which affect this Agreement.
3.8 Limitations. In the event the operations of Health Choices' facilities or any substantial portion thereof
are interrupted by war, fire, insurrection, Tabor/provider contract troubles, riots, the elements, earthquakes or
acts of God, the provision of this Agreement (or such portions hereof as Health Choices is thereby rendered
incapable of performing) shall be suspended for the duration of such interruption.
3.9 .Arbitration. In the event of any dispute of any kind concerning this Agreement and/or the performance
of obligations hereunder, said dispute shall be submitted to arbitration in accordance with the rules of the
American Arbitration Association. The parties agree to be bound by the results of such arbitration. The fees
and expenses of the arbitrator shall be shared equally by the parties.
• 3A0 Duties of Termination. As of the effective date of termination pursuant to any provision of this
Agreement, it shall be considered of no further force or effect, and each of the parties shall be relieved and
discharged from the Agreement, and Health Choices' agency shall be automatically revoked, provided,
however, each party shall remain liable for any obligations or liabilities arising from activities carried on by such
party or its agents, servants, or employees during the period (including any period covered above) this
Agreement shall have been in effect, and the arbitration provision of Section 3.9 shall survive termination.
Termination shall not, at Purchaser's option, terminate the duties and obligations of the parties hereto for
Covered Persons then being treated by Contracting Providers on an inpatient basis, including payment
therefdre, until the Covered Person is discharged or for thirty (30) days, whichever is sooner.
3.11 Performance by Health Choices. Health Choices shall perform its obligations under this Agreement
through, at its discretion, employees or arrangements or contracts with agents or independent contractors.
Obligations under this Agreement which will be performed solely by Health Choices and not delegated to any
other party or entity shall include payment of Purchaser's claims.
3.12 Successors and Assigns. The provisions of this Agreement and obligations arising hereunder shall
extend to, be binding upon, and inure to the benefit of the executors, administrators, successors, and assigns
of the parties hereto.
3.13 Assignment. Purchaser shall not assign rights_an_d_obligations under this Agreement without the
prior written consent of Health Choices. Health Choices may assign its respective rights and responsibilities
under this Agreement to any entity which owns or controls Health Choices, to any entity which is currently
owned or controlled by Health Choices, or to any entity which is currently under common ownership or control
with Health Choices.
3.14 Headings. The headings of the various section of this Agreement are inserted merely for the purpose
of convenience and do not, expressly or by implication, limit, define or extend the specific terms of the section
so designated.
H:admin\agreo\HMS City. agr
Attachment List
Attachment A Purchaser's Health Care Plan
Attachment B Administrative Services
Attachment C Contracting Provider Compensation
Attachment D Compensation to Health Choices, Inc.
Attachment E Schedule of Insurance
H:admInlagree\HMSCAy.agr
Attachment B
Administrative Services
Health Choices shall perform the following administrative services for Purchaser with respect to the Plan:
1. Stop -Loss Coverage. Upon request, Health Choices shall make a recommendation to Purchaser for the
procurement of stop -loss coverage and shall, if requested, assist in placing such coverage through a
reinsurance company.
2. Preparation of Plan Document(s). Health Choices shall assist Purchaser in preparation, or revision as
appropriate, of the coverage documents for the Plan.
3. Financial Systems and Services. Health Choices shall establish and administer accounting procedures
and systems for the preparation of appropriate financial reports for the efficient management of and planning
for the Plan. The foregoing shall include, but not be limited to:
(a) Health Choices shall prepare and deliver to Purchaser non -certified financial reports on a quarterly basis.
The reports shall include a_ statement of expenses in reasonable detail, an estimate of claims incurred but not
reported and a comparison of budget with actual results;
(b) On a quarterly basis or when reasonably requested by Purchaser, Health Choices shall furnish Purchaser
with reports regarding the utilization and cost of health services and supplies rendered to Covered Persons
by providers of these services. Such reports shall include, but not be limited to, eligibility data and information
regarding the types and costs of services rendered and the frequency with which each type of service was
performed; and
(c) Health Choices shall provide the necessary information to enable Purchaser to prepare and file all
financial reports required of Purchaser regarding the Plan by any federal, state or other agency or authority.
4. Claims Processing and Administration. Subject to the restrictions in Section 4(c) below, Health Choices
shall design, Implement and maintain such systems and procedures as may be necessary for the appropriate
adjudication and timely payment of all claims for payment submitted to Purchaser (including 'Covered Person
and provider claims) and to assure the availability of appropriate and accurate information for the
administration of the Plan's programs. Health Choices services shall include, but not be limited to, the
following:
(a) Drafting or specifying all documents, forms and records to be used by provider for their claims of
reimbursement and to be used by the Plan to reimburse them and also to develop procedures to be utilized
in the adjudication of claims;
(b) Evaluating and processing all claims for payment submitted to Health Choices under the Plan. Health
Choices shall investigate reported health core claims in the manner and to the extent necessary and supervise
a settlement of those health care claims and other demands that the Plan is legally obligated to pay; prepare
checks or drafts drawn against Purchaser's funds allocated to the Plan to settle such claims or demands; and
maintain files for the Plan;
H: admin\agraelHMSCIty. agr
• h i
8. Reports.
(a) Health Choices shall provide Purchaser with such information to enable Purchaser to file such reports as
may be required by any regulatory agency having jurisdiction over the operations of the Plan including, to the
extent applicable, the U.S. Department of Labor (including Form 5500 and Summary Annual Report), the
Internal Revenue Service, and state governmental agencies.
(b) Health Choices shall report, at Purchaser's request, concerning the activities of the Plan as shall be
reasonably necessary for Purchaser, its officers and directors, to fulfill their corporate responsibilities.
9. Government Regulation. Health Choices shall use reasonable efforts, within the scope of its authority
andresponsibilities hereunder, to ensure that the Plan complies with the requirements of any applicable state
or federal statute, ordinance, law, rule, regulation, or order of any governmental or regulatory body having
jurisdiction over the Plan.
10. Deposit and Disbursement of Funds.
(a) Health Choices shall make appropriate banking arrangements for the deposit in designated bank accounts
of all monies received from Purchaser or otherwise arising from the operation pf the Plan and shall make
disbursements from such accounts on behalf of the Purchaser in such amounts and at such times as the
same are required. To effectuate those arrangements, the Purchaser agrees to enter into a bank funding
agreement subject to the approval of Health Choices, and to take all necessary actions for the execution,
implementation and performance of that agreement. To the extent Health .Choices receives payments directly
from Covered Persons on behalf of Purchaser, they shall be deemed to have been received by the Purchaser.
Any payments to Covered Persons by Health Choices shall not be deemed received until the time of actual
receipt by the Covered Person.
(b) Health Choices shall serve as Purchaser's true and lawful attorney-in-fact to bill and collect such amounts
as mays =be payable to the Purchaser for the Plan; to collect in the Purchaser's name accounts receivable
generated by such billing; and to take possession of and endorse in Purchaser's name any cash, notes,
checks; money orders, insurance payments, and any other instruments received in payment..
11. Legal Services and Actions. Health Choices shall arrange with the prior written consent of the
Purchaser for the provision of legal services as are necessary to meet the legal needs of the Plan; however,
the cost of such services are the responsibility of the Purchaser,
12. Excluded Expenses and Services. Expenses incurred by the Plan, or by Health Choices on behalf of
the Plan with authorization obtained in advance from Purchaser, for the following services shall be the sole
responsibility of Purchaser:
(a) All direct and indirect costs for providers and suppliers in connection with the delivery of health care
services and supplies to Covered Persons, including all compensation and reimbursement paid to medical
and paramedical personnel and health care facilities;
(b) Expenses associated with meetings, brochures, communications and mailings to Purchaser (including
its management, or Board of Directors or committees), and Covered Persons;
(c) All insurance costs, including professional liability/malpractice, general liability and all reinsurance and
stop -loss, which may be purchased for Purchaser or the Plan;
FI: admin\agree\HMSCily.agr
Attachment C
Contracting Provider Compensation
For Covered Services provided by Contracting Providers in accordance with the terms and conditions of the
Plan :and the provisions of agreements through which Health Choices has arranged for the provision of
Covered Services to Covered Persons, Purchaser shall provide compensation in the amounts charged up to
the maximum rate to which each Contracting Provider, or an entity acting on the Contracting Provider's behalf,
has agreed with Health Choices or its designee, as such rate of schedule may be amended from time to time
in accordance with the terms of the applicable agreement governing such Contracting Provider, Such
payment shall be subject to the applicable copayments, deductibles, claim review and claim audits under the
Plan,
Contracting Providers shall accept the above compensation as payment in full for Covered Services, except
for applicable copayments, deductibles, and adjustments as a result of claim review and claim audits under
the Plan.
H:admf n\agroo\HMSCily.agr
City of Dubuque Insurance Requirements for Professional Services
1.
insurance Schedule C
4 wav•V-)c eci / it -a( CA,(Ce
shall furnish a signed Certificate of Insurance to the City of Dubuque, lowa for the
coverage required in Exhibit I prior to commencing work and at the end of the project if the term of work
is longer than 60 days, Providers presenting annual certificates shall present a Certificate at the end of
each project with the final billing. Each Certificate shall be prepared an the most current ACORD form
approved by the Iowa Department of Insurance or an equivalent. Each certificate shall include a
statement under Description of Operations as to why issued. Eg: Project # or Project Location at
or construction of
2. All policies of insurance required hereunder shall be with a carrier authorized to do business in lowa and
all carriers shall have a rating of A or better in the currentA,M. Best's Rating Guide,
3. Each Certificate shall be furnished to the contracting department of the City of Dubuque,
4, Failure to provide minimum coverage shall not be deemed a waiver of these requirements by the City of
Dubuque. Failure to obtain or maintain the required insurance shall be considered a material breach of
this agreement.
5. Consultants shall require all subconsultants and sub-subconsultants to obtain and maintain during the
performance of work insurance for, the coverages described In this Insurance Schedule and shall obtain
certificates of insurances from all such subconsultants and sub-subconsultants. Consultants agree that it
shall be liable for the failure of a subconsultants and sub-subconsultants to obtain and maintain such
coverages, The City may request a copy of such certificates from the Consultants.
6, All required endorsements to various policies shall be attached to Certificate of insurance.
7. Whenever a specific ISO form is listed, an equivalent form may be substituted subject to the provider
identifying and listing in writing all deviations and exclusions that differ from the ISO form.
8. Provider shall be required to carry the minimum coverage/limits, or greater if required by law or other
legal agreement, in Exhibit I. If provider's limits of liability are higher than the required minimum limits
then the provider's limits shall be this agreement's required limits,
9, Whenever an ISO form is referenced the current edition of the form must be used.
Page 1 of 3 Schedule C Professional Services May 2016
Cif_y ofiia_bhugiaeinslar-a.nce_Bequirements for Professional Services
Insurance--Schedule-C-(continued)
Exhibit I
A) COMMERCIAL GENERAL LIABILITY
General Aggregate Limit $2,000,000
Products -Completed Operations Aggregate Limit $1,000,000
Personal and Advertising Injury Limit $1,000,000
Each Occurrence $1,000,000
Fire Damage Limit (any one occurrence) $ 50,000
Medical Payments $ 5,000
a) Coverage shall be written an an occurrence, not claims made, form. The general liability
coverage shall be written in accord with ISO form CG0001 or business owners form BP0002,
All deviations from the standard ISO commercial general liability form CG 0001, or Business
owners form BP 0002, shall be clearly Identified.
b) Include ISO endorsement form CG 25 04 "Designated Location(s) General Aggregate Limit"
or CG 25 03 "Designated Construction Project (s) General Aggregate Limit" as appropriate,
c) Include endorsement indicating that coverage is primary and non-contributory.
d) Include endorsement to preserve Governmental Immunity. (Sample attached).
e) Include an endorsement that deletes any fellow employee exclusion.
f) Include additional insured endorsement for,
The City of Dubuque, including all its elected and appointed officials, all its employees
and volunteers, all its boards, commissions and/or authorities and their board members,
employees and volunteers. Use ISO form CG 2026.
B) AUTOMOBILE LIABILITY $1,000,000 (Combined Single Limit)
C) WORKERS' COMPENSATION & EMPLOYERS LIABILITY
Statutory benefits covering all employees injured on the job by accident or disease as prescribed by
Iowa Code Chapter 85 as amended.
Coverage A Statutory—State of Iowa
Coverage B Employers Liability
Each Accident $100,000
Each Employee -Disease $100,000
Policy Limit -Disease $500,000
Policy shall include an endorsement providing a waiver of subrogation to the City of Dubuque.
Coverage B limits shall be greater if required by Umbrella Carrier,
D) UMBRELLA LIABILITY $1,000,000
Umbrella liability coverage must be at least following form with the underlying policies included
herein.
E) PROFESSIONAL LIABILITY $1,000,000
a) Provide evidence of coverage for 5 years after completion of project.
F) CYBER LIABILITY $1,000,000
Coverage for First and Third Party liability including but not limited to lost data and
restoration, loss of income and cyber breach of information.
Yes
No
Page 2 of 3 Schedule C Professional Services May 2016
City of Dubuque Insurance Requirements for Professional Services
Preservation of Governmental Immunities Endorsement
1. Nonwaiver of Governmental Immunity, The insurance carrier expressly agrees and states that the
purchase of this policy and the including of the City of Dubuque, Iowa as an Additional Insured does
not waive any of the defenses of governmental immunity available to the City of Dubuque, Iowa
under Code of Iowa Section 670.4 as it is now exists and as it may be amended from time to time.
2 Claims Coverage. The insurance carrier further agrees that this policy of insurance shall cover only
those claims not subject to the defense of governmental immunity under the Code of Iowa Section
670.4 as it now exists and as it may be amended from time to time. Those claims not subject to
Code of Iowa Section 670.4 shall be covered by the terms and conditions of this insurance policy.
3. Assertion of Government Immunity. The City of Dubuque, Iowa shall be responsible for asserting any
defense of governmental immunity, and may do so at any time and shall do so upon the timely
written request of the insurance carrier.
4. Non -Denial of Coverage. The insurance carrier shall not deny coverage under this policy and the
insurance carrier shall not deny any of the rights and benefits accruing to the City of Dubuque, Iowa
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, Iowa.
No Other Change in Policy. The above preservation of governmental immunities shall not otherwise
change or alter the coverage available under the policy.
SPECINIEN
Page 3 of 3 Schedule C Professional Services May 2016