Signed Contract_Tri-State Adjustment Collection Services Copyrighted
September 5, 2017
City of Dubuque Consent Items # 12.
ITEM TITLE: Signed Contracts
SUMMARY: Tri-State Adjustments, Inc. Collection Services Agreement
SUGGESTED DISPOSITION: Suggested Disposition: Receive and File
ATTACHMENTS:
Description Type
Tri-State Adustments Collection Services Agreement Supporting Documentation
PWK 9SERVICES AGREEMENT
..... .... . .. ....
THIS AGREEMENT is made and entered into by and between, CITY OF DUBUQUE
(hereinafter referred to as"Client"), whose principal place of business is, CITY HALL, 50 WEST 13" STREET
DUBUQUE, IA 52001 and Tri-State Adiustments, Inc. (hereinafter referred to as "TSA" and "Business
Associate" interchangeably), whose principal place of business is 3439 East Avenue South, La Crosse WI
54601, as of the date of execution by a duly authorized representative of TSA.
RECITALS:
WHEREAS, Client desires from time to time during the term of this Agreement, to submit to TSA certain claims,
accounts or other evidences of indebtedness (hereinafter called "Claims"), and
WHEREAS, TSA desires to provide Client with collection services with respect to said Claims.
NOW THEREFORE, for and in consideration of the mutual covenants hereinafter set forth, it is mutually agreed
by and between the parties hereto as follows:
1. TSA agrees that all activities of TSA shall be carried out in compliance with all applicable federal, state, and local
laws.
2. Client hereby warrants that all Claims forwarded to TSA will be valid and legally enforceable debts, and that Client
will, both before and after forwarding said Claims, comply with all applicable federal, state and local laws with
respect thereto. Further, Client agrees to provide, whenever requested to do so by TSA: a written verification of a
Claim; a copy of the judgment, if any, on which a Claim is based; the name and address of the person or entity to
whom the debt was originally owed, if different from Client.
3. If any court of competent jurisdiction shall rule that any provision of this Agreement is invalid or unenforceable, the
remaining provisions shall remain in full force and effect and shall not be affected by said ruling.
4. This Agreement shall be binding on the heirs, legal representatives, successors and assigns of the parties hereto.
5. This agreement shall be construed under the laws of the State of Wisconsin, and the parties agree that any action
related to this agreement shall be instituted and prosecuted in the circuit court for La Crosse County Wisconsin.
The parties waive the right to a change of venue.
6. Client and Collector agree that all actions taken by Client and TSA pursuant to this Agreement shall be in
accordance with the TERMS AND CONDITIONS, if any, set forth on the subsequent pages. Said TERMS AND
CONDITIONS have been signed by both parties and are hereby made a part of the Agreement as fully and
effectually as if they were set forth herein. Thus, whenever the term "Agreement" is used herein, it shall be
construed to include said TERMS AND CONDITIONS. This Agreement, including the TERMS AND
CONDITIONS, contains the entire agreement between the parties hereto and cannot be amended or modified in
any respect except by an amendment in writing signed by both parties.
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SERVICE TERMS AND CONDITIONS
CITY OF DUBUQUE (Client) engages Tri-State Adjustments Inc. (TSA) to provide collection services on (Client's)
accounts as those services are described herein. Each party agrees to the following terms and conditions:
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DEBT COLLECTION SERVICES
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• Validation of debt sent to debtor via mail.
• TSA will contact debtor via telephone, if no phone number is provided TSA will check the appropriate
resources to obtain a telephone number to contact the debtor.
• TSA will contact the debtor to secure appropriate payment following all FDCPA and State regulations.
• If voluntary payment arrangements are not secured, TSA will determine at TSA's discretion if legal action is
warranted.
• If legal action is warranted TSA will request authorization by sending a Suit Authorization requesting litigation.
• Upon receiving approval from client, TSA will pursue the process of litigation and garnishment to collect the
debt.
CLIENT RESPONSIBILITIES AND OBLIGATIONS
• Client will cooperate, and cause its employees to cooperate, with TSA to allow TSA to perform its duties
under this Agreement.
• Client will report all direct payments to TSA weekly.
• Client will submit accounts electronically or in excel format via email or TSA's collaboration center.
• Client shall provide additional access to patient information electronically if needed.
• Provision of Information. Client will furnish TSA with all information necessary to enable TSA to perform the
services under this Agreement. If applicable, all information provided is considered "protected health
information" (PHI) as defined by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and
is to be treated accordingly. The parties will enter in to a Business Associate Agreement that will enumerate
each parties resp era iuil'siies related to PHI or EP HI.
• Client shall provide proof of payment, via a screen print or payment report of the posted payment, within ten
(10)working days of receiving payment;
• Client will make its best efforts to provide TSA with accurate and complete Account balances;
• Client will promptly notify TSA of a dispute or request for verification of information with respect to any
Account; and
• Accuracy of Information. Client is responsible for providing the information identified above relating to the
Accounts to TSA in the required format, and TSA will have no responsibility for the accuracy of the
information received or problems arising out of erroneous or incomplete information received from Client.
• Special Instructions. Client will notify TSA in advance of any special instructions to be used by TSA in
providing the services (such as listings of specific patients who are to be excluded from follow-up services).
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Payment for Services
Client agrees to pay TSA a contingency fee on amounts collected as follows: I
• 10% - Pre Collections (First 30 Days)
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• 32% Regular Collections
• 45% Litigation
6 N/A Forwarded accounts
i 10% - Offset Program Collections
Special Tnstru,etlmns- Post Jul interest will be added as stated on th-e judgment and said interest will
be retained by Tri-State Adjustments Inc. only after the amount of such judgment has been collected in full.
Payment Terms: Client will pay to TSA, within thirty (30) days from the date an invoice is delivered to Client, all
payments due under this Agreement. Any amount payable under this Agreement and not paid within thirty (30) days
will be delinquent and will bear interest at the rate of no more than 12% annum or 1% per month on the unpaid
balance.
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Taxes: All taxes and other levies in the nature of sales, use or excise taxes resulting from the services provided to
Client hereunder will be the sole responsibility of Client and will be paid by Client directly.
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Interest: TSA shall add 5% interest per annum to all accounts listed with TSA; effective from this date forward and
retained by TSA.
Termination Clause
This agreement shall be effective for a minimum of twelve (12) months from date of first placements. At the end of the
term, this agreement shall continue on a month-to-month basis. After the end of the term, either party may cancel on
thirty (30) days written notice to the other party. During the term if either party defaults in any material obligation owed
to the other party pursuant to this agreement, then this agreement may be terminated if the default is not cured
following at least thirty (30) days'written notice to the defaulting party.
INDEMNIFICATION
TSA hereby covenants and agrees to indemnify and hold harmless Client, its successors and assigns, from and
against any fines, penalties or interest assessed against Client arising out of the negligence or willful misconduct of
TSA or its employees in the course of rendering the Services. Client guarantees that any information furnished to
TSA by Client will be accurately taken from Client's books and records. Client hereby covenants and agrees to
indemnify and hold harmless TSA, its successors and assigns, from and against all damage, costs, loss and expense
including, but not limited to, any reasonable attorney's fees, that TSA may suffer or incur to the extent such damage,
costs, loss or expense is caused by the negligent acts or omissions or willful misconduct of Client or its employees.
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IN WITNESS WHEREOF, the parties have hereunto sets their hands and seal the day and year first above written.
CITY OF DUBUQUE–UTILITIES Tri-State Adiustments, Inc._
Client Rhona son
By ABY
Title_ ` �' Title President
Date— t Date `
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