Tri-State Occupational Health, L.L.C. AgreementCopyrighted
September 18, 2017
City of Dubuque Consent Items # 5.
ITEM TITLE: Tri-State Occupational Health, L.L.C. Agreement
Amendment
SUMMARY: City Manager recommending approval of an amendment to
the Agreement between Tri-State Occupational Health,
L.L.C. and the City of Dubuque for case management
services for workers' compensation claims and police and
fire job-related injuries and illnesses.
SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Approve
ATTACHMENTS:
Description
Tri-State Occupational Health Amendment to
Agreement -MVM Memo
Staff Memo
Amendment to Agreement
Insurance Requirements for Professional Services
Type
City Manager Memo
Staff Memo
Supporting Documentation
Supporting Documentation
Masterpiece on the Mississippi
TO: The Honorable Mayor and City Council Members
FROM: Michael C. Van Milligen, City Manager
Dubuque
bell
All -America City
'1Il1'
2007 • 2012 • 2013 • 2017
SUBJECT: Amendment to the Agreement between Tri-State Occupational Health,
L.L.C. and the City of Dubuque for Case Management Services for
Workers Compensation Claims and Police and Fire Job Related Injuries
and Illnesses
DATE: September 11, 2017
Personnel Manager Randy Peck recommends City Council approval of an amendment
to the Agreement between Tri-State Occupational Health, L.L.C. and the City of
Dubuque for case management services for workers compensation claims and police
and fire job related injuries and illnesses. The amendment will continue the agreement
from October 1, 2017 through September 30, 2018. The cost of the service will
increase from $44.20 per hour to $45.50 per hour. The current rate has been in effect
for one year. The City uses their services for approximately eight hours per week for a
total annual cost of $18,928.
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
Randy Peck, Personnel Manager
Masterpiece on the Mississippi
Dubuque
*****
All -America City
2007 • 2012 • 2013 • 2017
TO: Michael C. Van Milligen, City Manage
FROM: Randy Peck, Personnel Manager
SUBJECT: Amendment to the Agreement between Tri-State Occupational Health,
L.L.C. and the City of Dubuque for Case Management Services for
Workers Compensation Claims and Police and Fire Job Related Injuries
and Illnesses
DATE: August 29, 2017
I have attached an amendment to the Agreement between Tri-State Occupational
Health, L.L.C. and the City of Dubuque for case management services for workers
compensation claims and police and fire job related injuries and illnesses. The
amendment will continue the agreement from October 1, 2017 through September 30,
2018. The cost of the service will increase from $44.20 per hour to $45.50 per hour.
The current rate has been in effect for one year. We use their services for approximately
8 hours per week for a total annual cost of $18,928.
The requested action is for the City Council to pass a motion approving the amendment
to the Agreement and authorizing you to sign the amendment.
RP:alk
AMENDMENT TO AGREEMENT
BETWEEN
TRI-STATE OCCUPATIONAL HEALTH, L.L.C.
AND
CITY OF DUBUQUE
The Agreement between TRI-STATE OCCUPATIONAL HEALTH, L,L,C, (TSOH) and CITY OF
DUBUQUE, effective October 6, 2014, is hereby amended as follows:
1. Agreement Parameters. C. is deleted in its entirety and replaced with:
C. The term of this Agreement shall begin on October 1, 2017, and shall continue
through September 30, 2018,
2. Reimbursement for Onsite Occupational Health Nursing Services. A. is deleted in
its entirety and replaced with:
A. For onsite occupational health nursing services the City will pay TSOH $45.50 per
hout
This.Amendment will become a pari of the original Service Agreement of October 6, 2014, The
parties hereby ratify and affirm that all other terms and provisions of the original Agreement and their
intent shall remain in full force and effect.
TRI-STATE OCCUPATIONAL HEAL 11, L.L.C.
Br an Schatz
President
CITY OF DUBUQUE
Date
Michael Van Milligen Dae
City Manager
Agreement
Setween
TrJ-State Occupational Health, L.L.C.
And
The City of Dubuque
This Agreement Is made and entered Into this ' '4 day
of 1:e..! l7,/ 2014, by and between Tri-State Occupational, L,L.C,, a corporation
organized and established under the laws of Iowa, having its principal place of business
at 1940 Elm Street, Dubuque, Dubuque County, Iowa, ("TSOH"), and the City c`
Dubuque, having Its principal place of business at 50 West 13th Street, Dubuque,
Dubuque County, Iowa ("City"),
Scope
A. TSOH Is In the business of providing occupational medicine, worker's
compensation and related therapy services and as specifically relates to
-this agreement Is -In -the -business -of -providing onsite occupational health
nursing services through ils physicians, providers and clinical nursing
staff.
Recitals
A. City will:
1. Provide a facility location for the provision of onsite occupational health
nursing services.
2, Assume all of the roles and responsibility for OSHA record-keeping
and related functions.
B, TSOH will;
1. Provide onsite occupational health nursing services to the City.
2. Provide employee supervision, Including clinical and medical direction
oversight of the onsite occupational health nursing services,
3, Provide onslte occupational nursing services for eight (8) hours per
work week.
4. Recommend all referral and fo'low-up treatment services (e.g. therapy,
orthopedics, surgery, eta), to optimize qual'hy of care and case
management. TSOH will direct care according to City's wishes, and
City acknowledges that care coordination and treatment outcomes
outside TSOH recommendations may or may not meet TSOH's
standard o[care.
5, Provide occupational therapy and rehabilitation services at City
request,
O. Manage the employee medical chart on-site, maintaining aseparation
of occupational health and worker's compensation care notes from
personal health and medical care information. TSOH will retain
ownershlp of personal health nforniatlon.
7. Abide by the foVowing Attaohmont:
• AAOHN Code of Ethies and nterpretative Statements
• AAOHN Case Management: The Ocoupatlonal and Ervironrnenta
Heaith Nurse Role
^ AAOHN Delivery of Occupational end Environmental Health
Services
• Standarcis of Occupational and Environmental Health Nursing
In consideration of the matters describedmhove, and of the mutual benefits and
obligations set forth in this agreement, the partlee agree as follows:
Section 1
Agreement Parameters
A. TSOH will provide onsite .occupational health nursing services for an
average scheduled time frame of eight (8).hours every work week. Start
and end times for coverage will be agreed to In advance by TSOH and
B. Onsita occupationalhealthnurs|ng services will be provided by an
appropriately qualified TSOH nurse.
C. The Initial term of this Agreement shall from the 6th day of October, 2014,
tomidnight onthe 30hday ofSeptember, 2015.
Section 2
Reimbursement for Onsito Occupational Health Nursing Services
A. For onslte occupationalhealth nursing services the City will puyTSOH
$43,35 per hour.
B, Onsite occupational health nursing services provided byTSOH hnCity will
beinvoiced onomonthly basis,
Section
Compliance with All Applicable Laws
TSOH and CIty agree hatthey are bound by and will comply wlth all appllcahle
federal, state, local laws, ordinances or regulations, TSOH and City agree to defend,
indemnify and hold harmless 000hnih r aai t lo,ss or damage, Including, but not
limited to, reasonable attorneys' fees, resulting from their respective negligence In the
performance or nonperformance of this Agreement.
Section 4
Independent Contractor Relationship
The parties agree that the relations'nip between TSOH and City In one of owner -
independent contractor and nothing herein shall be construed or interpreted in any way
to create an employer-employee relationship between TSOH and City or between City
and any of TSOH's officers, agents or employees.
Section 5
City Responsibilities
A. CIty will provide a minimum ane (1) weeknotice toTGDH|f the regularly
agreed toCity work schedule. for the onsite occupational health nurse Is to
be cancelled. Such notice shall be provided by contacting the TSOH
Manager or Cflnic& Manager,
B. City will pay TS01-1 invoiced fees within 30 days.
Section 6
Agreement Not ToHire Nor Solicit Employees
City agrees that for uperiod nf of termtnation of this
Agreernent, netther City nar any of s members shall hire, saijctt,, or attempt to hlrs or
solfcit any of TSOH's emplcyees that are or wero subject to thls Agreement. City and
its members further agree Ihat the remedy at Iaw for anybreach by City by City and Ita
members of this Section Owill hainadequate and that TSOH shall be entitled to
injunctive relief in case. of any such breach, and TSOH shall be entitled to recover Its
costs |ncurre,d In conducting any tawsult, Including reasonable attorneys' fees and
expenses. This provi3lon can be walved by mutual agreement of TSOH and City,
received and acknowledged |nwriting.
Section 7
Pynent of Taxes or Beneflts
TSOH shall pay any and all a���t-related taxes and benefits for the TSOH
employee(s) subject to this Agreement.
Section 8
Use xfTrade Names and Signs
City shall not use inany directly mIndirectly, whole or in part, tho
sgnature, rnonograrn or any other trademark or name that Is now or may In the future
be owned by TSOH, except In a manner; and to an extent that TSOI-1 may specifically
consent In writing. If any trademark or name Is used in any way by City with the
express written approval of TOOH. City on the turm|nmton of this Agreement, shall
discontinue all such use and shall not subsequently usa any name, titia or expression In
connection with any business In which City may be engaged that, In the judtuf
T8OH, so nearly resembles any trademark or name, owned by TSOH as may he likely
to ead to corfusian or uncerta!nty on the part of the pubtc,
Svction0—
TranofemhU|ty
All benefits and duties of either party under this Agreement are non -transferable,
Section 10
Termination Notice Clause
Thls agreerflent may be termlnated by elther party, with or w0hout cause, upon
thirty (30) days written notice to the other party,
Section 11
Liability Of Parties To The Agreement Upon Termination Of Agreement
Upon termination of this xgn*omant. City shall remain liable to TSOH for any
payments then owed to TSOH.
Section 12
Modification
This Agreement reflects all the agreemonb, understandings, taUurm,
conditions and warranties by and between the parties. Neither party shall be liable for
any repnsoenhutIon made unless It is expressly set forth in this Agreement, and this
Agreement may not be modified or amended except In a writing signed by both m' the
parties,
)
}
Section 13
GmmrohJUty
If any provision of this Agreement sha be declared by eny court of competent
Jurlsdiction to be U|ego|, void or unonfomaoWo, all other provisions o[this Agreement
shall not be 'affected and shall mmu(n In fuu force and effec
Section 14
Governing Law
This Agreement shall be governed by the laws of the Stae of lows.
Section 15
Arbitration
If a dispute arises with respect to his Agrooment, it shat be dec$ded finay by an
arbitrator In an arbitration proceeding conforming to the Rules of the American
Arbitration Association applicable to commercial arbitrations. The arbitrator shall be
-selected 1n-aonordanoe—to the Rules of the Amerfan Arbitration Association, The
arbitration shall take place In Dubuque, Iowa. and the decision of the arbitrator shall bu
conclusively binding upon the partles and final and such decision shall be enforceable
as a Judgment In any court of competentJud d! U The bitb shall assess the
cost of arbitration to the non'provu||(ng party, and award reasonably Incurred attorney's
feas and costs, in favor oF the substantiJy prevafling party at the arbraton,
Section 16
Acts of Governments, War, Terrorism, Natural Disaster Clause
If either to this Agreement is affected In such a wuy by changes in laN, acts
of war, acts of foreign gnvammants, acts of terrodom, natural d)oanters, or similar
catastrophes, to such an extent that they cannot fulfill their obligations under this
Agreement, that party will be excused from performing under the Agreement, and the
Section 17
Notice
Unless otherwise provided for In this Agreement, all notices which are required or
may be given pursuant to the terms of this Agreement shall be In writing and shall be
deemed duly given If delivered personally, mailed by registered or certified mail,
postage prepaid, return receipt requested, or sent by facsimile with confirmation.
Notices shall be sent as follows:
A. To: Tri-State Occupational Health, L,L,C,
Attention: TSOH Manager
1940 Elm Street Dubuque, Iowa 52001
Telephone: (563) 584.4500
Facsimile: (563) 582-7847
To:
City of Dubuque
Attn: Personnel Manager
50 West 13'h Street
Dubuque, Iowa 52001
Telephone: (563) 589-4125
Facsimile: (563) 690-6025
Section 18
Insurance
TSOH shall at all times during the performance of this Agreement maintain
Insurance as required by the attached Insurance Schedule,
Tri-State Occupational Health, L,L,C, City of Dubuque
By; /
Michael C. Van Mil!igen, Ciyy Manager
Data: (0I/ r) r�/ L/
J
Insurance Schedule
City of Dubuque Insurance Requirements for Professional Services
INSURANCE SCHEDULE J
Tri-State Occupational Health, L.L.C.
shall furnish a signed certificate of insurance to the City of Dubuque, Iowa 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, Contractors presenting annual certificates shall present a
certificate at the end of each project with the final billing. Each certificate shall be prepared on
the most current ACORD form approved by the lowa Department of Insurance or an equivalent
approved by the Finance Director. Each certificate shall include a statement under Description of
Operations as to why the certificate was issued. Eg: Project # or Project Location at
or construction of
2. All policies of Insurance required hereunder shall be with an insurer authorized to do business In
Iowa and all insurers shall have a rating of A or better in the current A.M. Best's Rating Guide.
3. Each certificate shall be furnished to the Personnel Department of the City of Dubuque,
4. Failure to provide coverage required by this Insurance Schedule 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. Contractors 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.
Contractors agree that they shall be liable for the failure of a subconsultant and sub-
subconsultant to obtain and maintain such coverages. The City may request a copy of such
certificates from the Contractor.
6. All required endorsements shall be attached to certificate of insurance.
7. Whenever a specific ISO form is listed, required the current edition of the form must be used,,or
an equivalent form may be substituted if approved by the Finance Director and subject to the
contractor identifying and listing in writing all deviations and exclusions from the ISO form.
8. Contractors shall be required to carry the minimum coverage/limits, or greater If required by law
or other legal agreement, in Exhibit I. If the contractor's limits of liability are higher than the
required minimum limits then the provider's limits shall be this agreement's required limits.
Page 1 of 4 Schedule J Professional Services July 2017
City of Dubuque insurance Requirements for Professional Services
INSURANCE SCHEDULE J (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
1) Coverage shall be written on 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.
2) 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.
3) Include endorsement indicating that coverage is primary and non-contributory.
4) Include Preservation of Governmental Immunities Endorsement, (Sample
attached).
5) Include an endorsement that deletes any fellow employee exclusion.
6) 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.
7) Policy shall include Waiver of Right to Recover from Others endorsement,
B) AUTOMOBILE LIABILITY
Combined Single Limit $1,000,000
0) 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 Waiver of Right to Recover from Others endorsement.
Nonelection of Workers' Compensation or Employers' Liability Coverage under Iowa
Code sec. 87.22
yes form attached
Page 2 of 4 Schedule J Professional Services July 2017
City of Dubuque Insurance Requirements for Professional Services
INSURANCE SCHEDULE J (continued)
D) UMBRELLA/EXCESS LIABILITY $1,000,000
Umbrella/excess liability coverage must be at least following form with the underlying
policies Included herein.
E) PROFESSIONAL LIABILITY $1,000,000
Provide evidence of coverage for 5 years after completion of project,
F) CYBER LIABILITY
X yes _ no
$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.
Page 3 of 4 Schedule J Professional Services July 2017
City of Dubuque insurance Requirements for Professional Services
PRESERVATION OF GOVERNMENTAL IMMUNITIES ENDORSEMENT
1' Nonwaiver of Governmental Immunity. The insurer 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 Coveraae. The insurer further agrees that this policy of insurance shall cover only those
claims not au'�octhzthe defense ofgovernmental immunity under the Code ofIowa Section O7O.4ao|t
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 insurer.
4. Non -Denial of Coveraae. The insurer shall not deny coverage under this policy and the insurer
shall not deny any of the rights and benefits accruing to the City of Dubuque, Iowa under this policy for
reasons ofgovernmental immunity unless and until acourt ofcompetent jurisdiction has ruled in favor of
the defense(s) of governmenta immunity asserted by the City of Dubuque, Iowa,
No Other Chance in Policy. The above preservation of governmental immunities shall not otherwise
change or alter the coverage available under the policy.
EC
(DEPARTMENT MANAGER: FILL IN ALL BLANKS AND CHECK BOXES)
Page 4 of 4 Schedule J Professional Services July 2017