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Workers' Compensation Claims Administrative Services AgreementTHE CITY OF DUBUQUE Masterpiece on the Mississippi Dubuque All-American City 2007 TO: The Honorable Mayor and City Council Members FROM: Michael C. Van Milligen, City Manager SUBJECT: Acceptance of Worker's Compensation Claims Administrative Services Agreement DATE: December 30, 2008 Personnel Manager Randy Peck is recommending approval of an agreement with Alternative Services Concepts for services related to the administration of the City's Worker's Compensation Program. I concur with the recommendation and respectfully request Mayor and City Council approval. Michael C. Van Milligen MCVM/jh Attachment cc: Barry Lindahl, City Attorney Cindy Steinhauser, Assistant City Manager Randy Peck, Personnel Manager THE CITY OF DUBUQUE Masterpiece on the Mississippi Dubuque All-Ameriacn City 2007 TO: Michael C. Van Milligen, City Manager FROM: Randy Peck, Personnel Manager SUBJECT: Acceptance of Worker's Compensation Claims Administrative Services Agreement DATE: December 16, 2008 I received the attached Agreement between the City of Dubuque and Alternative Services Concepts (ASC) for services related to the administration of the City's Worker's Compensation Program. The effective Date of the Agreement is October 1, 2008. On October 20, 2008, the City Council approved the renewal rates for Worker's Compensation Claims Services effective October 1, 2008 through September 30, 2009. The following is a comparison between the current rates and the renewal rates: Current Rate Renewal. Rate..... Service per Claimant Fee per Claimant Fee Increase/Decrease Workers' Compensation • Medical Only $160 $165 +$5 • Indemnity $736 $750 +$14 • Managed Medical Only $208 $750 +$542 Run-in Claims • Indemnity $450 $450 $0 • Med'ical' Only $50 $50 $0 Incident Reports $40 $40 $0 Catastrophic Claims Time and Expense Time and Expense Estimated Claims Fee $18,720 $18,300 -$420 Account Administration Fee $3,000 $3,000 $0 Litigation Fee $200 Plus Base Fee $250 Plus Base Fee +$50 Subrogation Fee -15% of Recovery 15% of Recovery stems Fee $2,500 $2,500 $0 Maintenance Fee for Claims open after 24 Months ` $450 $450. $0 Minimum and Deposit Claims Fee $24,220 $23,800 -$420 Managed medical only claims will be paid as indemnity claims, which means the cost for a managed medical only claim will increase from $208 per claim to $750 per claim. Under Additional Services, the client data transmission fee will increase from $295 per release to $2,500 per release. This fee would apply only if we went with a different third party administrator for our worker's compensation claims. The new fee provides for the transfer of all financial information to a new third party administrator. Under the previous fee schedule, the amount of information transferred to a new third party administrator would have been more limited. Also, the fee for medical cost management services will increase from 22% of savings to 25% of savings. Under the renewal proposal, the minimum claims fee will be reduced from $24,220 in 2008 to $23,800 in 2009. The reason the minimum claims fee is reduced is because we anticipate fewer medical claims next year, based upon claims history. In addition, the fee for managed medical only claims has not been included in the minimum claims fee. Consequently, the increase in the cost of the managed medical only fee would not be reflected in next year's minimum claims fee. Total expenses for worker's compensation claims administration services were $24,589.85 in 2007 and $27,420 in 2008. I anticipate that the administrative service fee for 2009 will be approximately $31,000, based on the new fee schedule. The Agreement has been reviewed by City Attorney Barry Lindahl and he found the terms to be acceptable. I request that the City Council pass a motion authorizing you to sign the Agreement. If you have any questions, please feel free to call. RP:tlb ~Iterr~~4~re w-~~nr~ci~ ~~nvep~t~, b~.~, CLAIMS SERVICE CONTRACT THIS AGREEMENT is made and entered into with an effective date of October 1, 2008 between ALTERNATIVE SERVICE CONCEPTS, LLC, a Delaware Corporation, with principal offices at 1101 Kermit Drive, Suite 800, P.O. Box 305148, Nashville, Tennessee 37230-5148, hereinafter referred to as "ASC", and CITY OF DUEUQUE, IOWA with principal offices in Dubuque, Iowa, hereinafter referred to as "Client". WITNESS: WHEREAS, "ASC" is in the claims service business; and WHEREAS, "Client" desires to contract with "ASC" as its claims service company to service the workers' compensation claims of "Client's" arising out of their facilities located in Dubuque, Iowa. NOW, THEREFORE, "ASC" and "Client" contract as follows: "ASC" AGREES: 1. (a) To review all claims and/or losses reported during the term of this Contract which involve workers' compensation claims against "Client". (b) To investigate, adjust, settle or resist all such losses and/or claims within the agreed payment authority limit of Two Thousand Five Hundred Dollars ($2,500). (c) To investigate, adjust, settle or resist all such losses and/or claims as are in excess of the agreed payment authority limit of Two Thousand Five Hundred Dollars ($2,500) only with specific prior approval of "Client". (d) To report excess claims to "Client's" excess carrier only if "Client" fulfills its obligations under "Client Agrees" Section, 4c. 2. To furnish all claim forms necessary for proper claims administration. 3. To establish claim and/or loss fifes for each reported claim and/or loss. Such files shall be the exclusive property of "Client". Such files are available for review by "Client" at any reasonable time, with notice. 4. To maintain 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 Professional Services. 5. To indemnify, defend and, hold harmless "Client" with respect to any claims asserted as a result of any errors, omissions, torts, intentional torts or other negligence on the Dubuque/1008 Page 1 0769 part of "ASC" and/or its employees, unless the complained 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 claim and/or loss payments and for associated allocated expense within the payment authority limit of Two Thousand Five Hundred Dollars ($2,500) and for claim and/or loss payments in excess of the payment authority 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 to this Contract. 3. To pay "ASC" within thirty (30) days of the effective date of all invoices. All past due invoices are subject to an interest penalty of one and one-half percent (1 1/2%) per month. In the event "ASC" brings any action or proceeding to recover any part or all of an outstanding indebtedness, "ASC" shall be entitled to recover as additional damages any reasonable 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 service fee to be paid to "ASC" as prescribed in this Contract. (b) "Allocated Loss Expenses" shall include but not be limited to attorneys' fees; experts' fees (i.e. engineering, physicians, chemists, etc.); fees for independent medical examinations; witnesses' fees; witnesses' travel expenses; court reporters' fees; transcript fees; the cost of obtaining public records; commercial photographers' fees; automobile appraisal or property appraisal fees; medical cost containment services, such as utilization review, provider bill audit, preadmission authorization, hospital bill audit, and medical case management; all outside expense items; extraordinary travel expenses incurred by "ASC" at the request of "Client"; and any other similar fee, cost or expenses associated with the investigation, negotiation, settlement or defense of any claim hereunder or as required for the collection of subrogation on behalf of "Client". (c) To provide "ASC" with complete copies of all excess policies which apply to the claims reported during the Contract period. Dubuque/1008 Page 2 07269 5. To relinquish authority to "ASC" in all matters relating to claims service within the agreed payment authority limit of Two Thousand Five Hundred Dollars ($2,500). 6. To indemnify, defend and hold harmless "ASC" with respect to any claims asserted as a result of an errors, omissions, torts, intentional torts, or other negligence on the part of the "City" and/or its employees, unless the complained of actions of "City" were taken at the specific direction of "ASC". "ASC" AND "CLIENT" MUTUALLY AGREE AS FOLLOWS: 1. (a) The term of this Contract is continuous from its effective date for one (1) year. This Contract may be terminated by either "ASC" or "Client" with cause by providing sixty (60) days' prior written notice by certified mail. (b) In the event that this Contract terminates or expires for any reason "Client" shall have the option: (i) to have "ASC" handle open files which have been reported for an additional fee based on our prevailing annual rate per file. (ii) to have "ASC" handle open files on atime-and-expense basis. (iii) to have "ASC" return the files to the client. 2. This Contract covers Claim Service for "Client" in the United States of America. 3. In the event any one or more of the provisions of this Contract shall be determined to be invalid or unenforceable by any court or other appropriate authority, the remainder of this Contract shall continue in full force and effect, as if said invalid and unenforceable portion had not been included in this Contract. 4. This Contract shall be construed and interpreted in accordance with the laws of the state of Iowa. 5. This Contract represents the entire understanding of "ASC" and "Client" and supersedes all prior oral and written communications between "ASC" and "Client" as to the subject matter. Neither this Contract nor any provisions of it may be amended, modified or waived except in writing signed by a duly authorized 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 party to observe or perform any of the terms or provisions of this Contract, or with respect to any default hereunder by such other party, shall not be Dubuque/1008 Page 3 07269 construed as a waiver or operate as a waiver of any rights or remedies of either "ASC" or "Client" or operate to deprive either "ASC" or "Client" of its right to institute and maintain any action or proceeding which it may deem necessary to protect, assert or enforce any such rights or remedies. 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 employed shall not have been employed by the other party during the immediately preceding six (6) months or unless the hiring party shall have the other party's prior written consent. This provision shall survive the termination of this Contract for a period 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 administrative fees. After the three (3) year period, files will either be returned to "Client" or destroyed if permitted by Statute. IN WITNESS WHEREOF, "ASC" and "Client" have caused this Contract to be executed by the person authorized to act in their respective names. ALTERNATIVE SERVICE CONC S LLC WITNESS: ,~ ~ `~ ,~ BY: TITLE: CEO DATE: WITNESS: CITY OF DUBUQUE, IOW ~ ~ r ,~ a 3 BY: ~~" ~ - - ~~~ .. _ Michael C. Van Milligen TITLE: C~a.tTNLna.ge*- DATE: Dubuque/1008 Page 4 07269 Alternative Service Concepts, LLC City of ubuque, Iowa ctober 1, 200 - eptember 30, 2009 Two-Year Claims Handling ® .. Workers' Compensation Medical Only 20 $165 $ 3,300 Indemnity 20 $750 $15,000 Litigation fee TBD $250 + base fee Run-In Claims Indemnity TBD $450 --- Medical Only TBD $50 --- Incident Reports' TBD $ 40 --- Catastrophic Claims2 TBD Time & Expense --- Estimated Minimum Claims Fee $18,300 Account Administration Fee $ 3,000 Systems Fee $ 2, 500 Minimum & Deposit Claims Fee $23,800 Claims will be handled for two years from the date the loss is reported to ASC with no additional per claim fee. Any claim remaining open after 24 months will be subject to an annual maintenance fee of $450.00 Notes ASC will handle the number of claims indicated for the minimum claims fee. If the fee for the actual number of claims is more than the minimum claims fee, ASC will invoice the client for the difference. The account administration fee will be 7.5% of the claims fee or $3,000, whichever is greater. The administration fee includes: • Account Setup ® New Claim Setup • Client Meetings (Frequency to be Determined) ' Recorrlerl Ira claims system only. Must be specified as "bzcident" at time of reporting. ~ Any event resulting in 10 or more claimants and/or property losses over $50,000 will be treated as a catastrophe. Dubuque/1008 Page 5 07269 "1: k ., ... ® Excess Reporting ® State Reporting ® Storage Fees At the conclusion of the contract, the following options are available for continued handling of open claims: • Negotiated annual fee per claim • Time and expense at ASC's prevailing rates • Claims returned to client Subrogation All parties will automatically be placed on notice if the potential for subrogation exists. Pursuit of subrogation will be performed at the client's request. Pursuit of recovery fee is 15% of recovery. Additional Services and Fees3 Client Data Transmission ................................................................... $2500 Per Release Carrier Data Transmission ................................................................. $400 Per Release State-Mandated EDI .......................................................................... $3 Per Report/Bill Computer Compatible Checks & Electronic Transfers ................... ..At Cost Data Conversion From Prior Administrator ........................................ At Cost On-Line Access (One User) ............................................................... No Charge Additional Users ........................................................................... $60 Per User Per ..................................................................................................... Month Reports Produced by Client ............................................................... No Charge Reports Produced by ASC ................................................................. $50 Per Copy Systems Training ............................................................................. T&E ($85 Per Hour) Customized Programming ................................................................. T&E ($/Hour) Index Bureau Reporting ..................................................................... $6.25 Per Report Actuarial Data Requests .................................................................... $50 Per Hour Travel Over 100 Miles ........................................................................ T&E ($85 Per Hour) Outside Investigation ........................................................................ T&E ($85 Per Hour) Medical Cost Manacement4 ee c e u ing ........................_..............................................25% of Savings PPO Usage ............................ ........................................... 30% of Savings Field Medical Case Management ........................................... $68 Per Hour Invoicing and Payment Terms Fees will be invoiced annually. Fees are payable upon receipt of the invoice. ASC reserves the right to charge 1'/2% per month or the maximum legal rate on unpaid balances after 30 days. Allocated Expenses Allocated expenses will be charged to the claim file and include fees for: • Legal services • Professional photographs • Medical records • Experts' /rehabilitation services • Index Bureau reporting • Accident reconstruction • Architects, contractors • Engineers, chemists • Police, fire, coroner, weather reports • Expert witness statements 3 As required or requested. Most services are optional. `' Pricing for additional managed care services is available upon request. Dubuque/1008 Page 6 07269 • Surveillance • Extraordinary travel at client's request • Independent medical examinations, MRIs, etc. Workers' Compensation Definitions • Official documents and transcripts • Court reporters • Managed care Medical Only Claims -Work-related claims that require medical treatment only. • Subrogation not required • Investigation sufficient to determine claim type and compensability • Lost days do not exceed statutory waiting period • No loss notices, captioned reports, client meetings, or settlement authority required • Payments do not exceed $2,500 • Two-point contact made Indemnity Claims -Work-related claims that involve disability or payment of medical and other expenses in excess of $2,500. Claims that require investigation for subrogation and settlement negotiations. All claims, regardless of type, will be investigated, evaluated, and adjudicated in accordance with state statutory requirements and corporate guidelines. ALTERNATIVE SERVICE CONCEPTS, LLC WITNESS: ~ (~~ BY: TITLE: CEO DATE: CITY OF DUBUQUE, IOWA f WITNESS: ;,~`~' ~,:=.~' -~~`" BY: ~, a~.__ "chael C. Van Milligen t,~" TITLE: ~c~~T~~g~ DATE: ~' ~~` ~~ Dubuque/1008 Page 7 07269 INSURANCE SCHEDULE C INSURANCE REQUIREMENTS FOR PROFESSIONAL SERVICES TO THE CITY OF DUBUQUE 1. All policies of insurance required hereunder shall be with an insurer authorized to do business in Iowa: AI~I insurers shall have a rating of A better in the current A.M. Best Rating Guide. 2: All Certificates of Insurance required hereunder shall provide a thirty (30) day notice of cancellation to the City of Dubuque, except for a ten (10) day notice for non- payment, if cancellation is prior to the expiration date. 3, shall furnish a signed Certificate of Insurance to the City of Dubuque, Iowa for the coverage required in Paragraph 6 below. Such Certificates shall include copies of the following endorsements: a) Commercial General Liability policy is primary and non-contributing. b) Commercial General Liability additional insured endorsement. c) Governmental Immunities Endorsement. shall upon request, provide Certificates of Insurance for all subcontractors and sub-sub contractors who perform work or services pursuant to the provisions of this contract. Said certificates shall meet the insurance requirements as required of 4. Each certificate. shall be submitted to the contracting department of the City of Dubuque. 5._ 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. 6. Contractor shall be required to carry the following minimum coverage/limits or greater if required by law or other legal agreement: a) COMMERCIAL GENERAL LIABILITY General Aggregate Limit Products-Completed Operations Aggregate Limit Personal and Advertising Injury Limit Fah (lrri ~rran~e I imit Fire Damage limit (any one occurrence) Medical Payments $2,0.00,000 $1,000,000 $1, 000, 000 ~~ ~~n nn~ $ 50,000 $ 5,000 1 of 2 January 2008 INSURANCE SCHE®ULE C (Continued) INSURANCE REQUIREMENTS FOR PROFESSIONAL SERVICES TO THE CITY OF ®UBUQUE This coverage shall be written on an occurrence form, not claims made form. All deviations or exclusions from the standard ISO commercial general liability form CG 0001 or Business owners BP 0002 shall be clearly identified. Form CG 25 04 03 97 `Designated Location (s) General Aggregate Limit' shall be included. Governmental Immunity endorsement identical or equivalent to form attached. Additional Insured Requirement: 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 shall be named as an additional insured on General Liability including "ongoing operations" coverage equivalent to ISO CG 20 10 07 04. b) Automobile $1,000,000 combined single limit. c) WORKERS COMPENSATION & EMPLOYERS LIABILITY Statutory for Coverage A Employers Liability: Each Accident $ 100,000 Each Employee Disease $ 100,000 Policy Limit Disease $ 500,000 d) PROFESSIONAL LIABILITY $1,000,000 e) UMBRELLA/EXCESS LIABILITY *Coverage and/or limit of liability to be determiried on a case-by-case basis by Finance Director. Completion Checklist ^ Certificate of Liability Insurance (2 pages) ^ Designated Location(s) General Aggregate Limit. CG 25 04 03 97 (2 pages) ^ Additional Insured CG 20 10 07 04 ^ Governmental Immunities Endorsement 2 of 2 January 2008 DATE (MMIDD/YYl'Y) R ~, I I I I I I 12~7~2007 PRODUCER (563) 123-4567 FAx (563) 987-6543 THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ;urance Agency HOLDER. THIS CERTIFICATE DOES NpT AMEND, EXTEND OR ., vreet Address ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Cit ST Zi Code INSURERS AFFORDING COVERAGE NAIL # INSURED INSURER A: IllSUranCe COffi an COffipany INSURER 8: Street INSURER C: INSURER D: C1t .St Z1 COde INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. fNSR LTR ADD'L INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS GENERAL LIABILITY ~ EACH OCCURRENCE ~ S 1, 000, 000 DAMAGE TORENTED 50 000 $ X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence + A X CLAIMS MADEOCCUR MEDEXP(Anyoneperson) $ 5,000 - - PERSONAL 8 AOV INJURY ' ~ nnn n w + i °'~%+ ~ GENERAL AGGREGATE $ 2+000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ 1 + 000 + 000 POLICY X JE ~ LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 1 + 000 + 000 X ANY AUTO (Ea accident) A ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY S OWNED AUTOS N (Per accident) - NO PROPERTY DAMAGE $ 1 -, + ~ ~, (Per accident) I ) GARAGE LIABILITY `~ ~ 1 , , AUTO ONLY - EA ACCIDENT S i ANY AUTO ~ 1 ~ I OTHER THAN EA ACC $ ~ ~~ ~ ~ ~ j J - ~ I AUTO ONLY: AGG $ A EXCESS/UMBRELLA LIABILITY Y + . ~, '' _ . _/. _ - l~ '! ! ~ EACH OCCURRENCE $ 1 + 000 + 000 R CLAIMS MADE X C ~ ! ~ ,~ i ,i ~ I', ~/ ~ AGGREGATE $ 1, 000, 000 OC U ~ ~,i 'y , ~. ` $ CTIBLE D ' '~ ~ S DE U X RETENTION $ 0 ` $ A WORKERS COMPENSATION AND WC STATU- OTH- X TORY LIMITS ER EMPLOYERS' LIABILITY E.L. EACH ACCIDENT 100 000 S + ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? E.L. DISEASE-EAEMPLOYEE $ 100,000 If yes, describe under E.L. DISEASE • POLICY LIMIT $ 500 + 000 SPECIAL PROVISIONS below $1,000,000 A OTHER professional Liability DESCRIPTION OFOPERA7wN5/l-ucAnunarvcn~~~w,cn~.~ua,~rvanvucv ~~ ~~.~...~..~.•~..~•••~~ --~•~-~ ••--•-•-~-- I The City of Dubuque is an additional insured an general liability policies including ongoing & completed operations ^,o.•?r?rt= ersuava7.ent to ISO CG 2010 0704 5 CG 2037 0704. General Liability policy is primary &non-contributing. Form CG 2504 0337 "Designated Locations" ger_eral liability aggregate lim;t as included. Governmental immunities enaorsamentl CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City Of Dubuque EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 50 West 13th Street 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT Dubuque , IA 52 001 FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTAflVES. AUTHORIZED REPRESENTATIVE 4CORD 25 (2001/08) NS025 (Dloa).os AMS VMP Mortgage Solutions, Inc. (800)327-0545 ©ACORD CORPORATION 1988 Page 1 of 2 i~®~~~~~ If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). ®ISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. 1CORD 25 (2001108) V$025 (0108).06 AM$ Page 2 of 2 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 25 04 03 97 THIS EN®®RSEMENT CHANGES THE P®LICY. PLEASE RE~.® IT CAREFULLY. I This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Location(s): ANY AND ALL COVERED LOCATIONS (If no entry appears above, information required to complete this endorsement ww oe snown m me veciarauuns as applicable to this endorsement.) For all sums which the insured becomes legally A the Declarations nor shall they reduce any . obligated to pay as damages caused by "occur- d N I " other Designated Location General Aggre- ate Limit for any other designated "location" ), an under COVERAGE A (SECTIO -rences g for all- medical expenses caused by accidents shown in the Schedule above. under COVERAGE C (SECTION I), which can be 4. The limits shown in the Declarations for Each attributed only to operations at a single desig- Occurrence, Fire Damage and Medical Ex- nated "location" shown in the Schedule above: pense continue to apply. However, instead of 1. A separate Designated Location General -being subject to the General Aggregate Limit Aggregate Limit applies to each designated shown in the Declarations, such limits will be "location", and that limit is equal to the subject to the applicable Designated Location amount of the General Aggregate Limit General Aggregate Limit. shown in the Declarations. B. For all sums which the insured becomes legally 2. The Designated Location General Aggregate obligated to pay as damages caused by "occur- Limit is the most we will pay for the sum of, all rences" under COVERAGE A (SECTION 1), and damages under COVERAGE A, except dam- for all medical expenses caused by accidents - ages because of "bodily injury" or "property ION I), which can- under COVERAGE C (SECT damage" included in the "products-completed not be attributed only to operations at a single operations hazard", and for medical expenses designated "location" shown in the Schedule .under COVERAGE C regardless of the Hum- above: ber of: 1. Any payments made under COVERAGE A for Insureds; a damages or under COVERAGE C for medical . expenses shall reduce the amount available b. Claims made or "suits" brought; or under the General Aggregate Limit or the c. Persons or organizations making claims or Products-Completed Operations Aggregate bringing "suits". Limit, whichever is applicable; and 3. Any payments made under COVERAGE A for 2. Such payments shall not reduce any Desig- . damages or under COVERAGE C fog medical natPd Location General Aggregate Limit. exrenses shaii reduce the ucsignaied Lc::a- tion General Aggregate Limit -for that desig- nated "location". Such payments shall not re- duce the General Aggregate Limit shown in CG 25 04 03 97 Page 7 of 2 CG 25 04 03 97 C. When coverage for liability arising out of the "products-completed operations hazard" is pro- vided, any payments for damages because of "bodily injury" or "property damage" included in the "products-completed operations hazard" will reduce the Products-Completed Operations Ag- gregate Limit, and not reduce the General Ag- gregate Limit nor the Designated Location Gen- eral Aggregate Limit. D. For the purposes of this endorsement, the ®efi- nitions Section is amended by the addition of the following definition: "Location" means premises involving the same or connecting lots, or premises whose. connection is interrupted only by a street, roadway, waterway or right-of-way of a railroad. E. The provisions of Limits Of Insurance (SECTION III) not otherwise modified by this endorsement shall continue to apply as stipulated. . Copyright, Insurance Services Office, Inc., 1996 CG 25 04 03 97 Page 2 of 2 POLICY NUMBER: This endorsement modifies insurance provided under the fiollowing: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 :Name Of Additional Insured Person(s) Or Organization(s) 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. Location(s) Of Covered Operations Information required to com lete this Schedule, if not shown above,: will be shown in the Declarations. A. Section II -Who Is An .Insured is amended to include as an additional. insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or n r-~_ ..a.. nmicci~nv of thn.gc aetinn f)n VOUr behalf; in the performance of your ongoing operations for. the additional ins.ured(s) at the location(s) desig- nated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does riot apply to "bodily injury" or "pf vj.iciiy daifiaye" UCCUrrl lg cfiter: Page 1 of 2 CG 20 10 07 04 1. All work, including materials, parts or equip- ment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insureds) at the location of the covered operations has been completed; or 2. That portion of, "your work" out of which the injury or damage arises has been put t® its. in- tended use by any person or .organization other than another contractof or subcontractor engaged in performing operations fora princi- pal as a part of the same project. All terms and conditions of this policy apply unless modified by this endorsement. Page 2 of 2 ©ISO Properties, Inc., 2004 CG 20 10 07 04 - CITY OF DUEUQUE, IOWA 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. ~1~' ~~' ~~_l I~!1-~_l~r~T 1 of 1 January 2008