Cottingham & Butler Insurance Services Agreement for Employer Mandate Reporting ServicesCopyrighted
October 16, 2017
City of Dubuque Consent Items # 19.
ITEM TITLE: Cottingham & Butler Insurance Services Agreement for
Employer Mandate Reporting Services
SUMMARY: City Manager approval of an agreement with Cottingham &
Butler Insurance Services to prepare and file the required
Internal Revenue Service forms 1094-C and 1095-C on
behalf of the City in accordance with the Patient Protection
and Affordable Care Act.
SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Approve
ATTACHMENTS:
Description Type
Employer Mandate Reporting Services Agreement -MVM City Manager Memo
Memo
Staff Memo Staff Memo
Employer Mandate Reporting Services Contract Supporting Documentation
Insurance Schedule J Supporting Documentation
THE CITY OF
Dui
Masterpiece on the Mississippi
TO: The Honorable Mayor and City Council Members
FROM: Michael C. Van Milligen, City Manager
SUBJECT: Employer Mandate Reporting Services Agreement
DATE: October 10, 2017
Dubuque
bell
All -America City
'1Il1'
2007 • 2012 • 2013 • 2017
The Patient Protection and Affordable Care Act requires employers to comply with
certain reporting and disclosure requirements for health insurance coverage provided
during the 2017 calendar year. The IRS requires all employers with 50 or more
employees to file 1094-C and 1095-C forms. Last year Cottingham & Butler Insurance
Services, Inc. prepared and filed the necessary forms with the IRS for a fee of $6,250
plus $3.75 for each form filed and prepared beyond 500 forms. They are proposing to
keep their fees the same as last year.
Personnel Manager Randy Peck recommends City Council approval of an agreement
with Cottingham & Butler Insurance Services to prepare and file the required Internal
Revenue Service forms 1094-C and 1095-C on behalf of the City.
I concur with the recommendation and respectfully request Mayor and City Council
approval.
f7tAlkied? kcnt (14 An --
Michael C. Van Milligen
MCVM:jh
Attachment
cc: Crenna Brumwell, City Attorney
Teri Goodmann, Assistant City Manager
Cori Burbach, Assistant City Manager
Randy Peck, Personnel Manager
Masterpiece on the Mississippi
TO:
FROM:
SUBJECT:
DATE:
Dubuque
AII-Amerlca City
2007 • 2012 • 2013 • 2017
Michael C. Van Milligen, City Manager
Randy Peck, Personnel Manager
Employer Mandate Reporting Services Agreement
October 9, 2017
The Patient Protection and Affordable Care Act added Sections 6055 and 6056 to the
Internal Revenue Code. Under these provisions, employers must comply with certain
reporting and disclosure requirements for health insurance coverage provided during
the 2017 calendar year. The IRS requires all employers with 50 or more employees to
file 1094-C and 1095-C forms under these code sections. Rules under Section 6055
require employers providing minimum benefits coverage to an individual to file a return
and transmittal form with the IRS for every calendar year of coverage. Section 6056
requires employers to report information to both the IRS and their employees on the
healthcare coverage offered to employees.
Last year Cottingham & Butler Insurance Services, Inc. prepared and filed the
necessary forms with the IRS. Their fee last year was $6,250 plus $3.75 for each form
filed and prepared beyond 500 forms. They are proposing to keep their fees the same
as last year.
I recommend that we enter into the attached agreement with Cottingham & Butler
Insurance Services to prepare and file the required Internal Revenue Service forms
1094-C and 1095-C on behalf of the City of Dubuque. The requested action is for the
City Council to approve the agreement and authorizing you to sign the Agreement.
RP:alk
Employer Mandate Reporting Services Contract
This Agreement (the "Agreement") between Cottingham & Butler insurance Services, Inc,
("0&13"), and the gt,yeef,11.thecieseLe, (the "Campany") (collectively the "Parties"),
confirms that the Company will engage C&B to prepare and file required Internal Revenue
Service ("IRS") Forms 1094-0 and 1095-0 (collectively the "Forms") on behalf of the Company
and hat C&B will provide to the Company an electronic copy of Form 1095-0 for distribution to
employees.
ARTICLE Services, Term, and Fees
• 1.1 SCOPE OF SERVICES,. o&B will, provide Services necessary for the Company to complete and
file the =•orms, C&B.vvill also provide to the COrneany electronic copies of completed Form 1095-C In a
format suitable for distribution the Company's employees, along with one submission of Social Security
Number and names to the IRS for TIN Matching,
• 1.2 TERM,. C&B will provide servIces-under the.Agreement from the date the execution date °Ito
Agreement until April 2nd, 2018, The ,Company will provide to C&I3 complete calendar year
information as required for filing of the Forms no later than January 12, 2018.
1.3 FEES AND COSTS. For conIpletion of 500 or fewer Forms, the Company agrees to pay the
greater of $3,125 or $12.60 per Form completed, For completion of over 500 Forms, the Company
agrees to pay 86,250 plus $3.75 for each Form beyond 500. The Company furthermore agrees to pay
8600 for each additional Employer Identification Number, if applicable. Printing and / or mailing of
forms must be requested In advance and the Company will pay an additional S1,30 per form.
In addition to the fees outlined above, C&B will charge the Company for any actual out-of-pocket
costs that are incurred in rendering services. These costs may include travel expenses, delivery and
courier services, express mall, air courier services and outsice contractor document reproduotion.
C&B may ask Company to 'pay directly any expenses In excess of $100,00, Out-of-pocket costs are
not subject to any mark-up.
C&B will provide to the Company an invoice for all estimated fees and costs no later than
December 16, 2017, with payment due from the Company no later than December 31, 2017, Upon
filing and delivery of the Forms, C&B will provlce to the Company a final invoice reconciling any
difference between estimated and actual costs. Any remaining payments resulting from the final
invoice will be due within 30 days,
1,4 TERMINATION,, The Company may terminate the Agreement at any time upon written notice to
C&B, C&B may terminate the Agreement if (a) the Company falls to pay any fees or expenses that
have been billet to the Company within the time set out in paragraph 1.3 above, or (b) the Company
falls to provide required data to C&B by January 12, 2018, or (c) for no cause with 14 days written
notice, The Company will bo liable for any and all fees and expenses incurred up to the termination
date, inducing the base fees described In paragraph 1.3 above,
Insurance Services Inc Is not a law 5h -n and does not provide leoal services. There Is no attorney-ollent relationship,
of 3
ARTICLE It: PROVISION OF DATA AND LIMITATION OF LIABILITY
2,1 REQUIRED DATA, The Company will provide to C&B any and all data required for the completion
of the Forms. Such data will Include names, addresses, and social security numbers of employees of
the Company as well as data concerning employment numbers and health plan offerings for
employees of the Company. The Company acknowledges that the Company bears sole responsibility
for gathering applicable data and providing the data to C&B for completion of the Forms,
2.2 LIMITATION OF LIABILITY AND ACKNOWLEDGEMENT OF COMPLIANCE.
RsPONSIBILITIES. C&B will not undertake any independent investigation or verification of Company
data, and C&B does not guarantee the accuracy of the completed Forms 1094-C and 1095-C. The
Company hereby recognizes, acknowledges, and agrees that It bears the ultimate responsibility for
complying with any state or federal law, including but not limited to provisions of the Patient Protection
and Affordable Care Act and the Health Insurance Portability and Accountability Act, Moreover, the
Company hereby recognizes and acknowledges that federal law Is subject to change at any time, C&B
accepts no responsibility for Company's compliance with these laws.
2.3 AGREEIV ENT TO INDEMNIFY AND HOLD HARMLESS, The Company and its officers, directors,
employees, agents, successors, and assigns hereby agree to defend, indemnify, and hold harmless
C&B and C&I3's officers, directors, employees, agents, successors, and assigns, from and against any •
and all ()fah% costs, damages,'loses, ilabilities, actions, recoveries, judgments, and expenses
(Including attorney fees and expenses regardless of whether litigation was commenced) arising out of
or in connection with the Company's failure to comply with any state or federal law, Including but not
limited to provisions of the Patient Protection and Affordable Care Act and the Health Insurance
Portability and Accountability Act.
ARTICLE III: GENERAL TERMS AND CONDITIONS
3,1 DISCLAIMER OF VVARRANTIES, IN NO EVENT WILL C&B INCUR LIABILITY FORANY
CONSEQUENTIAL, SPECIAL, PUNITIVE, OR INDIRECT LOSS OR DAMAGES, REGARDLESS OF
WHETHER SUCH DAMAGES ARE BASED CN CONTRACT, TO.RT (INCLUDING NEGUGENCE).
STRICT LIABILITY, OR ANY OTHER THEORY OR FORM OF ACTION, AND REGARDLESS OF
WHETHER C&B KNEW OR.SHOULD HAVE KNOWN..OF THE LIKELIHOOD OF SUCH DAMAGES IN
ANY CIRCUMSTANCES. THE COMPANY ACKNOWLEDGES THAT C&B MAKES NO
WARRANTIES, EXPRESS OR IMPLIED, INCLUDING WITHOUT LIMITATION THE WARRANTIEs,
OF MERCHANTABILITY AND QF FITNESS FOR A PARTICULAR PURPOSE.
3,2 NO PROVISION OF LEGAL ADVICE, C&B will not provide any regal or financial advice to the
Company nor will C&B act as a fiduciary of the Company under this Agreement.
3,3 CONFIDENTIALITY, CO, its employees and agents will hold in strict confidence all data furnished
by the Company or produced by C&B under this Agreement. However, such parties will not be held
liable if such data is released through other sources, or If C&B, its employees or agents release the
data because Company has consented to such disclosure.
C&B Insurance Sonilces Inc Is not a low firm and does not provide legal eel -Vices, There Is no attorney-client relations*,
2 at 3
3.4 RECORD RETENTION,This Agreement does not relieve the Company of Its obligations under
fec era! or state laws or regulations to retain records relating to any cat a Drevicled to OB.
3,5 ENTIRE AGREEMENT. This Agreement enc any addendum to this Agreement (hereinafter called
"Contract Documents") constitutes the entire agreement between C&B and the Company,
3,6 NOTICE. Any person identified by Company In this Agreement or any certification, notice or other
communication delivered to cui may receive Information, communications and notices regarding the
service, and Is authorized to transact all business, make all agreements and sign and deliver all
documents in connection with the service. If the identity of such a person changes, the Company will
promptly notify C&B in Writing of the change. C&B will have a reasonable time after receipt of a
certification, notice or other communication to act on It,
3.7 GOVERNING LAW. This Agreement shall be governed by the laws of the State of Iowa.
3,8 BINDING AGREEMENT. This Agreement shall be bIndlng,on and inure to the benefit of the
parties to thIS Agreement and their respective heirs, representatives, successors and assigns.
3.9 ASSIGNABILITY. This Agreement may not be assigned by either party without the express written
consent of the other party, which consent shall not be unreasonably withheld, except that CU may
delegate and assign any of Its duties hereunder to any affiliate of C&B or to any third party
subcontractor, without the need for prior approval.
3,10 NO IMPLIED WAIVER,. The failure of C&B to enforce or insist upon compliance with any of the
terms or conditions of this Agreement, the waiver of any term or condition of this Agreement, or the
granting of an extension of time for performance, shall not constitute the permanent waiver of any term
or condition of this Agreement and this Agreement and each of Its provisions shall remain at all times In
full force and effect,
3,11 AUTHORITY,. The undersigned warrants and represents that the undersigned has full power and
authority to enter Into this Agreement, to bind each Party hereto, and to grant the rights set forth herein,
3,12 SEVERABILITY,. If any term In this Agreement Is held by a court of competent Jurisdiction to be
invalid or unenforceable, then the Agreement, Including all of the remaining terms, will remain in full
force and effect as If such invalid or unenforceable provision had never been included.
C8413 Insurance Servlsos Inc Is nol a law ftrm and does not provide legal services. There is no attorney-client relationship.
3 of 3
The Parties hereby enter into this Agreement as of the clate listed below,
COTTINGI-IAM AND BUTLER [CLIENT NAME]
INSURANCE SERVICES, INC. City of Dubuque, IA
By:
riti
Date:
8,7?pLt---}/ Paiii/V&W
Senior Vice President
10/31/2017
By:
i lane: U. Van Milligen
Tit's:City Manager
Date;
ond does rot provide legal services. There Is no attorney.ollent rilatIonshIp.
4 of 3
1.
City of Dubuque lnsurance Requirements for Professionl Services
INSURANCE SCHEDULE J
Cottingharn and Butier Insurance Services, Inc.
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 presentingannua|oerbOcateanha||proaenio
certificate at the end of eaoh project with the final bitling. Each cartificate shall be prepared on
the most current ACORD form approved by the Iowa Department of Insurance or an equivalent
approved by the Financo Director. Each certtficate shall include a statement undsr Desoription of
Operations as to why the certificate was issued. Eg: Project � or Pject Location at
or construction of
2. Alt polt6ies of insuranceregqiredhereunderoho||ba*ithan|naurerauUnorizedtodobua|nomoin
lowa and all insurers shall have a rating of A or better in the current A.M. Best's Rating Guide.
3. Each certhicate shall �m��b�furn|ohed�othe Department of the City of Dbuque.
4. Failure to provide coverage required by this Insurance Schedule shall not be deemed a waiver of
these requirements by the Ciy 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-suboonou|tants.
Contractors agre thatt thshall beliable for the failure ofaaubooneu|tontand sub-
subconsultant to obtain and maintain such coverages. The City may request a copy of such
certificates from the Contractor.
6. Alt required endorsements shall be attached to oertificate of insurance.
7. Whenever a specific ISO form is listed, required the current edition of the form mst be used, or
an equivailent forrn 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 1, If the contractor's limits of Ilabfllty are hlgher than the
required minimum limits then the providers limits shall be this agrement's required limits.
Page 1 of 4 Schedule J Professional Services July 2017
City of Dubuque nsurance Requirements for Professional Services
|N��U��0(�����(�A�cF1U| SCHEDULE ,~�.~^..~��~^.��~�^-~� (continued)
Exhibit
A) COMMERCIAL GENERAL LIABILITY
General Aggregate Limit $2.000.000
Products -Completed Operations Aggregate Lirnit $1.000.000
Personal and Advertising Injury Limit $1.000.000
Each Occurrence $1'080.000
Fire Damage Limit (any one occurrence) $50'000
Medical Payments $5.000
1) Coverage shall be written en an occurrence, not claims made, form. The general
IiabiUty coverage shall be written in accord with ISOform CG0001 or business
owners form BP0002. AH deviations from the standard ISO commercial general
Iiability 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 Liit" orCG25O3^DaaignahsdConobouUon Project () General
Aggregate Limit" as appropriate.
3) Include endorsement |ndioa�ngthat coverage isphmaryand non'nonbibutory.
4)
Include Preservation ofGovernmental Immunities Endorsement. (Sample
attached).
5) !nclude ari endorsement that deletes any fellow employee exclusion
6) lnclude additional irisured 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
C) WORKERS' COMPENSATION & EMPLOYERS L!ABIL(TY
Statutory benefits covering all employees injured on the job by accident or disease as
prescribed by towa Code Chapter 85 as amended.
Coverage A
Coverage B
Statutory—State of Iowa
Employers Liability
Each Accident $100.000
Each Employee -Disease $100.000
Policy Limit -Disease $500.000
PoIicy shall include Waiver of Right to Recover from Others endorsement.
Nonelection of Workers' Compensation or Employers' Liability Coverage under lowa
Code sec. 87.22
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 $1,000,000
Xyes
no
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 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 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 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 Chance in Policy. The above preservation of governmental immunities shall not otherwise
change or alter the coverage available under the policy.
(DEPARTMENT MANAGER: FILL IN ALL BLANKS AND CHECK BOXES)
Page 4 of 4 Schedule J Professional Services July 2017