Tri-State Occupational Health Agreement Amendment 2018 Copyrighted
August 20, 2018
City of Dubuque Consent Items # 15.
ITEM TITLE: Tri-State Occupational HealthAgreementAmendment
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 Type
Tri-State Occupation Health Amendment to Agreement- City Manager Memo
NNM Memo
Staff Memo Staff Memo
Amendment Supporting Documentation
Agreement Supporting Documentation
Insurance Schedule J Supporting Documentation
THE CITY OF Dubuque
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AIFA�erlwGh
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Masterpiece on the Mississippi Z°°'�w'2
7A13 2017
TO: The Honorable Mayor and City Council Members
FROM: Michael C. Van Milligen, City 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 9, 2018
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 , 2018, through September 30, 2019. The cost of the service will
increase from $45.50 per hour to $46.85 per hour, for a total annual cost of$19,490.
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
Cori Burbach, Assistant City Manager
Randy Peck, Personnel Manager
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TO: Michael C. Van Milligen, City Manager
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 7, 2018
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, 2018 through September 30,
2019. The cost of the service will increase from $45.50 per hour to $46.85 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$19,490. �
The requested action is for the Cifiy 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, LL.C. (TSOH) and CITY' OF
DUBUQUE, effective October 6, 2014, is hereby amended as follows:
Agreement Pararxreters. C, is deleted in its entirety and replaced with:
C. The term of this Agreement shall begin on October 1, 2018, and shall continue
through September 30, 2019.
eimb . , ,. a .: s . l .R e Occu
its entirety and replaced vviilz:
s deleted in
A..For onsite occupational health nursing services the City will pay TSOH $46.85 per hour,
This Amendment will become a part of the original Service Agreement of October 6, 2014, The
parties hereby ratify and aim that all other terms and provisions of the original Agreement and their
intent shall remain in full force and effect.
TRI-STATE OCCUPATIONAL HEALTH, LLC.
Sue Meade
Board of Managers Chairperson
CITY OF DUBUQUE
Michael Van Defilligen
City Manager
Date
)
Agre?menE
Between
Tri•5taEs Occupatlonal Health, L.L,C,
And
Tho Cify of Dubuque
Thls Agr2emenf is macle and enterecl 1n;o this ,�;:� d�,�
of .�i���'���!j��2014, by and beb�veen Tri-Stafa Occupafional, L,t„C., � corporatian �
organized and establish9d urder the laays of 1o4��a, f1�VIFlg Ifs principal p(ace of business
afi 1940 Elm S;reef, Dubuque, Dubuque County, IoUr�, ("TSOH"}, and fhe Cif/ oP
Dubuque, havinc� Its principal plac� of businsss at 50 U'lest 13th Sfroet Dubuqu�,
Dubuque Counly, lo�va ("Clty"), '
' 5cope
A. 'i'S0H is In the business of praviding accup7f;onal medicine, wor�er's
compensafion and related therapy services and �s specific�lly relat9s to
--------- -� -this a�reemenf;-is-in-the-busin�ss-of-provlding onsita occupational-healih� � ------
__ nursing sevices throuyh iis ph/sicians, providars and clinical nursing
staff.
i
Recitals
A. City will;
. 1. Provide a facility lacation for fhe provision of onsit�occupa!lon�l heal�h
rursing se�iices.
2, Assuma all of the roles and rEspons�bility for OSHA recard-keeping
a�d related fu7cfions.
B, TS�H�vill;
1, Pr�vlde onsifaoccupational he�lfn nursing services to tha Gi`y,
2, Provfde empfoy�e supa�v!sio,�, Includin� cllnlcal and medical dir�ction
oversighi of fh�e onsita cccupaf;or.�l neallh nu�sing se�iices,
3. Pr�vide onsita eccupation�l nursiny ser�,ices for ei�hf (�) hours per
�vorl<ev�ek.
a. Recomrr�end al� raferral ancf io'lo�,�r-up t;eatment ser�iices (e.g, therapy,
orfhopedics, suryery, etc.), to aptimize qaa!ty of cara and casa
mana�emen!. TSOH �ri'll cJir�ct car according to Cily's avishes, and
City ackno��r!adg�s tha! cara coordinafior• a�d tr�2tment out��om�s
� outside 7SOH recammendations ma/ or may rot .meet TSpH's
sfandard o(care,
5, Pro�iicle occupational fherapy �nd rehabili�a;ion sei�vices a! City
request, � -
6, h�lanage tne employe� medicaf chari on-site, maintaininc� a separakion
of acc�.ipa0onal haalth and worke�'s comoensation care notes frorn
psrsonal healfh and rredical care informatlon. TSOH wlil retaln
ot��mership of personal healfh Informafion,
7. Abide by ths fo[lo�,virg Altachmenfs:
� AAOHN Code oC Ethics�nd lnferpre;akive Stafemenfs
� f1A0H�i Case Nlanagement; Th�e Occupatlanal �nd Environmental
Noaltt� Nurse Role ,
� AAOHN Deliv�ry of Occupatlor�al ancl Envlronmer,al Health
Servlcas
� S:andards of Occupational�nd Ertvironmen!al Heali�� �lursing
In considerati�n of the mat;e°s descri.bed above, and of the mutual bonefils and
obligations sef forth in this agreernenf, the partles ayrse as folloN�s:
---- --- ----- - ------- -------- -
._... ----�-------�-- - - Secfion 1
Ac�reomanE Parameters
A, TSOH �viil provide onsi�e.occupatlonal hea!th nursing services for an
� average scheduled fime frame oP elghl (d) hours every work w�ek. Start
and end tirr�es for poverac�.e 4vili be agreed to In a�v�nce by TSOH and
City,
B, Orsica oca�patlonal healih nursing sarrlces will be pro��ided by �n
appropriately qualifled TSOH nurse.
C. The ini`.ial term of this Agreameni shall from t��e 6ti�day of October,20�4,
to midnighf on fha 3Gth day of Sepfamber,2Q15,
SecHon 2
Relmbursement for onsito Occupatlona( Noalth Nurslnc�Services
A. For onsife occupational health rn.�rsing seriices th� C!ty �vill pay TS01-I
�43,35 per hour,
B, Onsit�occupafional �,��Ith nursing se:v(res providacJ by TS�H to City U�ill
be invoicad c�n� nrrthky basis. �
}
Sect�on 3 •
Cornpliance w(fh All Appiicak�le l.aws
TSOH and Ciry agree fha� t;�ey are bound by and wlll camply wlfh�II app;icable
f�d�ral, staie, loc�l laaas, orclinance;or r��ulations,TSpH and City ac�ree ta dofend, �
indemnify and�old harmfess each.other against Icss or damac�e, including,buf nof
� Iimited fo, raason�ble attorne/s'fees, resufting from kheir rospecfive negl!gence in lhe
performance or nonnerformanco af this A,greernonf,
Section 4
Independant CanQraetor Relatlansnip
Tn�partles agree that fhe rel�tionsnip between TSOH and City in cne of o�,vner� �
independenf contractor and nothing herein shali be conskrued or interprefad in anyway
to craafP an employer�ernployee r�latlonship betwasn TSOH and Cih�cr bet4veen Cify
a�d any oP TSQH's ofF;cers, agants or e�tiployees,
Soction 5 �
CiEy F2esponsib(lities
M A, City wiR provide� minimum one (1) �veek natice fo TSOH If t��e regul�rly
ag;ead to City work schedule for the onsit�occupational heallh nurse Is to
be cancel;ed. 5uch notice shail be pru��ided �y ccnt�ct;'ng the TS�H
6Aan�ger or Clinical P�iana�er.
8, Cify�r�ili pa�TSOH invoiced fees Uiithin 30 days.
Sect(o'n B
A�reem�nt Nof To Hiro Nor Soficlf Employees
Cfty agraes that far a perlod af t�No(2}y�ears from the dat�of farrrin��ion of this
Agreomen!, neither Git9 nor any or ifs m�mbErs sha(I hir�, solicit,or�ttempt fo hirs or
soliuit Gny a`TSOH's emplcyees tha;�re or�,vere sub;oct fo this Agreement. Ci;y and
its members furthar agre2 thal the ren�ed�at la�,�i for any�reach by City a.�cl!ty
mambers of t;�is Section 6 w;tl b�inadar,uate�nd fhat T80H snall be ei;ti`.led fa
injunctive reiief in casa of any such breach,and TS01-I shall be enti;lecl to r�covsr its
cos;s Incu��red in conduct:nc�any la��vsuir, Includiny reasonaUl��ftorneys'f�es and
�xpenses. Tnia�rovi�ioi� can b:��i�i�ied b/mutual agreement of TSOFI�nd City,
recF(ved and acknr�,��ledged In�irfkin�.
) Section 7 ,
Payment oF Taxes or�enafits
TSOH shall pay any ard all employm�nt-re!atad taxGs and benefits for fhe TSOH �
employao(s)subject to tnis Agre�rnent
• Section �
Use of Trade Names and Signs
Ci'y shall nof uss in any manner directly or indirecfly, or in ��ihole or in parl, th�
s!gnature, monogram or any ofher trademark or name fhat Is no44i or may in tha futura
be owned by TSOH, except In a manner, �nd to an exfent that TSaF+m�y specifically
consent in �vritirc�, !f any tradamark or name Is used in any way by Clt�/ 4vlth fhQ
express ��iritfan approv�f oF TSOH, City on fhe tarminatien of this Agresmenf, shall
discon�inue�II such use a��d shall not subs�quantly use�ny name,titla cr expression In
connectlon �vith any busfness in +rrhich Cify may bs enc�aged that, fn lho judgment af
TSOH, so ne�rly resemblas any tracl�m�rk or n�me, o�rrned by T50H as may be 1lkely
to lead fo confusion or uncerta;nfy on fhe part of the�pubGc,
• - - --- ---... -- ----------�—=---SectPon-g---- --------- — ---
Transferability
All benef;fs and dut;es oF elther party uncler thl,Ac�re�mant ara non-transferable,
i
� Section 1Q
Terminafian Noflca Clause
Thls agreamer`,may be terminated Uy elthe�party,Niifh or withouf cause,upon '
tr,irty(30)da�s airif:an notice Co the other party,
Section 1•I
L.fability Of Parties To The AgresrnenE Upon Termination Qf Agreoment
Upon tarminafion of this a�r�ement, City shall rama.in Ii�ble to 7SOH for any
payments than o�,ved t�1'SOH.
Section 12
Modification
This Agreemerl r:,�fleot; all th� a�reemenfs, u:7ders,a�dir,��s, represenla�ior.s,
conditions ancl w�rranfies by and beb,veer khe parties. P�leitrer j�art� sh�l� b�: liable for
any rap�esentation m�da unfess if is e;tprssly sef far;h in this Ayr�emer}t, and �his
,=�gresmer,t may no;` be modified or amei7ra�:a excepf in � ��rriting si�ned �y pofh o'the
parties,
.�
Secfion 13
Soverablllty �
If any provision cf fhls Agr�emenf shalf be daclared by any courf of competent
Jur(sdlc�ion to be Ilfegal, �roid or unenforcea�le, all otner provisions of this Agreemenf �
shall not be aF'ecfed ard sh�ll r�main in full farca and effect
Sectlon �4
Goyorninc� La�r�
Thfs Ayroemsnt shall bo go��erned by the la�,vs of the Stafe or lo�va.
• Sect(nn 15
ArbiEraflon
If a dispu;e arlses�vifh resp�ct to fhls Agreement, it shall ba decided finally by an
arbilrator !n an arbifr�tion proceedln� conForming to tho Rules of tne American
Arbitration Associaflon appllc�ble fo ccmmerclak arbitratiors, Th� arbitraf�r shall be
-- -�el?ct�d-In-�cc�rd�nce to-the Rules of the Amer can A�r�'rlration �ssoriation, The
arbitration shall take place In Dubuquo, lo�ia, and tiie decislon af the arbitralor shall be
conclusivel/ binding upon the parlies and final and such decision shall be enforceable
as a Judgment In �ny couri af r.ampefent Jurlsdictia.n. The arbi�rator shall assess the
} casf of aroifratien ta the nan-prevailin�pariy, and �avard reasorahlylncurred altorney's
feos and cosls, in favor af the substantially prevailiny patty�!fhe ar6itration.
� Section 16
Acts oP Governments, War, Terrarism, �latura) nfsaster Clause
If eiuher par�y to this Agreernen�is affected in such a v�ay by changes in I�av,acts
o` war, acfs of fora,�n �overnment�, acts cf te�rorism, nafural dis�,ters, or siini!.ar
catas:rophes, to s�.ich an e;<ten; fhat they canr,ot ful�ll fheir ebligations und�r tnis
Agreem�nt, tnat party Urlll ba excused From perforrning undar tha algraement, and th�
�1�r2eTei�t�Niil be tsrminated,
� Sectfon 17
Notice
Uni�ss ofherNise providad for in fhfs Ac�reemen!, all not�ces which are requlred or
may be gfven pursuanf fo t,�e term� of this Agreement shall be 1n writln� ard shall be
deemed duly given fr clelivered personally, mailed by regls•`.ared or ceriified mail,
postage prapGid, refurn recolpf reques,ed, or sent by f�csimlfe a+rifh corfirrnafion.
Noticos snall be sent�s fo!la�,vs; .
A. To; Tri�Sfat� Occup�fional H�a;fh, L.L,C,
A!tentian: 1"SOH i�Aanager
1940 Elm Streef Dubuque, lowa 520�1 �
. Telephone; (583)584-45C0
Facsimfle;(563)582-7847
B. To; Cif/of dubuque
Atfn; Parsonnel Nlanager
50 Wsst 13�h Sfr�e�
- -- — ----- - -- -------- ---DuSuque, lo�,va 52001 ------ -------- - ----
Telepho�7e;(503)589•4125
Facsimila; (503)690-6025
� ? Section 18
Insurance
7SOH shall at a!I times during the perfcrmance of this A�re�m�nt ma�ntair,
insurance a, required by tne attached Insuranca Schedu!e,
Tri-5tate Occupatlonai Health, L,L,C, C(ty of Dubuque
%` .
f ,,, �_c,L---�" ` r 1
ey: �- :::� . .�.-. ��; � `�
, hllichael C.rVan ,b�i��ig�n� �i�y p,i��na�ar
D�t�;_ �,:��/ � D�t!�: ('�;.i I ��'��/��
� % '
Cifiy of Dubuque Insurance Requirements for Professional Services
. IN�URANCE ��HEDULE J �
Tri-State Occupational Heaith, L.L.C. I
1, shall furnish a signed cerflficate of insurance fo the City of Dubuque, lowa for �'I
the covarage required in �xhibit I pr'ior to commencing worl<and at the end of the proJect if the ,,
term of work is longer than 60 days. Contracfiors presenting annual certificates shall present a 'i
cerfiificate at the end of each proJect with the final billing. E�ch certificate shall be prepared on I
the most current ACORD form approved by the lowa Department oF Insurance or an equivalent ��I
approved by the Finance Direcfior. Cach cerfiificate shall include a statement under Description of
Operations as to why the certificate was issued. Eg; ProJect# or ProJect Location at
o.r construction of
2, All policiesof insurance required hereunder shall bo with an insurer authorized to do business in �
' lowa and all (nsurers shall have a rating of A or betfier in the current A,M. BesYs Rating Guide, ;
3. Each certificate shall be furnished to the Personnel Department oP the City of Dubuque. ;
I
4. Failure to provide coverage required by this Insurance Schedule shall not be deemed a waiver of j
these requlrements by the City of Dubuque, Failure to obtain or maintaln the required fnsurance �
shall be considered a material breach of this agreement. I
5. Contractors shall requlre all subconsulkants and sub-subconsultants to obfiain and maintain during
the performance of worl<insurance for the coverages described ln this Insurance Schedule and
shall ob#ain cerkificates oF insurances from all such subconsultants and sub-subconsuitants, �
Contractors agree that fihey shall be liable for the Faliure of a subconsultant and sub-
subconsultant to obtain and maintain such coverages. Tho City may request a copy of such �
certificates from the Contractor. !
6. All required endorsements shail be attached to certificate of insurance. i
7, Whenever�specific ISO form is Ilsted, required the currenf edition oP the form must be used, or
an equ(valent form may be substituted if approved�by the Finance Director and subJect tn fihe
contraotor idontifying and listing in writing all deviations and exclusions from the ISO form,
8, Contractors shall be required to carry the minimum caverage/Iimits, or greater if required by law
or other legal agreement, in Exhibit I, If the contractar's limits oP liability are.higher than the
required minimum Iimifis then the provider's limits shall be this agreemeni's required limits.
Page 1 of 4� Schedule J Professional Services November 2017
City of Dubuque Insurance Requirements for ProFessional Services
IN�UFtANCE SCHEDULE J (continued)
Exhibit I
A) COMMERCIAL GENERAL LIAB(LITY
General Aggregate Limit $2,000,000
I'roducts-Completed Operafions Aggregate Limit $1,000,000
Personal and Advertising Injury Limit $1,000,000
Each Occurrence , $1,000,000
F'ire Damage Limit(any ono occurrence) $50,Q00
Medical Payments $5,000
1) Coverage shall be written on an occurrence, not claims made, form, Th�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
Ilability form CG 0001, or business owners form BP 0002, shall be clearly
identified.
2) Includa ISO endorsement form CG 25 04"Designated l.ocatian(s)General
Aggregate Limit"ar CG 25 03"Designated Construcfilon Project(s)General
Aggregate Limit"as appropriate,
3) Include endorsement indicating that coverage is prlmary and non-contributory,
4) Include Preservation of Governmental Immunities Endorsement, (Sample
attached),
5) Include additional insured endorsement for:
The City of Qubuque, including all its elected and appointed officials,all its
employees and volunteers, all its boards, commissions and/or�uthorifies and
their board members, employees and volunteers. Use ISO form CG 2026.
6) Policy shall Include Walver of FZight to Recover from Others endorsement,
B) AUTQMOBIL�LIABILITY
Combined Single L.imit $1,OOO,U00
C) WOFtKERS' COMPENSATION& I�MpLOYERS LIABILITY
Statutory beneflfs covering all employees injured on thejob by accident or disease as
prescribed by lowa Code Chapter 85 as amended,
Coverage A Statutory--State oF Iowa '
Coverage B Employers Liability
� Each Accident $100,000
Cach �mployee-Disease $100,000
Policy Limit-Disease $600,000
Policy shall include Waiver of Right to C;ecover from Others endorsement.
Nonelection of Workers" Compensation or Emplayers' Liabiflty Coverage under lowa
Code sec, 87.22
____yes _form attached
I'age 2 of 4 Schedule J Professianal Services November 2017
City of Dwbuque Insurance.Requirements for Professianal Servic�s
. INSURAIVCE SCHEDULE J (con�inued)
D) UMBRELLA/�XCESS L,IABILITY $1,OQ0,000
Umbrell�/excess liability coverage must be at least foliowing form wifih the underlying '
policies included herein. j
E) PROFESSIONAL LIABIL.ITY $1,000,000 ��I
Provide evidence of coverage for 5 years after completion of project. I��
F) CYBER LIABILITY $1,000,000
X yes ,u no
�
Coverage Por First and Third Party Ilability fncluding but nok limit�d i•o lost data and �
restoration, loss of income and cyber breach of information. �
Page 3 of 4 Schedule J Professional Services November 2017
City of Dubuque Insurance Requirements for professional Services
PR�SERVATION OF GOVERNMENT�4L MMMUNITIES ENDO�SEMENT
1. Nonwaiver of Governmental Immunitv. Tho insurer expressly agrees and sfiates that the purchase
of this policy and the including of the'City of Dubuque, lowa as an Additional Insured does not waive any �
of the defenses of governmental immunity avallable to the City of bubuque, lowa under Code of lowa
Section 670,4 as it is now exisks�ncl as lt may be amended from time to time.
2, Cla(ms Cover�ae, The insurer furfiher agrees that th(s policy of insurance shalf cover only those
claims not subject ta the defense of governmental immunity under the Code of lowa Secfiion 670,4 as it
now exists and as it may be amended from time to time.Those claims not subject to Code of lowa
Section 670,4 shall be covered by the terms and conditions of this insurance policy.
3. Assertion of Governmenfi Immunitv, The City of Dubuque, low� shall be responsible far 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 Co_v,eraae.The insurer shall not deny coverage under this pohcy and the fnsurer
shall nofi deny any of the rights and benefits accruing to the Cify of Dubuque, lawa under this policy for
� reasons of governmental immunity unless and until a court nf competont Jurisdiction has ruled in favor of
. the defense(s)of gnvernmental immunity asserted by the City of Dubuquo, lowa,
No Other Chanae in Polic� The above preservation of governmental immuriities shall not otherwise
change or alter the coverage available under the policy.
��
(D�PAR7MENT MAIVAG�R: FILL IN ALL BL.ANKS AND CF�IEGK BOXES)
Page 4 of 4 Schedule J Professional Services November 2017