Iowa Municipalities Workers' Compensation Association (IMWCA) Resolution Authorizing MembershipCopyrighted
May 18, 2020
City of Dubuque Consent Items # 14.
ITEM TITLE: Iowa Municipalities Workers' Compensation Association
(I MWCA) Resolution Authorizing Membership
SUMMARY: City Manager recommending approval of a Resolution
authorizing the City to apply for membership in the Iowa
Municipalities Workers' Compensation Association as
approved by the City Council on May 4, 2020.
SUGGESTED DISPOSITION:
RESOLUTION Authorizing the City to apply for
membership in the Iowa Municipalities Workers'
Compensation Association (I MWCA)
Suggested Disposition: Receive and File; Adopt
Resolution(s)
ATTACHMENTS:
Description Type
Iowa Municipalities Workers Compensation Resolution- City Manager Memo
MVM Memo
Staff Memo Staff Memo
Resolution Resolutions
I MW CA Item from May 4, 2020 Supporting Documentation
Masterpiece on the Mississippi
TO: The Honorable Mayor and City Council Members
FROM: Michael C. Van Milligen, City Manager
Dubuque
All-A.aia City
111111
2007.2012.2013
2017*2019
SUBJECT: Recommendation for Approval and Acceptance of the Iowa Municipalities
Workers' Compensation Resolution Authorizing the City of Dubuque to
Apply for Membership in the Iowa Municipalities Workers' Compensation
Association commencing at 12:01 am, May
DATE: May 14, 2020
On May 4, 2020, the City Council approved the recommendation that the City of
Dubuque transition from a self -insured workers' compensation program to a fully
insured program through the Iowa Municipalities Workers' Compensation Association.
Given the City Council's prior approval to transition to the Iowa Municipalities Workers'
Compensation Associations' fully insured program, Human Resources Director Shelley
Stickfort recommends City Council approval of a Resolution authorizing the City to apply
for membership in the Iowa Municipalities Workers' Compensation Association.
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
Shelley Stickfort, Human Resources Director
Masterpiece on the Mississippi
Dubuque
tend
III•Ameriu City
illir
2007•2012.2013
2017*2019
TO: Mike Van Milligen, City Manager
FROM: Shelley Stickfort, Human Resources Director
DATE: May 13, 2020
Human Resources Department
City Hall
50 West 13th Street
Dubuque, IA 52001-4805
Office (563) 589-4125
Fax (563) 690-6025
TTY (563) 690-6678
humanresources@cityofdubuque.org
www.cityofdubuque.org
RE: Recommendation for Approval and Acceptance of the Iowa Municipalities Workers'
Compensation Resolution Authorizing the City of Dubuque to Apply for Membership in
the Iowa Municipalities Workers' Compensation Association (IMWCA) commencing at
12:01 am, May 15, 2020.
On May 4, 2020 the City Council approved the recommendation that the City of Dubuque
transition from a self -insured workers' compensation program to a fully insured program through
the Iowa Municipalities Workers' Compensation Association (IMWCA).
That recommendation was the outcome of a lengthy process that included a comparative cost
analysis, review of service provision, and other relevant materials and information.
On May 12, 2020 IMWCA provided a 90-minute orientation session for the City's Human
Resources Staff, Risk Management/Financial Staff, and Department Managers. The orientation
session included information about IMWCA's history, services, partners, and protocols for their
Chapter 85 Workers' Compensation program.
In addition, on May 12, 2020, IMWCA provided a welcome packet to the City of Dubuque.
Included within that packet is the unexecuted Iowa Municipalities Workers' Compensation
Resolution Authorizing the City of Dubuque to Apply for Membership in the Iowa
Municipalities Workers' Compensation Association (IMWCA).
Given the Council's prior approval to transition to IMWCA's fully insured program, I
recommend that the City adopt the "Resolution Authorizing the City to Apply for Membership in
the Iowa Municipalities Workers' Compensation Association (IMWCA)."
Service People Integrity Responsibility Innovation Teamwork
Prepay er
Information: Jeff Hovey 500 SW 7th Street, Suite 101 DSM, IA 50309-4506 (515)244-2708
Name Street Address City/State/Zip Phone
Iowa Municipalities Workers' Compensation Association
500 SW 7"' Street, Suite 101
Des Moines, IA 50309-4506
Return to Prenarer
RESOLUTION NO. 15 0 — 2 0
A RESOLUTION AUTHORIZING THE CITY TO APPLY FOR
MEMBERSHIP 1N THE IOWA MUNICIPALITIES
WORKERS' COMPENSATION ASSOCIATION (IMWCA)
WHEREAS, the Iowa Municipalities Workers' Compensation Association, a Chapter 28E association, has been established as
a group self-insurance program, for the purpose of providing coverage for workers' compensation and related employer liability to
Iowa cities, counties, 28E entities and a political subdivision and,
WHEREAS, the City of Dubuque desires to become a member of the Association, a self -insured group, in order to obtain
coverage for workers' compensation and related employer liability.
NOW THEREFORE BE IT RESOLVED, that the City of Dubuque hereby adopts the Agreement of the Iowa Municipalities
Workers' Compensation Association, and authorizes and directsM . V a n M i 11 i g e n and S . Stickfort to execute the
documents necessary for the City of Dubuque to become a member of the Association. 4 `'kP.
Passed thisl 8 day of M a y ,202 0 .
I hereby ce fy that this Resolution was properly adopted on the above date
19,
Signature/' )Itle
Signature/fide
Roy D. Buol, Mayor Kevin S. Firnstahl, City Clerk_' "•4g.
APPLICATION FOR MEMBERSHIP IN E ;,, : ""*, 1 rj
IOWA MUNICIPALITIES WORKERS' COMPENSATION ASSOCIATION
01
Pursuant to Resolution duly adopted, certified copy of which is set out above, the undersigned city hereby applies for
membership in the Iowa Municipalities Workers' Compensation Association effective 12:01 a.m May 15, 2020.
The city agrees that the Association shall be the city's agent in fact in all matters relating to workers' compensation and
related employer liability, and the city will abide by the rules and regulations of the Association.
Date: May 18, 2020
Signature/Title• /,61'-/Av 1/1/
Michael Van Milligen, City Manage r / ksf
County of: Dubuque
Address: 50 W. 13th St.
Dubuque, IA 52001
Signature/Title:
Shelley Stickfort, Human Resources Director
APPROVAL OF
IOWA MUNICIPALITIES WORKERS' COMPENSATION ASSOCIATION
Approved for membership and coverage effective 12:01 a.m., May 15, 2020.
Director of Risk Services
Jeff Hovey Title Date
State of Iowa
County of Polk County
Signed and sworn to before me on , 20
Notary Public
Notary Seal
Copyrighted
May 4, 2020
City of Dubuque Consent Items # 10.
ITEM TITLE: Recommendation for Approval and Acceptance of the
Iowa Municipalities Workers' Compensation Coverage
SUMMARY: City Manager recommending that the City transition from a
self -insured workers' compensation program to a fully
funded workers' compensation coverage option. It is further
recommended that the City execute the Agreement for
I MWCA to provide claims administration services for a fee
of $10,000 for the twenty-five open claims for fiscal year
2021 beginning on July 1, 2020 and at the pro -rated fee
from May 15, 2020 to June 30, 2020.
SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Approve
ATTACHMENTS:
Description Type
Worker's Comp Fully Insured_MVM Memo City Manager Memo
Staff Memo Staff Memo
Administrative Agreement & Insurance Schedule J Supporting Documentation
City of Dubuque Open Claims Supporting Documentation
Masterpiece on the Mississippi
TO: The Honorable Mayor and City Council Members
FROM: Michael C. Van Milligen, City Manager
Dubuque
had
IYI-Aeries oih
if
2007.2012.2013
2017*2019
SUBJECT: Recommendation for Approval and Acceptance of the Iowa Municipalities
Workers' Compensation Coverage quotes for coverage May 15, 2020-
June 30, 2020 and for all of fiscal year 2021.
DATE: May 1, 2020
Shelley Stickfort, Director of Human Resources, has recommended that the City
transition from a self -insured workers' compensation program to a fully funded workers'
compensation coverage option. Gallagher Risk Management Services was retained in
February 2019 to manage an RFP process for the purpose of conducting a cost
analysis and making recommendation between the City's current self -insured workers'
compensation program and a fully funded workers' compensation coverage option for
the City of Dubuque.
In March 2020 Gallagher recommended that the City not move forward with an RFP
process and instead obtain an updated quote from Iowa Municipalities Worker's
Compensation Association (IMWCA) to compare to the City's self -insured program.
After conducting a comparative cost analysis, review of service provision, review of
service satisfaction evaluations and cost benefits provided by IMWCA's currently insured
cities and counties, and other relevant materials and information, Stickfort recommends
that the City transition from its current self -insured workers' compensation program to a
fully funded workers' compensation program and accept IMWCA's quote for a first dollar
(zero deductible) premium of $733,040 for the City's non -fire and non -police employees
for fiscal year 2021 beginning on July 1, 2020. She further recommends that the City
accept IMWCA's quote for a first dollar (zero deductible) pro -rated premium for the City's
non -fire and non -police employees for the remainder of fiscal year 2020, effective May
15, 2020 through June 30, 2020.
The City's estimated cost savings for moving to IMWCA as the City's provider for fully
insured workers' compensation coverage is $94,819 the first full fiscal year.
While cost is an important factor, assuring a safe work environment for City employees is
also a high priority. Provided within the IMWCA's fully insured program are employee
safety services that include, but are not limited to, on -site safety consultations that occur
at least quarterly, on -site specialized training programs including safety committee
development and incident reviews, over 60 courses of online, interactive, free safety
training available to all employees, and hundreds of safety videos available on demand.
The IMWCA Human Resource specialist that would be assigned to the City assists with
managing the City's workers' compensation exposures and shares model programs and
policies including incident review, return -to -work policies, and safety policies.
IMWCA was created in 1981 and has almost forty years of experience providing workers'
compensation services to local governments. Its professional and experienced staff are
well versed in municipal operations and understand the risks and challenges local
government employees face every day.
Lastly, Stickfort recommends that the City execute the Agreement for IMWCA to provide
claims administration services for a fee of $10,000 for the twenty-five open claims for
fiscal year 2021 beginning on July 1, 2020 and at the pro -rated fee from May 15, 2020 to
June 30, 2020.
I concur with the recommendation and respectfully request Mayor and City Council
approval.
li-
Mic aeI C. Van Milligen
MCVM:
Attachment
cc: Crenna Brumwell, City Attorney
Teri Goodmann, Assistant City Manager
Cori Burbach, Assistant City Manager
2
Masterpiece on the Mississippi
Dubuque
hfrri
AA•imeriu City
2007•2012.2013
2017*2019
TO: Mike Van Milligen, City Manager
FROM: Shelley Stickfort, Human Resources Director
DATE: May 1, 2020
Human Resources Department
City Hall
50 West 13th Street
Dubuque, IA 52001-0805
Office (563) 589-4125
Fax (563) 690-6025
TTY (563) 690-6678
humanresources@cityofdubuque.org
www.cityofdubuque.org
RE: Recommendation for Approval and Acceptance of the Iowa Municipalities Workers'
Compensation Coverage quotes for coverage May 15, 2020- June 30, 2020 and for all of
fiscal year 2021.
Beginning in February 2019, Arthur J. Gallaher Risk Management Services, Inc. was retained by
the City of Dubuque to carry out project management of an RFP process for the purpose of
conducting a cost analysis and making recommendation between the City's current self -insured
workers' compensation program and a fully funded workers' compensation coverage option for
the City of Dubuque. On March 19, 2020 the project manager from Gallagher notified us that
after approaching twenty markets the insurance market for municipalities the size of Dubuque
with police and fire exposure is very limited. Gallagher recommended that the City not move
forward with an RFP process and instead obtain an updated quote from Iowa Municipalities
Worker's Compensation Association (IMWCA) to compare to the City's self -insured program.
Given this, Gallagher further indicated that it would not charge the City for its retained services.
As recommended, the City worked with a local agent Sue Miller from O'Connor and English
Insurance Agency to get an updated quote from IMWCA for conducting a comparison between
self -funded versus fully funded workers' compensation insurance coverage programs. On April
6, 2020 IMWCA presented comprehensive information about their organization/association and
premium quotes for fully -funded services that included a no -deductible option and a variety of
deductible amounts for workers' compensation insurance coverage that included workers'
compensation coverage as provided for in Iowa Code Chapter 85, as well as medical only
coverage as provided for under Iowa Code Chapter 411 for Police Officers and Fire Fighters. In
addition, IMWCA offered to provide claim management services for an agreed upon fee for
existing, open workers' compensation claims occurring prior to transitioning to a fully insured
program if the City so desired.
After conducting a comparative cost analysis, review of service provision, review of service
satisfaction evaluations and cost benefits provided by IMWCA's currently insured cities and
counties, and other relevant materials and information, I am recommending that the City
Service People integrity Responsibility innovation Teamwork
transition from its current self -insured workers' compensation program to a fully funded
workers' compensation program and accept IMWCA's quote for a first dollar (zero deductible)
premium of $733,040 for the City's non -fire and non -police employees for fiscal year 2021
beginning on July 1, 2020. I also recommend that the City accept IMWCA's quote for a first
dollar (zero deductible) pro -rated premium for the City's non -fire and non -police employees for
the remainder of fiscal year 2020, effective May 15, 2020 through June 30, 2020.
The City's estimated cost savings for moving to IMWCA as our provider for fully insured
workers' compensation coverage is $94,819 the first full fiscal year.
While cost is an important factor, assuring a safe work environment for City employees is also a
high priority. Provided within the IMWCA's fully insured program are employee safety services
that include, but are not limited to, on -site safety consultations that occur at least quarterly, on -
site specialized training programs including safety committee development and incident reviews,
over 60 courses of online, interactive, free safety training available to all employees, and
hundreds of safety videos available on demand. The IMWCA Human Resource specialist that
would be assigned to the City assists with managing the City's workers' compensation exposures
and shares model programs and policies including incident review, return -to -work policies, and
safety policies.
1MWCA was created in 1981 and has almost forty years of experience providing workers'
compensation services to local governments. Its professional and experienced staff are well
versed in municipal operations and understand the risks and challenges local government
employees face every day.
Lastly, I recommend that the City execute the Agreement for IMWCA to provide claims
administration services for a fee of $10,000 for the twenty-five open claims for fiscal year 2021
beginning on July 1, 2020 and at the pro -rated fee from May 15, 2020 to June 30, 2020.
The transition from our current self -funded workers' compensation program and third -party
claims administration through Alternative Services Concepts effective on May 15, 2020 to the
fully funded program through IMWCA will create a net savings for the City with no apparent
negative impact, and likely positive outcomes, on the City's workers' compensation services or
employee relationship.
Service People integrity Responsibility innovation Teamwork
ADMINISTRATIVE AGREEMENT
BETWEEN
IOWA MUNICIPALITIES WORKERS' COMPENSATION ASSOCIATION
AND
THE CITY OF ❑UBUQUE, IOWA
THIS ADMINISTRATIVE A REEMENT herein referred to as "Agreement", dated
for reference purposes the / day of j , 2020, is entered into by and
between the IOWA MUNICIPALITIES WORKERS COMPENSATION ASSOCIATION, a
separate legal entity created by Iowa cities pursuant to the provisions of Chapter 28E,
Code of Iowa, herein referred to as "IMWCA", and the City of Dubuque, Iowa, herein
referred to as "CITY".
W1TNESSETH:
WHEREAS, IMWCA provides and administers workers' compensation and related
employer liability coverage for its members qualifying therefore, and has made such
coverages and services available; and
WHEREAS, CITY wishes to self -fund the attached claims under Iowa Code
Chapters 85 for workers' compensation and Chapter 411 for medical -only claims of its
police officers and firefighters, and to contract with IMWCA to obtain claims administrative
services necessary to manage these claims transferred from the City's previous third -
party administrator, Alternative Service Concepts (ASC); and
WHEREAS, IMWCA has agreed to provide such services on the terms and
conditions set forth herein, provided that the City Council has approved this Agreement.
NOW, THEREFORE, in consideration of the mutual covenants, promises and
agreements contained herein, the parties hereby agree as follows:
SECTION 1. TERM. The term of this Agreement shall be from May 1, 2020 through
the life of each open claim (list attached), unless cancelled earlier as provided in Section
5.
SECTION 2. SERVICES.
A. Services Provided. Subject to all the other terms and conditions of this Agreement,
IMWCA shall be responsible for administering the attached claims under Iowa Code
Chapters 85 and 411 for City.
B. Services Only. IMWCA does not act as an insurer for the attached claims of City,
and this Agreement shall not be construed as an insurance policy or any agreement of
indemnity. IMWCA is not itself financially responsible for the payment or satisfaction of
claims, lawsuits or any form of cause of action against City by virtue of this Agreement.
042120cmb
SECTION 3. INDEPENDENT CONTRACTOR STATUS.
A. Status. IMWCA, for purposes of this Agreement, shall be an independent
contractor.
B. Hold Harmless and Indemnification. City shall indemnify and hold harmless
IMWCA from any and all loss, cost or expense incurred by IMWCA as a result of the
negligence of City, its officers or employees. IMWCA shall indemnify and hold City, its
officers and employees harmless from any and all loss, cost or expense incurred by City
as a result of the negligence of IMWCA, its officers or employees.
SECTION 4. COMPENSATION. In consideration of the performance by IMWCA of its
services and obligations provided under subparagraph A of Paragraph 2 above, City
agrees to pay IMWCA a one-time non-refundable payment in the sum of Ten Thousand
Dollars ($10,000) for the administration services and expenses for the period May 1, 2020
through the life of each open claim (list attached). In the event IMWCA's compensation
herein is not paid when due, IMWCA may, reserving all other remedies and rights under
this Agreement and in law, at its sole option and discretion, upon ten (10) days prior
written notice to City, discontinue processing the attached claims for City.
SECTION 5. CANCELLATION. This Agreement may be cancelled by either party
upon written notice to the other party, provided such notice specifies an effective date for
cancellation of not Tess than ninety (90) days after the date of such notice.
SECTION 6 CONDITIONS AND LIMITATIONS.
A. Profitability. IMWCA makes no representation or warranty to City that the business
of self -funding the attached claims arising against City under Chapter 85 or 411, and the
administration of those claims by IMWCA, shall result in financial gain to City or result in
City paying less costs for medical -only claims under Chapters 85 and 411 than it has cost
in previous years.
B. Information. City shall render complete and accurate information to IMWCA as
requested by IMWCA and advise IMWCA promptly of any changes in City's operations.
C. Cooperation. IMWCA's responsibility for the performance of service as specified in
paragraph 2 is conditioned upon the cooperation of City.
D. Legal Services. The services to be provided by IMWCA are not of a legal nature,
and IMWCA shall in no event give, or be required to give, any legal opinion or provide
any legal representation to City. IMWCA shall not be considered as engaged in the
practice of law. It is specifically agreed that if any legal action is initiated against IMWCA
or City by reason of the denial of a claim under Chapter 85 or Chapter 411, IMWCA will
have the option of returning the claim to City, and IMWCA will have no further
responsibility to administer that claim or to defend a legal action brought as a result of its
administration of that claim.
2
E. Assignment. Neither this Agreement nor any rights hereunder shall be assigned by
either party without the prior written consent of the other party first having been obtained.
F. Insurance. iMWCA shall at all times during the performance of this Agreement
maintain insurance as described in the attached Insurance Schedule.
G. Entire Agreement. This Agreement constitutes the entire understanding of the
agreement between the parties hereto, and supersedes all prior and contemporaneous
agreements or understandings, written or oral, of the parties hereto. This Agreement may
be amended only in writing executed by both parties.
H. Notices. All notices to be given pursuant to this Agreement shall be in writing, and
shall be deemed to have been duly given when personally delivered, or when mailed
postage prepaid by certified mail, return receipt requested, to the following address:
To IMWCA:
Iowa Municipalities Workers' Compensation Association
500 SW 7th Street, Suite 101
Des Moines, IA 50309
To City of Dubuque: City of Dubuque
Attn: City Manager
50 West 13th Street
Dubuque, IA 52001
i. Interpretation. This Agreement shall be interpreted by application of the laws of the
State of Iowa.
J. Representation and Warranties. IMWCA covenants, represents and warrants that
it is experienced and qualified to perform the administrative services contemplated by this
Agreement and is equipped to perform such administrative services. IMWCA makes no
warranties or assurances as to the outcome of any claim or service contemplated by this
agreement.
K. Severabilitv. in the event that any one or more of the provisions contained in this
Agreement or any application thereof shall be invalid, illegal or unenforceable in any
respect, the validity, legality or enforceability of the remaining provisions of this
Agreement or any other application thereof shall not in any way be affected or impaired
thereby.
3
IN WITNESS WHEREOF, the parties have executed this Agreement on the day
and year first above written.
CITY OF DUBUQUE, IOWA
By:
Roy 1 : uol, Mayor
ATTEST:
KevinFirnstahl, City Clerk
IOWA MUNICIPALITIES WORKERS'
COMPENSATION ASSOCIATION
By:
\
U
Printed Name and Title
4
CITY OF DUBUQUE
INSURANCE SCHEDULE
5
City of Dubuque Insurance Requirements for Professional Services
INSURANCE SCHEDULE J
1. Iowa Municipalities WorkersCompensation Association 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 AGORD form approved by the
Iowa Department of Insurance or an equivalent approved by the Director of Finance and Budget.
Each certificate shall include a statement under Description of Operations as to why the
certificate wee issued. Administrative Agreement Between Iowa Municipalities Workers'
Compensation Association and the City of Dubuque, lowa dated
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. Bests Rating Guide,
3. Each certificate Ishall be furnished to the Finance 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 perforrnance of work insurance for the coverages described in this Insurance Schedule and
shall obtain certificates of insurances from all such subconsultants and sub-subconsultarits.
Contractors agree that they shag 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 Director of Finance and Budget 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 agreements required limits.
Contractor shall be responsible for deductibles and self -insured retention.
Page 1 of 4 Schedule J Professional Services May 2019
6
Cityof Dubuque insurance Requirements for Professional Services
INSURANCE SCHEDULE J (continued)
Exhibit
A) COMMERCIAL GENERAL LIABILITY
General Aggregate Limit $2,000,000
Products-CompletedOperations Aggregate Limit $1,000,000
Personal and Advertising injury Limit $1,000,000
Each Occurrence $1,000000
Fire Damage Limit (any one occurrence) $50,000
Medical Payments $5,000
1) Coverage shall be.written .on an occurrence, not ciaims made, form. The general
liability coverage shall be written in accord with ISO; form CG 00 01 or business
owners form BP 00 02 All deviations from the standard ISO commercial general
liability form CG 00 01, or business owners form BP 00 02, 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 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 20 25
6) Policy shall include Waiver of Right to Recover from Others endorsement.
B) AUTOMOBILE LIABILITY
Combined Single Limit $1,000,000
C) WORKERS' COMPENSATION & EMPLOYERS LIABILITY
Statutory Benefits covering all employees injured on the job by accident or disease as
prescribed by Iowa Code Chapter 85,
Coverage A
Coverage B
Statutory —State of Iowa
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.
Coverage B limits shall be greater if required by the umbrella/excess insurer.
OR
Nonelection of Workers' Compensation or Employers' Liability Coverage under Iowa
Code sec. 87.22. Completed form must be attached.
Page 2 of 4 Schedule J Professional Services May 2019
7
City of Dubuque Insurance Requirements for Professional Services
INSURANCE SCHEDULE J (continued)
UMBRELLAIEXCESS LIABILITY $1,000,000
Umbrella/excess liability coverage must be at least following form with the underlying
policies included herein (General Liability, Automobile, Workers Compensation).
E) PROFESSIONAL LIABILITY .$1,000,000
Provide evidence of coverage for 5 years after completion of project.
P) CYBER LIABILITY $1,000,000
X yes rio
Coverage for First and Third Party liability inc ding but not limited to lost data and
restoration, loss of income and Cyber breach of information,
Page 3 of 4 Schedule J Professional Services May 2019
8
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 Coverage. 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 ImmuniN. The City of Dubuque, Iowa shall be responsible for asserting
any defense of governmental imrnur*, and may do so at any time and shall do so upon the timely written
request of the insurer.
4. Non -Denial of Coverade. 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 Change in Policy. The above preservation of governmental immunities shall not herwise
change or alter the coverage available under the policy,
SPECIMEN
(DEPARTMENT MANAGER: FILL IN ALL BLANKS AND CHECK BOXES)
Page 4 of 4 Schedule J Professional Services May 2019
9
ASC
DOI
Department
Injury
Claim #
ASC
8/3/2015
11- Police
G5W right thigh
C269-15-00406-01
3/9/2020
11- Police
exposure
ASC
5/2/2019
11- Police
prostate cancer
C269-19-00495-01
3/9/2020
11- Police
low back
ASC
12/10/2019
11- Police
right shoulder
C269-19-00503-01
7/26/2019
11- Police
nose
2/17/2020
13 - Fire
low back
ASC
1/20/2016
13 - Fire
low back
ASC
2/19/2020
13 - Fire
back, shoulder
C269-20-00507-01
2/16/2020
13 - Fire
back
ASC
1/2/2013
13 - Fire
heart
C269-13-00336-01
ASC
2/16/2020
13 - Fire
left knee
C269-20-90015-01
ASC
7/20/1995
13 - Fire (retired)
back
C269-82-00004-01
A5C
2/6/2020
30 - Parks
right knee
C269-20-00504-01
ASC
7/10/2010
30 - Parks
neck/back
C269-10-00258-01
ASC
7/28/1999
30 - Parks
back
10/16/2019
36 - Library
right ankle
A5C
7/11/2016
42 - Water
left leg/back
C269-16-00440-01
3/17/2020
43 - WRRC
left ring finger
ASC
7/17/2017
43 - WRRC
facial fractures/laceration/broken teeth/nose
C269-17-00455-01
ASC
3/10/2020
54 - Public Works
exacerbation of umbilical hernia
C269-20-00508-01
A5C
12/21/2007
54 - Public Works
back
C269-07-00155-01
ASC
5/6/2019
54 - Public Works
right inguinal hernia
C269-19-00494-01
ASC
4/11/2018
54 - Public Works
low back, right hip, pelvis
C269-18-00475-01
ASC
3/30/2020
54 -Public Works
right thumb
C269000509-01
A5C
retired - Fire