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Acceptance of Worker's Compensation Claims Administrative Services
Masterpiece on the Mississippi Dubuque All-America City 1 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: November 29, 2010 Personnel Manager Randy Peck is recommending acceptance of the worker's compensation claims services contract with Alternate Services Concepts, Inc. I concur with the recommendation and respectfully request Mayor and City Council approval. MCVM:jh Attachment cc: Barry Lindahl, City Attorney Cindy Steinhauser, Assistant City Manager Randy Peck, Personnel Manager Michael C. Van Milligen Masterpiece on the Mississippi TO: Michael C. Van Milligen, FROM: Randy Peck, Personnel SUBJECT: Acceptance of Worker's Agreement DATE: November 22, 2010 Service Workers' Compensation • Medical Only • Indemnity Run -in Claims ; Indemnity Medical Only Incident Reports Catastrophic Claims Estimated Claims Fee Account Administration Fee City Manager Manager Compensation Claims Administrative Services 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, 2010. On October 13, 2010, the City Council approved the renewal rates for Worker's Compensation Claims Services effective October 1, 2010 through September 30, 2011. The following is a comparison between the current rates and the renewal rates: Current Rate per Claimant Fee per Claimant Fee $165 $760 $40 Time and Expense $20,020 $3,000 $250 Plus Base Fee 15% of Recovery $2,500 $68lhour Renewal Rate $170 $770 $40 Time and Expense Litigation Fee Subrogation Fee Systems Fee Field Medical Case Management Maintenance Fee for Claims Open after 24 Months $450 $20,340 3,000 $300 Plus Base Fee 15% of Recovery $2,500 $450 Dubuque AIFAmedcaCity 2007 Increase /Decrease +$5 +$10 $0 Time and Expense +' +$320 No Change $0 $0 MMSEA — Annual Transmission Fees (includes query and submissions) $1,920 $1,920 $0 Minimum and Deposit Claims Fee $25,520 Medical only claims will increase from $165 per claim to $170 per claim and indemnity claims will increase from $760 per claim to $770 per claim. The litigation fee will increase from $250 plus the base fee to $300 plus the base fee. Fixed medical case management will increase from $68 per hour to $75 per hour. The minimum deposit and claims fee will increase from $25,520 to $27,760. The only other change has to do with the options that would be available to us should we cancel the contract. Should we cancel our contract with ASC they would no longer manage claims based on their time and expense. 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 approving the Agreement and authorizing you to sign the Agreement. RP:sya $27,760 +$2,240 ASC Alternative Service Concepts, LLC CLAIMS SERVICE CONTRACT THIS AGREEMENT is made and entered into with an effective date of October 1, 2010 between ALTERNATIVE SERVICE CONCEPTS, LLC, formed in Delaware, with principal offices at 2501 McGavock Pike, Suite 802, P.O. Box 305148 Nashville, Tennessee 37214 -1213, hereinafter referred to as "ASC ", and CITY OF DUBUQUE, 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 files 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 /1010 Page 1 07269 ASC Alternative Service Concepts, LLC 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. 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). Dubuque /1010 Page 2 07269 • ASC Alternative Service Concepts, LC 6. To indemnify, defend and hold harmless "ASC" with respect to any claims asserted as a result of an )6rrors, 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" 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 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. Dubuque /1010 Page 3 07269 ASC Alternative Service Concepts, LLC 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. 9. "ASC" will query and transmit information under MMSEA requirements to CMS. 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 CONCEPTS, LLC WITNESS: / &57 57/1/Z j BY: TITLE: CEO DATE: le / !/0 CITY F DUBUQUE, IOWA WITNESS 4:6;4_,le BY: Dubuque /1010 Page 4 Michael Van Milligen TITLE: City Manager DATE: V(o 07269 Service _ Estimated Number Of Claimants Per - Claimant Fee Estimated Total Fee Workers' Compensation Medical Only 20 $170 $ 3,400 Indemnity 22 $770 $16,940 Litigation fee TBD $300 + base fee Run -In Claims • Indemnity TBD $450 - -- Medical Only TBD $ 50 - -- Incident Reports TBD $ 40 - -- Catastrophic Claims TBD Time & Expense - -- Estimated Minimum Claims Fee $20,340 MMSEA- Annual Transmission Fees (includes query & submissions) $ 1,920 Account Administration Fee $ 3,000 Systems Fee $ 2,500 Minimum & Deposit Claims Fee $27,760 ASC Alternative Service Concepts, LLC -Year Claims Handlin Alternative Service Concepts, LLC City of Dubuque, Iowa October 1, 2010 - October 1, 2011 Claims will be handled for two years from the date the Toss 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) • Excess Reporting I Recorded in claims system only. Must be specified as `Incident" at time of reporting. 2 Any event resulting in 10 or more claimants and /or property losses over $50,000 will be treated as a catastrophe. Dubuque /1010 Page 5 07269 ASC Alternative Service Concepts, LLC • 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 • 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 Fees Client Data Transmission Carrier Data Transmission State - Mandated EDI Computer Compatible Checks & Electronic Transfers Data Conversion From Prior Administrator On -Line Access (One User) Additional Users Reports Produced by Client Reports Produced by ASC Systems Training Customized Programming Index Bureau Reporting Actuarial Data Requests Travel Over 100 Miles Outside Investigation Medical Cost Management Fee Scheduling 28% of Savings PPO Usage 30% of Savings Field Medical Case Management $75 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 • Surveillance • Official documents and transcripts • Extraordinary travel at client's request • Court reporters • Independent medical examinations, • Managed care MRIs, etc. 3 As required or requested. Most services are optional. 4 Pricing for additional managed care services is available upon request. Dubuque /1010 Page 6 $2500 Per Release $400 Per Release $3 Per Report/Bill At Cost At Cost No Charge $60 Per User Per Month No Charge $50 Per Copy T &E ($85 Per Hour) T &E ($ /Hour) $6.25 Per Report $50 Per Hour T &E ($85 Per Hour) T &E ($85 Per Hour) 07269 ASC Alternative Service Concepts, LLC Workers' Compensation Definitions 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. WITNESS: ALTERNATIVE SERVICE CONCEPTS, LLC BY: /gledf get4-aff TITLE: CEO DATE: /�z 9 /M CITY OF DUBUQUE, IOWA BY: Mic1ael Van Milligen TITLE: City Manager DATE: /, V/0 Dubuque /1010 Page7 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. All 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 $2,000,000 Products - Completed Operations Aggregate Limit $1,000,000 Personal and Advertising Injury Limit $1,000,000 F Occurrence Limit $1 Fire Damage limit (any one occurrence) $ 50,000 Medical Payments $ 5,000 1 of 2 January 2008 INSURANCE SCHEDULE C (Continued) INSURANCE REQUIREMENTS FOR PROFESSIONAL SERVICES TO THE CITY OF DUBUQUE 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 20100704. 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 determined 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 ERAGES POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY !UIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. IREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1DD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM /DD/YY) POLICY EXPIRATION DATE (MMIDD/YY) • LIMITS VSRD X GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE • $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ . 50,000 X MED EXP (Any one person) $ 5,000 CLAIMS MADE X OCCUR PERSONAL 8 ACV INJURY 1,001..',000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OPAGG $ 1,000,000 GEM_ AGGREGATE LIMIT APPLIES PER: 7 POLICY JECOT TI LOC 1 AUTOMOBILE 17c LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 11 1 COMBINED SINGLE LIMIT (Ea accident) $ 1, 000, 000 X BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) GARAGE LIABILITY ANY AUTO LIABILITY ' /I I' I I r , 1 r 1 i AUTO ONLY- EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ EACH OCCURRENCE $ 1,000,000 EXCESS/UMBRELLA AGGREGATE • $ 1,000,000 7 OCCUR I CLAIMS MADE $ DEDUCTIBLE $ 0 $ $ _ X WORKERS EMPLOYERS' OFFICER/MEMBER PROPRIETOR/PARTNER/EXECUTIVE DFFICERIMEMBER If yes, RIEM describe RETENTION COMPENSATION AND LIABILITY EXCLUDED ?I{J�/y" EXLD under / C� — O � WC STATU- IOTH- X TORY LIMITS ER E.L. EACH ACCIDENT $ 100, 000 E.L. DISEASE - EA EMPLOYEE 100 000 $ r E.L. DISEASE - POLICY LIMIT $ 500,000 SPECIAL PROVISIONS below DTHER Professional Liability $1,000,000 I CORD,, CERTIFICATE OF LIABIL UCER (563) 123 -4567 • urance Agency .eet Address tED pany eet y y ITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURER A: Insurance Company INSURER B: INSURER C: INSURER D: • INSURER E: DATE (MM /DDIYYYY) 12/7/200 NAIC # ST Zip Code St Zip Code FAX (563) 987 -6543 EPTION OF OPERATIONS /LOCATIONSNEHICLES /EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS City of Dubuque is an additional insured on general liability policies including ongoing & completed operations rage equivalent to ISO CG 2010 0704 & CG 2037 0704. General Liability policy is primary & non - contributing. Form 504 0397 "Designated Locations" general liability aggregate limit is included. Governmental immunities endorseiuent ncluded. fIFICATE HOLDER City of Dubuque 50 West 13th Street Dubuque, IA 52001 ID 25 (2001/08) 5 (0108).06 AMS CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE VMP Mortgage Solutions, Inc. (800)327 -0545 © ACORD CORPORATION 1988 Page 1 of 2 :ORD 25 (2001/08) >025 (01os).06 AMS IMPORTANT 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). DISCLAIMER 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. 515 s cne dole Pr' °fes Page2of2 POLICY NUMBER: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED LOCATION(S) GENERAL AGGREGATE LIMIT 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 will be shown in the Declarations as applicable to this endorsement.) A. For all sums which the insured becomes legally obligated to pay as damages caused by "occur- rences" under COVERAGE A (SECTION I), and for all medical expenses caused by accidents under COVERAGE C (SECTION I), which can be attributed only to operations at a single desig- nated "location" shown in the Schedule above: 1 A separate Designated Location General Aggregate Limit applies to each designated "location ", and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2. The Designated Location General Aggregate Limit is the most we will pay for the sum of all damages under COVERAGE A, except dam - ages because of "bodily injury" or "property damage" included in the "products- completed operations hazard", and for medical expenses under COVERAGE C regardless of the num- ber of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits ". 3. Any payments made under COVERAGE A for damages or under COVERAGE C for medical expenses shaii reduce me Designated Loca- 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 COMMERCIAL GENERAL LIABILITY CG 25 04 03 97 the Declarations nor shall they reduce any other Designated Location General Aggre- gate Limit for any other designated "location" shown in the Schedule above. 4. The limits shown in the Declarations for Each Occurrence, Fire Damage and Medical Ex- pense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Designated Location General Aggregate Limit. B. For all sums which the insured becomes legally obligated to pay as damages caused by "occur- rences" under COVERAGE A (SECTION 1), and for all medical expenses caused by accidents under COVERAGE C (SECTION I), which can- not be attributed only to operations at a single designated "location" shown in the Schedule above: 1. Any payments made under COVERAGE A for damages or under COVERAGE C for medical expenses shall reduce the amount available under the General Aggregate Limit or, the Products - Completed Operations Aggregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Desig- nated Location General Aggregate Limit. Page 1 of 2 D. For the purposes of this endorsement, the Defi- nitions Section is amended by the addition of the following definition: CG25040397 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. Page 2 of 2 Copyright, Insurance Services Office, Inc., 1996 "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. CG 25 04 03 97 POLICY NUMBER: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE 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 complete 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 fh : t : , r n! ..t of those • n rtinn on your behalf; CG 20 10 07 04 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 in the performance of your ongoing operations for the additional insured(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 not apply to "bodily injury" or • "pi °petty damage" occurring after: Page 1 of 2 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 insured(s) at the location of the covered operations has been completed; or Page 2 of 2 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a princi- pal as a part of the same project. All terms and conditions of this policy apply unless modified by this endorsement. © ISO Properties, Inc., 2004 CG 20 10 07 04 CITY OF DUBUQUE, 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. SPECIMEN 1 of 1 January 2008