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25C - AGMT TPA CLAIMS SVCS
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25C - AGMT TPA CLAIMS SVCS
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Last modified
8/30/2019 1:21:33 PM
Creation date
8/30/2019 1:17:52 PM
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City Clerk
Doc Type
Agenda Packet
Agency
Human Resources
Item #
25C
Date
9/3/2019
Destruction Year
2024
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EXHIBIT 1 <br />FIRST AMENDMENT TO PROFESSIONAL SERVICES AGREEMENT FOR <br />THIRD PARTY WORKERS' COMPENSATION CLAIMS ADMINISTRATION <br />THIS FIRST AMENDMENT to the above -referenced agreement is entered into on September 3, <br />2019, by and between AdminSure, Inc. ('Administrator'), and the City of Santa Ana, a charter <br />city and municipal corporation organized and existing under the Constitution and laws of the State <br />of California ("City"). <br />RECITALS <br />A. The parties entered into Agreement No. A-2018-210, dated September 4, 2018, by which <br />Administrator agreed to provide claims administration services for the City's workers' <br />compensation self-insurance program ("Agreement"). <br />B. The Agreement remains in effect for a three-year term through August 31. 2021, with provision <br />for extension, and the parties now wish to expand the scope of work and increase the annual <br />amount to be expended under the Agreement in consideration of the expanded scope. <br />The Parties therefore agree: <br />Section 6, Claims Administration, is amended to include the following additional services: <br />Where applicable, the Independent Cities Risk Management Association ("ICRMA') shall be <br />included relative to any obligation or duty by the Administrator in Section 6 of the Agreement, <br />including without limitation claims administration, notification, monitoring, reporting, <br />litigation management, and disclosure. <br />2. Section 12, Consideration, is amended to include the following monthly fee structure <br />effective September 1, 2019. All other fees, if any, shall remain unchanged. <br />AdminSure, Inc. — Fee Structure Workers' Workers' <br />Compensation Compensation <br />Monthly Fee Annual Fee <br />Year (Completed -No Adjustment) <br />Year <br />Year 3 <br />Optional Year <br />Optional Year 5 <br />Optional Year 6 <br />Optional Year? <br />$ <br />42,125 <br />505,500 <br />$ 47,539 <br />$ <br />570,465 <br />$48,965 <br />$ <br />587,579 <br />$ 50,434 <br />$ <br />605,206 <br />$ 51,947 <br />$ <br />623,363 <br />$ 53,505 <br />$ <br />642,063 <br />$ 55,110 <br />$ <br />661,325 <br />3. Except as modified by this First Amendment, all terms and conditions of the Agreement shall <br />remain in full force and effect. <br />#6970v1 <br />25C-5 <br />
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