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Home My WebLink About03/29/2006 AGENDA llDl Il '[~>~itj~;~~:~~j~,~:jl CITY COUNCIL 345 6th Street, Suite 600, Bremerton, WA 98337-1873 03 (360) 473-5280 ***AMENDED*** MARCH 29, 2006 CITY COUNCIL MEETING AGENDA 1. PRE-COUNCIL STUDY SESSION: 5:00 - 5:30 P.M. in COUNCIL CONFERENCE ROOM 603 A. General Council Business 2. CALL TO ORDER: 5:30 P.M. in MEETING CHAMBERS LOCATED ON FIRST FLOOR A. Pledge of Allegiance B. Invocation 3. PUBLIC RECOGNITION & ANNOUNCEMENTS - "A Call to Citizens..." 4. CONSENT AGENDA A. Claims & Check Register (#AB06-056) B. Appointment of Matthew Keough and Joan Dingfield; and Reappointment of Steve Corda and Douglas Groneman to the Parks & Recreation Commission (#AB06-057) C. Appointment of John Ales; and Reappointment of Holly James to the Civil Service Commission (#AB06-058) D. Reassignment of Police Officer to an Operations Sergeant in the Bremerton Police Department (#AB06-059) E. 2006 Kitsap Physicians Service (KPA) Contract Approval (#AB06-060) F. Public Safety Bond Issue Professional Sorvices Agreement 'Nith AHAI J/\CKSON ELLISON MURAKAMI LLP for Architectural and Engineering Services for ne\': Municipal Court Building at-4Q1Il & Park (1fAB06 061) This item has been pulled G. Resolution No. 2989, authorizing retroactive application of salary adjustments for certain Management & Professional Employee Positions (#AB06-062) H. Resolution No. 2990, authorizing a 1 % cost-of-living adjustment for the Mayor and all Management & Professional Employee Classifications (#AB06-063) I. Resolution No. 2992, authorizing \the Redevelopment Project Administrator of Economic Development to apply for Grant funding from the Communi~ Economic Revitalization Board - Job Development fund Program (JfftlSo" -O"(rI) 5. GENERAL BUSINESS A. Purchase of Pugst Sound Energy 17,550 sq. ft. Parking Lot at 101ll & Park for a new Municipal Court Facility (#AB06 06<1) This item has been pulled B. Ordinance No. 4966, amending certain Chapters of Title 2 of the Bremerton Municipal Code (BMC) relating to reorganization of Financial Services and Human Resources Department; and 2006 Budget Adjustment in accordance with these organizational changes, and changing the position of Director of Human Resources to Manager of Human Resources per the revised 2006 Management Salary Plan (#AB06-065) 6. ADJOURNMENT OF CITY COUNCIL BUSINESS MEETING CONTINUED ON BACK... II Americans with Disabilities Act (ADA) accommodations provided upon request. Those requiring special accommodations should contact the City Clerk's Office at (360) 473-5323 by noon on the Monday preceding the Council meeting. CITY COUNCIL STUDY SESSION Immediately following the City Council Meeting, the Council Members will reconvene in COUNCIL CONFERENCE ROOM 603 to hear presentations on the following items. Please note that no action or public comment will be taken, and the content of these items is subject to change... 1. Amendment No. 1 to the Professional Services Agreement with GRANT SOLUTIONS for Grant Writing Services - Tom Knuckey, Public Works & Utilities, Engineering 2. Professional Services Agreement with PARAMETRIX, INC. for Port Washington Narrows Beach Sewer, Boardwalk, and Evergreen Park Expansion Project - Tom Knuckey, Public Works & Utilities, Engineering 3. Proposed ordinance approving and authorizing termination of the Development Agreement with NORTHWEST CORPORATE CAMPUS, LLC - Roger Lubovich, City Attorney 4. Proposed resolution to continue the Moratorium enacted November 30, 2005; and continued by Resolution No. 2987, on development over 40-feet high in the Highland/Pleasant Avenues District -- Chris Hugo, Department of Community Development Mayor Cary Bozeman PROCLAMATION April is Child Abuse Prevention Month Whereas, preventing child abuse and neglect is a community problem that depends on involvement among people throughout the community; Whereas, child maltreatment occurs when people find themselves in stressful situations, without community resources, and don't know how to cope; Whereas, the majority of child abuse cases stem from situations and conditions that are preventable in an engaged and supportive community; Whereas, child abuse and neglect can be reduced by making sure each family has the support they need to raise their children in a healthy environment; Whereas, child abuse and neglect not only directly harm children, but also increase the likelihood of criminal behavior, substance abuse, health problems and risky behavior such as smoking; Whereas, all citizens should become involved in supporting families in raising their children in a safe, nurturing environment; Whereas, effective child abuse prevention programs succeed because of partnerships created among social service agencies, schools, faith communities, civic organizations, law enforcement agencies, and the business community; Therefore, I, Cary Bozeman, Mayor of the City of Bremerton, do hereby proclaim April as Child Abuse Prevention Month, and call upon all citizens, community agencies, faith groups, medical facilities, and businesses to increase their participation in our efforts to support families, thereby preventing child abuse and strengthening the communities in which we live. Signed this 29"' day of March 200~ Cary Bozeman, Mayor ..._.... .~ ./I KITSAP COMMUNITY .. -~ources A COllllJltmi{r !Ie/ion ]>arlnf1'ship helping people. dWJ/ging /il't~J April is Child Abuse Prevention Month Show your support by wearing a Blue Ribbon! Child Abuse happens daily in Kitsap County. 1 in 35 Washington State children are victims of abuse or neglect yearly. Join the Parenting Place in preventing Child Abuse. The Blue Ribbon campaign promotes awareness of child abuse and neglect. Wear your Blue Ribbon to show you care! There are 5 things you can do RIGHT NOW to help prevent Child Abuse and Neglect. 1. Reach Out. 2. Recognize the Waming Signs. 3. Report Suspected Abuse or Neglect. 4. Stay informed 5. Write your Congressmen and Legislators. From Prevent Child Abuse America For more information call The Parenting Place (360) 473-2134 Help Prevent Child Abuse! News Release PUBLIC WORKS & UTILITIES Administration Division Bremerton Residents May Dispose of Yard Waste for Free During Annual Spring Cleanup I Contact: Bob Tulp, Public Works Operations Manager 360-473-5753 Bob.Tulp@cLbremerton.wa.us For immediate release: March 30,2006 Do you have yard waste you need to get rid of? Are you a City of Bremerton resident? If so, you can take part in the City's Annual Spring Cleanup and dispose of this waste for free! Spring cleanup 2006 will be held Monday, April 1 ih through Saturday, April 22nd between the hours of 10:00AM to 6:00PM at the Public Works & Utilities Operations Center located at 100 Oyster Bay Avenue North in Bremerton. Any City of Bremerton resident interested in participating is reminded that nothing larger than a pick up truck load, or small trailer, of yard waste materials will be accepted. Yard waste materials are limited to leaves, branches, brush and grass clippings. Any items over 8 feet in length or 6 inches in diameter will NOT be accepted, nor will contaminated loads (cardboard, household garbage, processed lumber, etc.). The City reserves the right to reject any and all loads. Spring cleanup is an annual event held by the City of Bremerton Public Works & Utilities department. This is a courtesy for Bremerton residents only and proof of residency is required. For more information on this event please contact Public Works & Utilities Customer Response at 360-473-5920 or visit www.cLbremerton.wa.us. # # # # CITY COUNCIL MEETING SPEAKERS LIST PLEASE NOTE THAT ALL REQUESTS FOR INFORMATION FROM THE CITY OF BREMERTON MUST BE SUBMITTED IN WRITING. THANK YOU. PLEASE PRINT YOUR NAME BELOW IF YOU PLAN TO SPEAK DURING THE COUNCIL MEETING TONIGHT C)r$\cyr,'()C\ ,?-\'()dr rU -c/L~~~ 13A---~~ (}.... b)l"~orv JOh PAR K I1'\G t..0'1 r$$\J6 s L-y,rl-hiCL &tr/ $\)~~\- ~~(SO\l im <:',~~_:>~-,- =:':-' , .-, ,J.'.-"'"" BREMERTON MUNICIPAL COURT March 27, 2006 Dear Council Members: We wish to address our concerns regarding an item on the consent agenda for Wednesday, March 29, 2006. We understand that the City Council will be voting on whether to proceed with a Professional Services Agreement with Arai/Jackson Architectural Services for a new court building. After reviewing the Professional Services Agreement, we understand that the proposed court building will be 6200 square feet. We are concerned this square footage will not be adequate for the Bremerton Municipal Court's current or future needs. In October of 2003, based on their June 2003 "Space Needs Update" Arai/Jackson submitted a proposed design for a Public Safety Building. Reflected in this design is a court facility of 7,158 square feet with a 902 square foot entry/lobby shared with the police department for a total of 8,060 square feet. This design was based upon the spEtial needs we anticipated as the design process began back in 2000. The court space needs allotted in this design are still reflective of the court's current space requirements. Though we asked for some minor review changes, we have always supported the proposed 8,060 square footage. For your review, we hewe attached a copy of this design. In light of the aforementioned design process in which we participated, it is unclear to us how the 6200 square feet will accommodate the lobby, public restrooms, and jury room that doublE!s as a second, smaller courtroom, all previously included as "shared space." In addition, because we are no longer adjacent to the police and do not have access to their holding room, the court would require one of its own. We believe the proposed 6200 square foot facility will not allow for the anticipated increase in court activity in light of the expected growth of Bremerton. Thank you for this opportunity to address our concerns. Should you have any questions, please contact us. Sincerely, , , ili;' I , ,j "\'e' ., -...-.,.....-v..--"..."- v.....-- \,r'''-"''' ......~_, JdnlJa.~L.!(Qe n (-e-ciUrt Mana,ger ~ s N. Docter / dge _t.~;,~ ~. 7TH STREET 2 -6" HIGf1 SPE 0 -----<-- ~ ~~~ ~ I i ~ I 19 SPACES @ 9'-0" X 18'-0" 20'-0" HIGH SPEED 1 CO~~~2"~~C~ _@_ ~-~"_X_1~'=?~~ _ _ _ -=-_ _S~~~R~~AT~ --t> I, f I [i1i;---------'------------1 1 tv[; 5 SPACES @ 9'-0" X 18'-0" <l---- j - - - - -2 -He -5r-AC-ES -@-W'-6"-* +8'-9"- - - - - - - - __ ---' 2 MC SPACES @ 4'-0" X 8'-0" --t> ,I LL --, --' Z W > <( U LL o <( a.. 6TH STREET SCALE: 1" = 30'-0" 1IiT1""",,'""'""'= - - NORTH ffi SITE PLAN 0) H G ~ I f"\ 1/1 "9 '" M I I I P~C ! B B! B B B! II u l, ~I I ~~~,D DID 0 D~I nc- ill ^~ o ID DID~ D[J~ ==j~~' L U 0 i [J [J [J ~~ "'---- 100,0 0 ~:_ [] ""~i -JrsPEeT y~~ -cG\:JFffR0eM JI t4 ~ liB ~l'IB B 8~ 8] """" l"h' J:l I B ~ B B Oil! ''vC, q~IDB'D[]BIII =-= G !u 1000111 OCQooo J I BJC , BBY \ ' ~ /' / I ~ ~Oli , ,[ P,ROBATlON'1 70 sq tt i' -- -=]- t o 1 I IffibBATION , " 7~ ; ---.J. =---=- ----1- 0---11 AAOBA TlON II 7<J sf!l1 1 I --UOI i NORTH I I IEBI t~+w-+ , , B [,. 10'-0" [,. 1 I"i ,0" I I 1. J diUNTER I I ~I q::>UNTER IH WALK-UP I ~TATION I STATION ISTATION I 164 sq 11 i 164 sq tt _ ~_It . - - -LJ_ - l I I I I COiJF1T=Jjo OOORT-I I .fU:RK ~LERK, iLERK , 1 I :::IQ~ -~~-=tJ~~ I '-f0 I I ' ~II HI II? '~ 1 I ;"1 1 c;,l I ~I I I n~ I ~ I I 91 ~i "9 '" ..-, I ~ ~I I . I A' \ ~~,~.~. I I II -I ~/ ~~~ i ~I ,D @ 8], I I ;:I~, I I ~'\J [,. 10'-0" I 10'.0" i " ,r--~f I---+--~ ,~ t' \ n I COURTS LOBBY 11460 SQ fI ~ MECH. 156 sq It L \ , - ~ 1- - [J PART I PART o TlME I TlME 36 SQ ft : 36 SQ II I I 8'-0" ~ 12'-0" f 28'-0" [,. 12'-0" '1 1 ~ 90'-0" I ^ CITY OF BREMERT POLICE COURTS BUILDING 607 PACIFIC AVENU E BREMERTON, WA 98337 0.,,,, City of Bremerton Administrative Services Department 239 Fourth street 8.-emenon, VIlA 98337 Telep~e: 360.473.5234 FaXlflllle 360 473.5850 Architects Arai/Jackson Architects & Plar 1601 Eas1 JaM Street Seattle, WA 96112 Telephone: 206.3238800 Faxmile' 2063218518 Ovil Engineers Berger/ABAM Engineers, Inc. 2005 Firth Aven"e _ Thirtl RoO'" Seattle. WA 98121 Telephone: 206.374.9790 Falllfl'ljle 206.374.9795 Structural En!J1'W!en; Berger/ABAM Engineers, Inc 2'005 FIfth Averue. Third Roar Seattle, WA 98121 Telephone: 206.3749790 FaxlrTIIle: 206.3749795 Mechanical Engineers McGowen/Broz Engineers, Inc 15405 S.E. 31th Street- SUite: 201 BeBewe, I/VA. 98006-1 m Telephone 425,5648400 Faximlle 425.~ 8517 Bectrical Engineers McGowen/Broz Engineers, Inc 15405 S.E. 37lh S1reet. Sl.fte 201 Bellewe, WA 98cx>&1n2 Telephone 4255&48400 Faximle: 425564~17 ~ REGISTERED \ \ ) ARCHITECT \ lc=:J KEY ptAN , REVISIONS No Dale By ~bc:r'l SCHEMATIC DESIGN- FIRST FLOOR PLAN :i~ BACKGROUND This study builds on a previous study conducted for the City of Bremerton (DLR - 2000) that developed space needs for a new police lcourts facility. That study identified a building need of 24,960 gross square feet and site area of approximately 4 acres for the new facility. The City then looked at several potential sites for the new facility and determined that the best site would be the West One Bank building site located at 6th and Pacific. This 1.2 acre site currently houses a 20,524 sf bank building (4,097 sf basement, 10,550, sf main floor and 5,895 sf mezzanine) built in 1977 with surface parking for 72 vehicles. ArailJackson Architects and Planners were selected in 2003 to develop plans and specifications for Police / Courts facility. SPACE NEEDS VERIFICATION AND UPDATE The first phase of the project involved the confirmation of the (2000) space needs previously developed. The architects developed questionnaires for all staff to be located in the new facility and interviewed key personnel with the Police and Courts. The space needs and parking requirements were updated and reflect some changes. This document presents the updated Bremerton Police / Courts space and parking needs. All spaces that have been designated for inclusion in the project are listed. The spaces are indicated in NSF (net square feet). A grossing factor of between 18% and 33% (similar to the 2000 report) has been added to the net square feet in order to account for circulation (hallways and building structure). The space needs (GSF = gross square feet) compared to the 2000 space needs analysis is as follows: 2000 2004 2015 Shared Support 2,419 2,596 2,596 Municipal Courts 2,796 3,131 3,131 Municipal Court Administration 1,903 1,815 1,815 City Prosecutor 575 575 575 Probation/Home Detention 225 338 338 Police 17,220 17,765 17,765 Total (Gross Square Feet) 25,137 26,220 26,220 Space need changes are indicated in bold on the following pages. Arai / Jackson Architects and Planners 6/23/03 Page 1 City of Bremerton Summary FACILITY SPACE DATA SUMMARY: ALL DEPARTMENTS No. Name: 2000 2004 2015 Remarks 1.0 Shared Support 2,419 2,596 2,596 2.0 Municipal Courts 2,796 3,131 3,131 2.1 Municipal Court Administration 1,903 1,815 1,815 2.2 City Prosecutor 575 575 575 2.3 Probation/Home Detention 225 338 338 3.0 Police 17,220 17,765 17,765 Total Net Square Feet 19,396 20,244 20,244 5,741 5,976 5,976 Total Grossing Area (% Varies) Total Police / Courts Facility Gross Square Feet 25,137 26,220 26,220 Arai / Jackson Architects and Planners 6/26/03 Page 2 City of Bremerton 1.0 Shared Support FACILITY SPACE DATA SUMMARY No. Name: Size Qty 2000 2004 2015 Remarks 1.0.00 SHARED SUPPORT 1.0.01 Entry Vestibule ' 80 80 80 80 SHARED 1.0.02 Public Lobby 400 1 400 400 400 SHARED: Courts seating - 6; Police seating - 6 w/ standing report writing area; historic display wall and motorcycle. 1.0.03 Public Restrooms 150 2 300 300 300 SHARED 1.0.04 Multipurpose Room 500 1 500 500 500 SHARED: Courts require space separation from courtroom to impanel jurors. 3D-capacity. Police to use as training room. 1.005 Storage 80 1 80 80 Multipurpose Room storage. 1.0.06 Mechanical Room 480 1 480 480 480 1.0:07 Electrical Room 150 1 150 150 150 1.0.08 Phone Room (1st Floor) 120 1 60 120 120 1.0.09 Phone Room (2nd Floor) 10 1 0 10 10 1.0.10 Refuse/Recycling 80 1 80 80 80 NET Square Feet 2,050 2,200 2,200 Grossing Factor (18%) 369 396 396 GROSS Square Feet 2,419 2,596 2,596 Arai / Jackson Architects and Planners 6/26/03 Page 3 ,;... :a:&.l. City of Bremerton 2,0 Municipal Courts FACILITY SPACE DATA SUMMARY No. Name: Size Qty 2000 2004 2015 Remarks 2.0.00 MUNICIPAL COURTS 2.0.01 Witness Exclusion/ 80 2 160 160 160 Access to public lobby Attorney/Client 1 = PD office; Conference Rooms 1 = Attorney / client conference. 2.0.02 Municipal Courtroom 1,860 1 1,592 1,860 1,860 Includes sound vestibule, 6-person jury, 75--spectators. ADA accessible within courtroom. 2.0.03 Court Holding Use PD holding. 2.0.04 Courtroom Storage 60 1 60 60 60 PRIVATE 2.0.05 Jury Deliberation Room 140 1 140 140 140 6-capacity, directly accessible from courtroom, includes 4-foot counter/coffee bar. ADA accessible. 2.0.06 Jury/Staff Restrooms 60 2 120 120 120 ADA accessible 2.0.07 Judge's Chamber 165 1 165 165 165 PRIVATE NET Square Feet Grossing Factor (25%) GROSS Square Feet 2,237 559 2,796 2,505 626 3,13'1 2,505 626 3,131 Arai / Jackson Architects and Planners 6/26/03 Page 4 ,'k~~ City of Bremerton 2.1 Municipal Court Administration FACILITY SPACE DATA SUMMARY No. Name: Size Qty 2000 2004 2015 Remarks 2.1.00 MUNICIPAL COURT ADMINISTRA TION 2.1.01 Counterl 240 1 250 240 240 3-station counter, including Counter Workstations (3) 3 built-in workstations wI security glazing off public lobby wI walk-up access area. 2.1.02 Court Clerks (3) 80 3 320 240 240 OPEN 2.1.03 Part-Time Clerks (2) 36 2 72 72 72 OPEN workstation 2.1.04 Legal Technician 120 1 120 120 120 PRIVATE 2.1.05 Court Administrator 130 1 130 130 130 PRIVATE 2.1.06 Workroom 200 1 200 200 200 OPEN Mail Sorting & Deliver Area 2.1.07 Active Files 150 1 150 150 150 OPEN 2.1.08 Archive Files 100 1 100 100 100 Could be remote within building. 2.1.09 Break Room 140 1 140 140 140 SHARED space for 4-seated, + kitchen wall containing refrig, sink, microwave, toaster oven, coffee machine. 2.1.10 Coat Closet 20 1 0 20 20 For Administrative staff. 2.1.11 Janitorial Closet 40 1 40 40 40 NET Square Feet 1,522 1,452 1,452 Grossing Factor (25%) 381 363 363 GROSS Square Feet 1,903 1,815 1,815 Arai I Jackson Architects and Planners 6/26/03 Page 5 'r';;,.~ City of Bremerton 2.2 City Prosecutor FACILITY SPACE DATA SUMMARY No. Name: Size Qty 2000 2004 2015 Remarks 2.2.00 CITY PROSECUTOR 2.2.01 Waiting 0 1 0 0 0 In Public Lobby 2.2.02 Receptionist 120 1 120 120 120 OPEN 2.2.03 File Area 60 1 60 60 60 OPEN 2.2.04 Workroom 150 1 150 150 150 SHARED 2.2.05 Prosecuting Attorney 130 1 130 130 130 PRIVATE NET Square Feet Grossing Factor (25%) GROSS Square Feet 460 115 575 460 115 575 460 115 575 Arai / Jackson Architects and Planners 6/26/03 Page 6 , .. City of Bremerton FACILITY SPACE DATA SUMMARY No. Name: 2.3.00 PROBATION I HOME DETENTION 2.3.01 Waiting 2.3.02 Office Size Qty 270 2000 1 180 2.3 Probation/Home Detention 2004 2015 Remarks Within Public Lobby 270 270 Semi-private; (3) workstations. Close to Courtroom & Public Restrooms Arai / Jackson Architects and Planners NET Square Feet Grossing Factor (25%) GROSS Square Feet 180 45 225 270 68 338 270 68 338 6/26/03 Page 7 March 29, 2006 pY~SeY\. ie.vt <t} c.{~ Co~~a I k~ 3f'Jo&f If> So Bremerton City Council 345 6th Street, Suite 600 Bremerton, WA 98337 Dear Bremerton City Council, Some homeowners on Highland Avenue have a favorite story they are telling these days. It goes something like this. A single developer has charged into their quiet little historic neighborhood and is threatening everything they've planned and worked for. The telling is a little different each time, but the common theme is always there. Big bad real estate developer destroys historic single-family homes. Here is a little bit different version of the same story. Several property owners in this area spent several decades investing in and aggregating property in a downtown residential area. Chuck and Ann Laubach aggregated nine parcels between Highland and Pleasant. Mildred and Darrell Cullimore aggregated five parcels between Highland and Washington. Dr. Severson, Jim Herdman, Jim Adrian, and Bert Gegner also aggregated parcels on these streets. I can't speak for all of them, but I know why the Laubach's and the Cullimore's collected and preserved these aggregated parcels for so many years. They wanted to redevelop. They chose these streets because for as long as anyone can remember, these streets have been zoned for high density residential structures. The Laubach's actually began specific plans back in 1995. The time wasn't quite right and they abandoned those plans. Chuck Laubach passed away recently as did Mildred Cullimore. They did not live to see their plans come to fruition. That is how long it takes to create plans of this scale; it often doesn't happen in a lifetime. As dramatic and exciting as it all sounds, there is no single big bad developer that came on the scene yesterday. There is no predominantly single-family home neighborhood being destroyed. The development that is finally ready to proceed has been in the making for decades. The zoning has been in place for decades. The Johnny-Come-Latelys are the few homeowners who are trying to convince you that they moved into a quiet little neighborhood expecting to grow roses. They have told their poetic story enough times that they have attracted some other homeowners in other areas to take on the cause as their own. But it isn't their cause to take on because their neighborhoods are not in the only MR zone in the entire city. Their neighborhoods aren't in the Downtown Regional Center. Their neighborhoods are not targeted to receive an AVERAGE (not maximum) density of 40 dwelling units per acre. Their neighborhoods were not zoned for 20 years to receive 120 foot structures. Please don't destroy decades of solid planning undertaken by some of the most respected community leaders on the recent whim of a few homeowners. s;~~~ Shane Schrodt BILL # o? -()~ DATE SUBMITTED: AGENDA BILL CITY OF BREMERTON CITY COUNCIL 'fA ........................................................................................ SUBJECT: Claim & Checks Register Approval Committee Meeting Date: COUNCIL MEETING Date: ?.:.;:z '/-0 0 Department: Financial Services Presenter: Cathy Johnson Phone: SUMMARY: ATTACHMENTS: FISCAL IMPACTS (Include Budgeted Amount): APPROVALS: DEPARTMENT DIRECTOR: CITY ATTORNEY: FINANCE DIRECTOR: MAYOR: FISCAL/BUDGET: OPERA TrONS: COUNCIL PRESIDENT: /~~c;7:LA/1~f RECOMMENDED MOTION: Move to approve: 1) Check #'s 307/ tJ:;- .- 3()7 "3 r; / l CONSENT AGENDA IZlI EFT's ?9o~.- f9// $ 802;2:;2~.. &, S- 2) Regular Payroll for $ 3) Retiree Payroll for COUNCIL ACTION, Le $ o Deny o Table o Continue 0 No Action DA TE SUBMITTED: March 8, 2006 AGENDA BILL CITY OF BREMERTON CITY COUNCIL BILL # O~-a;7 LIB .......a...m......a..................................................................... SUBJECT: Appointments to the Parks & Recreation Commission Committee Meeting Date: March 22,2006 COUNCIL MEETING Date: March 29, 2006 Department: Executive Presenter: Mayor Bozeman Phone: 473-5266 SUMMARY: TThere are two vacancies on the Parks & Recreation Commission due to the resignations of Susan Bell and Nick Garguile Sf. It is recommended those vacancies be filled by Matthew Keough and Joan Dingfield. The terms of Steve Corda and Douglas Groneman have expired and it is recommended they be reappointed to another term. A TT ACHMENTS: Applications for appointment. FISCAL IMP ACTS (Include Budgeted Amount): nJa APPROV ALS: DEP AR TMENT DIRECTOR: CITY ATTORNEY: FINANCE DIRECTOR: MA YOR: FISCAL/BUDGET: OPERATIONS: COUNCIL PRESIDENT: I CONSENT AGENDA ~ RECOMMENDED MOTION: Move to confirm the appointments of Matthew Keough and Joan Dingfield and reappoint Steve Corda and Douglas Groneman to the Parks and Recreation Commission. - COUNCIL ACTION: D Approve D Deny D Table D Continue D No Action m.... ~ Application For City Boards! Commissions! Committee Note: As an applicant for a City Board, Commission or Committee, your name, address, and telephone number will be available to the press and public. You will be contacted before any action is taken on your appointment. (Please type or print clearly) Date: 10/17/05 Name: Matthew FIRST Francis MIDDLE Keough LAST Home Phone: (360) Home Address: NUMBER STREET WA STATE Bremerton CITY 98312 ZIP Occupation: Housing Administrator Employer: Kitsap Community Resources Work Address: 1201 Park Avenue NUMBER STREET VlA STATE Bremerton CITY 98337 ZIP Work Phone: (360) 473-2047 Fax: (520) 792-8708 E-Mail: mkeoug!:!~cr.org___ Education: BA, University of Virginia (Double Major: History, Foreign Affairs, Minor: Urban Planning) MS, University o(Arizona, Urban and Regional Planning, Concentration: Community Development Local References (names and phone numbers): Ms. Charleen Burnette, 308-0139 Ms. Jessica Kennedy, 479-7004 Dr. Bette Hyde, 478-5105 I am interested in serving (please check one or more): o o o o o rgJ o o o Disability Action Committee Civil Service Commission (i8 yrs. and older) Urban forest Committee Public Access Citizens Advisory Committee Community Development Block Grant Advisory Board Youth Coune! I Safe Streets Steering Committee Board of Appeals, Housing/Building Codes Other ~ Planning Commission (18 yrs. and older) ~ Parks & Recreation Commission o Ethics Commission D' Parking Advisory Board o Mayor's Select Committee on Law Enforcement ~ Bremerton Housing Authority o Solid Waste Management o Citizen's Cornmission on Council Salaries Is this an application for reappointment? No _____________________ If yes, how many years have you served on this commission/committee? _____________ C'ity Appointment Application Page! of2 Why are you applying for this appointment? I am applying out of my interest and dedication to local community development eftorts. I very much benefited from my professional time at the City ofBremerton and would like to contribute back to the City as an active, engaged citizen. '''hick of your peJl"sonal and/or profess!onal interests prompted you to apI}ly for ibis appointment? My professional interest and background in Planning prompts this application. I am avid defender and believer in public processes, especially in connecting citizens to govelTh'11ent, public resources, and decision making. Have you ever served on any other Bremerton Board. Commission, Committee OJ!" Task Force? lfyes, please list: None. Please Ji~t your qualifications for this appointment (include skills, activities, training, education): As a former Growth Planner for the City of Bremerton (August 2005), I have unique qualifications for appointment, particularly in a Planning capacity. My advanced degree and previous Community Development positions further qualify me in this respect. Furthermore, I am well-versed in the State and local Planning goals and requirements as well as local values and needs. I am most skilled as a facilator and very much enjoy working with the public. My past work experiences include working with youth, specifically, in leadership training programs. An area of expertise is Housing. I am experienced \\'ith Census-taking, map-generating, and strategizing over housing policies. I am currently employed as the Housing Director for Kitsap Community Resources, overseeing services that help low-income individuals move towards seif-sufficiency. An appointment, directly related to housing, would require review and consideration for local agencies, including my o"vn. What are your community interests (committees, organizations, special activities)? I am active in my local church, particularly around youth and education issues. I am avid public school supporter. My wife, Echo Keough, is active as a school volunteer and is currently an applicant for the Kitsap County Libra..ry Board to represent Bremerton. Our young son is our pride and joy; we enjoy farniliy activities through Bremerton's Park and Recreation programs, especially swimming. We welcome your willingness to serve Bremerton. For more information please contact the rv1ayor's Office at (360) 473-5266, FAX (360) 473-5883 or via email at mayor@ci.bremerton.wa.us. Please return the completed form to: Mayor's Office, 345 6th Street, Suite 600, Bremerton WA 98337. A i. V::' ( (--,,--,.'/7"1 /, elf! f~~ " ;'cfl-'\..~ ! ' t [/11 ';1 // 1.-'- ,,;/ ....v City Appointment Application PagG:2 of2 APPLICATION FOR CITY BOARDS/COMMISSIONS/COMMITTEE NOTE: As an applicant for a City Board, Commission or Committee, your name, address, and telephone number will be available to the press and public. You will be contacted before any action is taken on your appointment. (Please type or print clearly) DATE:March 8, 2006 NAME: Joan Dingfield HOME PHONE: 360 ~ HOME ADDRESS: . Bremerton STATE W~IP CODE 98310 OCCUPATION: School Board Office EMPLOYER: Seattle Puhlic. Sc.hools WORK PHONE: 206-252-0041 E-MAIL: jodingfield@seattleschooPAlX1:g 206-252-0101 BUSINESS ADDRESS: PO Box 34165. MS 11-010. Seattle WA 98124 EDUCATION: Sure. LOCAL REFERENCES (name & phone number): Mike Levi. 792-9210 Deborah Horn, Kitsap County Health Clinic, 478-2366 Bev Kincaid, Sound Grants, 895-1321 I AM INTERESTED IN SERVING ON (please check one or more): ( ) ( ) ( ) ( ) ( ) () Disability Action Committee ( ) Civil Service Commission ~ Ethics Commission ( ) Public Access Citizens Advisory Committee () Community Development Block Grant ( ) Advisory Committee ( ) Arts Commission Planning Commission Parks & Recreation Commission Citizen's Commission on Council Salaries Parking Advisory Board Solid Waste Management Bremerton Housing Authority . Is this an application for reappointment? No . If yes, how many years have you served on this commission/committee? ( ) Other Please turn page 4 WHY ARE YOU APPLYING FOR THIS APPOINTMENT? I want to continue being involved in the community after adjusting to the work commute to Seattle. I have a great interest in parks and working with government agencies to get best use out of tax dollars. I see Parks as an integral part of Bremerton becoming a very livable city and want to make this happen. WHICH OF YOUR PERSONAL AND/OR PROFESSIONAL INTERESTS PROMPTED YOU TO APPLY FOR THIS APPOINTMENT? Stephenson Canyon Dog Park and redevelopment of that area of the city. HAVE YOU SERVED ON ANY OTHER BREMERTON BOARD, COMMISSION, COMMITTEE OR TASK FORCE? IF YES, PLEASE LIST: Planning Commission Bremerton Ferry Advisory Committee PLEASE LIST YOUR QUALIFICATIONS FOR THIS APPOINTM ENT (INCLUDE SKILLS, ACTIVITIES, TRAINING, EDUCATION): Lots of community involvement and organizing Familiarity with the workings of government and the role commissioners play Campaign experience Time to read WHAT ARE YOUR COMMUNITY INTERESTS (COMMITTEES, ORGANIZATIONS, SPECIAL ACTIVITIES)? Marine Transportation Association of Kitsap (passenger ferry service) We welcome your willingness to serve Bremerton. Please return this completed form to: Mayor's Office 345 6th Street, Suite 600 Bremerton, W A 98337 (360) 473-5266 (360) 473-5883 FAX E-mail: mayor@ci.bremerton.wa.us APPLICATION FOR CITY BOARDS/COMMISSIONS/COMMITTEE NOTE: As an applicant for a City Board, Commission or Committee, your name, address, and telephone number will be available to the press and public. You will be contacted before any action is taken on your appointment. (Please type or print clearly) DA TE: /fJ/~~ r- NAME: 5/if/p (??~/f HOME PHONE: :?M- HOME ADDRESS: i5f!$/Ilf-,e1lJt/ STATE Pv# ZIP CODE fJl3'/tl OCCUPATION: !fA?/J~/Z/?tlA?1I EMPLOYER: fJ,eEitf p;Z7I:J1I 1!$t5/1 5?/ltVL WORK PHONE: 3!Sf) -1/71-6173'3 - E-MAIL: 5Uj/;:.A~#!ZPA~X1If~rJrUtf{ FAX: BUSINESS ADDRESS: LOCAL REFERENCES (name & phone number): PtftpIY )/;/&/;;/1 Ifp,Af1 /J'/Zt>Cr,e-l/s g~tlvf jk~I2i?t/;8f I AM INTERESTED IN SERVING ON (please check one or more): ( ) ( ) ( ) ( ) ( ) ( ) Disability Action Committee ( ) Civil Service Commission X" Ethics Commission ( ) Public Access Citizens Advisory Committee () Community Development Block Grant ( ) Advisory Committee ( ) Arts Commission Planning Commission Parks & Recreation Commission Citizen's Commission on Council Salaries Parking Advisory Board Solid Waste Management Bremerton Housing Authority ( ) Other Is this an application for reappointment? ,/F!? If yes, how many years have you served on this commission/committee? t1 /1;;:- r/(2/i1 Please turn page ~ WHY ARE YOU APPLYING FOR THIS APPOINTMENT? .:1 IJf~ff3j/& f- }t,.-/I7 A- ;?p'/,f/fR- r tJr 5~M~ j/~~y U/O #--&(?J!- 7!f.U .;::-~/ /~?N /# r#..?!? UMMT5f.&/Y"-7-IVC::..?t/P7-/V6 -IlfE-- ~f?/l-/~ M;Z? j?49(}6cl; "/)7>;; ~t?~r C,,/l(2?C- ~J mf273 /?~ v; z.-.. ;: ~ ~;?y T/f~ /J r~ f-r$lflPi ~ ClMf~~rt3 1M %~/5 AL--f!-by"/pY~':J3iiFij, ~ -1(Yf. ;e;;re IfF 4 , 5'rklf/ $ "tr Ie..- :;7p;Z-j/.7-?~.5- ~/!-~ EM Et z: WHICH OF YOUR PERSONAL AND/OR PROFESSIONAL INTERE TS PROMPTED YOU TO APf;i Y FOR ~ THIS APPOINTMENT: ~y ~Mfr A5 ? A /26-fP~/~r2 .5AY~ ;vf/3- A- r/7Y~f/b/f k~I!~A /LNU?f3P~? tfr /~ T/lE ~~T0 ,ffiJI! J kE#&p ~ P~~;VIE A- m~1f?-F~YT /Z#-7/rp;e ~ Af/ ~b~~c:e-. , . ~j) e: ~ ___ ~ 'C, ft-:-- ~ :P~.5 /f-rrlf~ #01 &-rf/E/vtE/f ~~tJf/P#-?U~ff~if-tJEF7,~~ /. . -;e -::. ~12:?f('(5 /2,.ec;2l~~1I HAVE YOU SERVED ON ANY OTHER BREMERTON BOARD~ M~~~COMMITTEE OR TASK,N'Up FORCE? IF YES, PLEASE LIST: :/--tJ5fi,Jt:-/lIl~ 1PP4CJIY Tl&('ItR-/!.5 UMJ55Mf~' (5~T 7 Iff i3-/?~P ~ j7tfJ /~/f/J;zE "~.-&~ ?7-#Vp~~' PLEASE LIST YOUR QUALIFICATIONS FOR THIS APPOINTMENT (INCLUDE SKillS, ACTIVITIES, TRAINING, EDUCATION): /v(y 6Xf'Ef2-.:pF;V'CE~ k.:FT/f /V!I/T/f .?/~p~AM->fj) T~Y#U/ Uf f1:Cf?M I5'AL~r;~/tJ;VPj' My f}14T~flL .G,Y/:?F#?:T~/;/cF r/1';1 ;;;XFF?-r.r~E JiI Ct:?A?-.IIJR"&' A-;VP.EPPC/JT-M~ ff/Z:r.~ ~ f//fr::rr17 '5'/4ZL5 r/-- tfl/A.i-..Tr;FLAW#,> .; p:E..I-Tt:?/~ ~?E Ph;L~ WHAT ARE YOUR COMMUNITY INTERESTS (COMMITTEES, ORGANIZATIONS, SPECIAL~~,€ ACTIVITIES)? c-//,M.r~ rl3"~fI&I7../0L/I~,H Fff~Ei?7lJ// >CA~L. ~r~ AC1T;:/E ?~rJZEI</ Jt--~r/l ,A-;b#"L1P A-/J~~.J7VtC ;ZE.?4~~~ J&~tlf~("f/;{'fZ;AJ- /.?~Y,~T5 ~~.~ff/VI3~72/~~ A{,EpM,/ ' Wf'EI-f/MFj//' d- ~.ecr2-EA-7J:i;.fI t'RMM(/J/-7T;c~C;. We welcome your willingness to serve Bremerton. Please return this completed form to: JVIayor's Office 345 6th Street, Suite 600 Bremerton, WA 98337 (360) 473-5266 (360) 473-5883 fAX E-mail: mayor@ci.bremerton.wa.us APPLICATION FOR CITY BOARDS/COMMISSIONS/COMMITTEE NOTE: As an applicant for a City Board, Commission or Committee, your name, address, and telephone number will be available to the press and public. You will be contacted before any action is taken on your appointment. (Please type or print clearly) DATE: I ().- 32/ - () 5-- NAME:-'oou(;...L;:rs C~ G-f2.0N'G!lv{ArJ HOME PHONE: HOME ADDRESS: STATE ~\JA- ZIP CODE <:18::1 j 0 OCCUPATION: /vl4JC CARt2IG/2 EMPLOYER: U. <;. PC)5,:7A L S6,f\)iC(?" WORK PHONE:l..} 7Crl, 75~7L/ E-MAIL: ,:} Rt'1Vif/"if.}/\:!),J3@ FAX: , c'c/vlClh~'I.. ,vGi BUSINESS ADDRESS: -- EDUCATION: 8' I.AJAs;.JJ,\J0-lotJ 5;'J: J:~ tV tA-11\,16-. '-I 7 cl - 757 '-J l-{ 73 -. <.tJ':3 [) 6- SlJlI Pf..)/N,.,)/i J -'77 '3 - ,/-; /, "J I.J !;., ....' I AM INTERESTED IN SERVING ON (please check one or more): ( ) ( ) ( ) ( ) ( ) Disability Action Committee ( ) Civil Service Commission t>4 Ethics Commission ( ) Public Access Citizens Advisory Committee () Community Development Block Grant ( ) Advisory Committee ( ) Arts Commission Planning Commission Parks & Recreation CommiSSion ( ) Citizen's Commission on Council Salaries Parking Advisory Board Solid Waste Management Bremerton Housing Authority ( ) Other Is this an application for reappointment? t:G:.S If yes, how many years have you served 0 thiS commission/committee?::> iX: Please turn page ~ WHY ARE YOU APPLYING FOR THIS APOINTMENT? .1c I~ALle' SG,QvGd ~oR- 5iy 'f~P-S W(1J} -Ilk- LAsI -rrJ~{?E ljr;;A--i2-S 5r2IeVi/vG-- A-S cJI+/l2.tIJi9I2.5oAJ, -:;: J:G-GL ~ ~AUG= ~()IV&: t4- Gcod ::rob SG-R,ViI'J fr- AND /CG-f/~.J-r:N6-/~ PAtek A-AJ=:i J2cc / (Dl14MIS5/oAJ WlSJ-j - CD^i-r:~u c; .:;~ V'N~M COI4/vtUN/( IN -r:J./ I 5; 120 L e, WHICH OF YOUR PERSONAL AND/OR PROFESSIONAL INTERESTS PROMPTED YOU TO APPLY FOR THIS APPOINTMENT: :r= t-1.vG AAJ 1~lr;;ICGS'- /l'J 1f)/2.0{ GGt:AJ6- -rk 6AJUJ -/2otJ'~,;LE;;.tJT AND R~C./2GA [;DAJ. -;: -rr!ou6-lf-r :If IV{ ,&fI1 GG- A-L3llr 'La COr4 8/~& 711-856= ;tJ/l;:R-E5& B, 6~I2UIN6-- -J1l..t1 COMM(')/Vi~ OV 7% PMJl. A-A)L) {Cr;c. COMMI g.s lOA.) . HAVE YOU SERVED ON ANY OTHER BREMERTON BOARD, COMMISSION, COMMITTEE OR TASK FORCE? IF YES, PLEASE LIST: E'ft5i pA-RK 5I.A~G)-/o(dG~S /Jl4NAJ/,vC.'- COMlVlt--r!{:;e=- / PLEASE LIST YOUR QUALIFICATIONS FOR THIS APPOINTMENT (INCLUDE SKILLS, ACTIVITIES, TRAINI G, EDUCATION): . v~ GlA-- d d&. 4IJd . cn-I/o sK.{LS B-1 ~GQ\J I ~b- 'A-s PIG0",clG-lVr A-AJd VJ '-'6- f~td&^Jr FOR.. ~ LocAL I) tV, 0 /J,. :r v G I+-L50 S e/2.()cc1 16 CJ-1A-IEfGaSC.,fj ,bF OU/2,~ $(41(2 (} F TJ+t: t;;fi/+- SC~100 L CD/V1MIS4;,o""'> ro~ HlJG- Lf6-A~5 A-tUc1 j.J.A-tlEfrlsO 56'R>>Gd O~ P#ll.lSH WHAT ARE YOUR COMMUNITY INTERESTS (COMMITTEES, ORGANIZATIONS, SPECIAL C6v^"c, L ACTIVITIES)? -+ ~A,( MOS" ~ lib iAJ M1 Coe-A-L CA-71-loC,C qloAJ..I4 ,::{ AvVI. /t,J b-'L:~~d,iu~ ll,1t'N;S-rG:-~ JF-rM~ -:r:. B6LoAJ6- -ro -r;J,;; <;;OC/~ "Ju5JIcc: I AND OtJIRGACJt- L-D/a;{MI7T{;;t: 'ALoNG-'-'<.J"J-I- 1J4(CI~h CovAJGtL 1+5 srJe-d. fj-!j{;I(IG.. . A"" . L - - 'I.~ C ~P~O,J sch/){)l. ~ " tY i:)A,'(j- fa ~ CYVL We welcome your willingness to serve Bremerton. Please return this completed form to: Mayor's Office 345 6th Street, Suite 600 Bremerton,WA 98337 (360) 473-5266 (360) 473-5883 FAX E-mail: mayor@ci.bremerton.wa.us DATE SUBMITTED: March 10,2006 BILL # ~-~ AGENDA BILL CITY OF BREMERTON CITY COUNCIL 'iC ...........................................................................&....&8...... SUBJECT: Appointments to the Civil Service Commission Committee Meeting Date: March 22,2006 COUNCIL MEETING Date: March 29,2006 Department: Executive Presenter: Mayor Bozeman Phone: 473-5266 SUMMARY: There is a vacancy on the Civil Service Commission due to the resignation of Maurice Correia. It is recommended the vacancy be filled by John Ales. The term of Civil Service Commissioner Holly James has expired and it is recommended she be reappointed to another term. A TT ACHMENTS: Applications for appointment. FISCAL IMP ACTS (Include Budgeted Amount): n/a APPROVALS: DEP ARTMENT DIRECTOR: CITY ATTORNEY: FINANCE DIRECTOR: MA YOR: FISCAL/BUDGET: OPERA TrONS: COUNCIL PRESIDENT: I CONSENT AGENDA ~ RECOMMENDED MOTION: Move to confirm the appointment of John Ales and reappoint Holly James to the Civil Service Commission. , COUNCIL ACTION: 0 Approve 0 Deny 0 Table o Continue 0 No Action Application For City Boards/ Commissions/ Committee Note: As an applicant for a City Board, Commission or Committee, your name, address, and telephone number will be available to the press and public. You will be contacted before any action is taken on your appointment. (Please type or print clearly) Date: 2/1/2006 Name: John FIRST Peter MIDDLE Ales LAST Home Address: NUMBER STREET Occupation: Architect Home Phone: (360) , WA STATE Bremerton CITY 98310 ZIP Employer: Mithun Inc. Work Address: 1201 Alaskan Way Suite 200 NUMBER STREET Work Phone: (206) 971-5671 WA Seattle CITY ZIP 98101 STATE Fax: (206) 623-7005 E-Mail: johnales@earthlink.net Education: Masters of Architecture - Washington University, St. Louis BA Architectural Studies & BS Constructruction Management - University of Washington, Seattle Local References (names and phone numbers): Wendy Priest (360) 373-2764 Mike Eliason (360) 620-3875 Brag Gehring (360) 373-5910 I am interested in serving (please check one or more): D Disability Action Committee [ZI Civil Service Commission (18 yrs. and older) D Urban Forest Committee D Public Access Citizens Advisory Committee D Community Development Block Grant Advisory Board D Youth Council D Safe Streets Steering Committee D Board of Appeals, Housing/Building Codes D Other ~ Planning Commission (18 yrs. and older) o Parks & Recreation Commission o Ethics Commission o Parking Advisory Board o Mayor's Select Committee on Law Enforcement o Bremerton Housing Authority o Solid Waste Management o Citizen's Commission on Council Salaries Is this an application for reappointment? No If yes, how many years have you served on this commission/committee? N/A City Appointment Application Page I of I Why are you applying for this appointment? I have had a strong desire to do civic service for our community since moving here with my family. When I heard that position on the Planning Commision was open, I explained my desires to my family. My familiy is very supportive of me devoting my time and efforts to serve on the Planning Commission if appointed. Which of your personal and/or professional interests prompted you to apply for this appointment? I feel that I can give back to the community by using the skills that I have developed in the design and development fields by serving on the Planning Commission. Have you ever served on any other Bremerton Board, Commission, Committee or Task Force? If yes, please list: No I have not. Please list your qualifications for this appointment (include skills, activities, training, education): I have degrees in both architecture and construction management from the University of Washington and a Masters of Architecture from Washington University in St. Louis. I am also a US Green Building Council LEED's (Leadership in Environmental and Energy Design) accredited design professional. One of the major strength I can bring to the Commission is my professional experience working with multiple jurisdictions on large housing and community planning projects for clients in both the public and private sector. What are your community interests (committees, organizations, special activities)? I have worked on Habitat for Humanity homes in St. Louis and Seattle. I recently volunteered my professional services for the site and conceptual design of a new group of Habitat for Humanities homes in south King County. Through the University of Washington School of Architecture, I volunteered at local elementary schools by talking about the architectural profession. I have been an active member ofthe Seattle Chapter of the American Institute of Architects and have volunteered at several oftheir functions. I have also volunteered time at my church, St Demetrios Greek Orthodox Church. We welcome your willingness to serve Bremerton. For more information please contact the Mayor's Office at (360) 473-5266, FAX (360) 473-5883 or via email at mayor@ci.bremerton.wa.us. Please return the completed form to: Mayor's Office, 345 6th Street, Suite 600, Bremerton W A 98337. City Appointment Application Page 2 of2 Application For City Boards/ Commissions/ Committee Note: As an applicant for a City Board, Commission or Committee, your name, address, and telephone number will be available to the press and public. You will be contacted before any action is taken on your appointment. (Please type or print clearly) Date: 1-26-06 Name: Holly FIRST Ann MIDDLE James LAST Home Phone: Home Address: NUMBER STREET WA STATE Bremerton CITY 98310 ZIP Business and Economic Occupation: Development Consultant Employer: Holly James Consulting Work Address: 327 Pacific Avenue NUMBER STREET WA STATE Bremerton CITY 98311 ZIP Work Phone: (360) 620-8493 Fax: (360) 415-0332 E-Mail : 110 lly@}I1011y.iames.com Education: Oregon State University of Hawaii Local References (names and phone numbers): Joan Dingfield (360) 990-0475 Beverly Kincaid (360) 895-1321 Mourine Anduiza (360) 692-7431 Phyllis Mann (360) 307-5870 I am interested in serving (please check one or more): D Disability Action Committee [2J Civil Service Commission (18 yrs. and older) DUrban Forest Committee o Public Access Citizens Advisory Committee o Community Development Block Grant Advisory Board o Youth Council o Safe Streets Steering Committee o Board of Appeals, Housing/Building Codes o Other D Planning Commission (18 yrs. and older) D Parks & Recreation Commission D Ethics Commission D Parking Advisory Board o Mayor's Select Committee on Law Enforcement o Bremerton Housing Authority o Solid Waste Management o Citizen's Commission on Council Salaries City Appointment Application Page I of2 Is this an application for reappointment? Yes If yes, how many years have you served on this commission/committee? Why are you applying for this appointment? 3 years Which of your personal and/or professional interests prompted you to apply for this appointment? I have always wanted to make a difference in my community. I believe in volunteerism. My second term on the Civil Service Commission will bring continuity to the Commission. Have you ever served on any other Bremerton Board, Commission, Committee or Task Force? If yes, please list: No Please list your qualifications for this appointment (include skills, activities, training, education): See Attached. What are your community interests (committees, organizations, special activities)? President of Soroptimist of Greater Bremerton Board Member of the Bremerton Symphony Board Member of MT AK Member of Downtown Business Association Member of Manette Business Association We welcome your willingness to serve Bremerton. For more information please contact the Mayor's Office at (360) 473-5266, FAX (360) 473-5883 or via email at mayor@ci.bremerton.wa.us. Please return the completed form to: Mayor's Office, 345 6th Street, Suite 600, Bremerton W A 98337. City Appointment Application Page 2 of2 Ho/lyJames Bremerton,. Washington 983] 0 PROFILE Twenty years of progressive management, government, arid public.relatious experience spanning private, public and non-profit sector. Proven professional reliability with a high level of achievement in cb.allengmg envinm~s. Self motivated with natural ability to work effectively with a diversified group of people for a COm.moo.goal. Experienced director, committee chair, trainer for volunteer service organizations. PROFESSIONAL SKILLS AND EXPERTISE Administration and Management o Prepared and administered annual operating budgoo.. o Designed and implemented long-range and short-term business plans. o . Analyzed profit and loss statements, contained costs and maintained eash flow. o Reduced administrative ovemead and product costs through standardizationltraininglincentives. o Regulated vendor services and contracts. .0 Enrolled organizations in tax credit programs. o Negotiated employee pay and benefit packages o Instituted programs for internal staff development; expanded employee promotion and adV"<1Ilcemem opportunities, lowered turnover. Revenue Development and FwuJraisiog D Created special-event fund-raisers at all entrance levels and draws. D Successfully recruited corporate and local business spmsors & donors. o Built ~unity calendar of events. o Achieved long-term stability through benefactor and eXecutive board recruitment. o Enhanced membership drives through special gift programs and dues structure. D Conducted research, reviewed and administered grants. Public Relations o Forged coalitions between business interests and community groups. o Acted as ao.official spokesperscD and.delegate. o Conducted community outreach, grassroots recru.it:meut, canvassing and publicity. o Coordinated public hearings, town meetings, voluuteer staffing&. membership involvement. o Developed focus groups, polling and telemarketing belies. o Produced news releases, program notes, biographies, newsletters and commercials. o Initiated press relations with media; ammged interviews and profiles of leaders. o Designed and produced theme logos, brodlUTeS. booklets. press kits. D Advised and coordinated legislative strategies and lobbied federal, state and municipal officials. o Researched international protocol fur domestic leadership; briefed foreign dignitaries. DA TE SUBMITTED: February 28, 2006 AGENDA BILL CITY OF BREMERTON CITY COUNCIL BILL # O~- oscr Lft:> SUBJECT: Sixth Operational Sergeant Committee Meeting Date: COUNCIL. MEETING Date: Department: Presenter: Phone: March 22, 2006 Apri15,2006 '3-R 9'-0 (p Police Chief Craig Rogers 473-5373 SUMMARY: The Police Department needs to increase its first line supervisory staff by adding one sergeant position to the Operations Division. There are seven budgeted, staffed and authorized police sergeant positions in the Department. There are 50 authorized police officer positions in the Department. There are a total of 63 authorized and budgeted cOlmnissioned officer positions in the Department. Re-assigning or classifying one police officer position to the requested sergeant assignment changes the numbers (reduces) from 50 to 49 police officer positions; and changes (increases) seven sergeant assigm11ents to eight assignments. The total force number of 63 remains the same (no changes). Increasing the supervisory staff and assignment level by one police sergeant position will minimize the need for staffing supervisory ranks with officers-in-charge (OICs). This sergeant will be assigned to Patrol and traffic functions of the Operations Division. This sergeant's responsibilities will include duties as a dayshift relief sergeant because currently there is only one dayshift sergeant, and also traffic sergeant duties and special events. A TT ACHMENTS: Staffing Authorizations 2006 FISCAL IMP ACTS (Include Budgeted Amount): There will be no budgetary impact. The Department will make this staffing upgrade with in the current budgetary and staffing authorizations. The Department has had vacant positions that will cover the salarylbenefit costs (Approximately $4,000.00) through the remainder of2006. APPROV ALS: DEP ARTMENT DIRECTOR: CITY ATTORNEY: FINANCE DIRECTOR: MAYOR: CONSENT AGENDA ~ FISCAL/BUDGET: OPERATIONS: COUNCIL PRESIDENT: RECOMMENDED MOTION: Move to authorize a re-assignment from a police officer position to an Operations sergeant position in the Bremerton Police Department. COUNCIL ACTION: 0 Approve 0 Deny 0 Table 0 Continue 0 No Action DATE SUBMITTED: March 13,2006 BILL # OCe,- 0<00 AGENDA BILL CITY OF BREMERTON CITY COUNCIL q~ ........................................................................................ SUBJECT: 2006 KPS Contracts Approval Committee Meeting Date: 3-22-06 COUNCIL MEETING Date: 3-29-06 Department: Human Resources Presenter: Carol Conley Phone: 473-5347 SUMMARY: Approval and authorization of formal execution of the 2006 contracts between the City and Kitsap Physicians Service (KPS) for employee group health insurance coverage. The new contracts, which were negotiated on our behalf by our benefits consultants, Willis of Seattle, reflect a 7.06% rate increase above 2005 levels. A TT ACHMENTS: KPS 2006 Premium Rates & Underwriting Criteria; Contracts: Plan A (LEOFF I Active, LEOFF II Active) and Plan A (LEOFF I Retirees under 65); Plan B (Management & Professional employees/dependents, Teamsters employees/dependents and Fire fighter dependents). FISCAL IMP ACTS (Include Budgeted Amount): The 2006 Budget has adequate budgeted funds in personnel benefits for this increase. APPROV ALS: DEPARTMENT DIRECTOR: CITY ATTORNEY: FINANCE DIRECTOR: MAYOR: FISCAL/BUDGET: OPERA TrONS: COUNCIL PRESIDENT: I CONSENT AGENDA rtri/ RECOMMENDED MOTION: I move to approve the 2006 KPS premium rates, underwriting criteria and the contracts between the City and KPS, and to authorize the Mayor to execute said contracts. COUNCIL ACTION: D Approve D Deny D Table D Continue D No Action 2006 Changes to City of Bremerton Benefit Booklet Page Language Reason Cover Remove "In Rehabilitation" 1 When to Enroll in this Group Plan" Clarification Added language regarding the application and Premium must be received by KPS instead of statinQ the enrollee must be enrolled 1-2 Enrollment Under Special Circumstances HIPAA Revision'of section to include HIPAA information Clarification 3 When Coverage Ends HIPAA Requirement Added information on how to obtain a Certificate of Creditable Coverage 4 Pre-Existing Conditions HIPAA Requirement Added statement about probationary period & State Children's Health Insurance Program 4 Transplant Procedures Clarification Specified wait period is 6 months 6 Services Which Require Prior Authorization Clarification because of Added "including diabetic equipment" to Durable medical equipment Diabetic benefit 10-14 Benefit Summary . Limiting Age - Added "Up to" to aQe Clarification . Professional Services - Added "Care Received in an Emergency room" Clarification . Hospital Services - Revised Emergency language Clarification/KPS practice . Chemical Dependency -Increased benefit to $13,000 State Regulation . Colonoscopy - Removed "not subject to the preventive care maximum or KPS Practice limit . Contraceptive Services - removed from Maternity Benefit Clarification/KPS Practice . Diabetic Education, Education and Supplies - Created a separate benefit to OIC Requirement clarify there are no benefit maximums to these services (Paid same as last year under either the Medical Equipment and Supplies or Nutritional Guidance benefits) Page Language Reason . Laboratory and Radiology Services - Revised to separate out Emergency Clarification/KPS Practice services . Mental Health Care - Removed Prior authorization language (Non-managed) Mental Health Parity Inpatient - Dependent benefit increased Regulation Outpatient - benefit increased and includes office visit copayment . Newborn Care - Revised to clarify that Routine newborn care is not subject Clarification to deductible . PKU - revised to include benefit for Employee (extension of 2005 OIC requirement endorsement) . Termination of Pregnancy - separated from Maternity benefit. This is a KPS practice medical benefit, not maternity Benefit Descriptions 15 . Preventive Care - moved statement regarding deductible Clarification 16-17 . Emergency Care - Revised to reflect current KPS practice Clarification/KPS Practice 17 . Ambulance Transportation - Added 3ra bullet Clarification/KPS Practice . Removed statement regarding air ambulance OIC requirement 18 . Chemical Dependency - added language to reflect definition of chronic OIC requirement condition Removed information regarding Managed program, as benefit is non Specific to City plans managed Changed "informational schools" to Residential treatment facilities - more Clarification/KPS Practice appropriate term 19 . Contraceptive Services - lanQuage moved from Maternity benefit Clarification 19 . Diabetic Education, Equipment and Supplies - new benefit language See explanation under Benefit summary section 22 . Contraceptive Service & Termination of Pregnancy -language moved to new sections 22 . Medical Equipment and Supplies - Removed "insulin pumps" Included under Diabetic benefit 23 . Mental Health Care - Removed language regarding managed care program 24 . Mental Health Care - Added "outdoor youth programs" to exclusions KPS Practice 24 . Newborn Care - clarified routine care is not subject to the deductible Clarification Page Language Reason 25 . Nutritional Guidance - Removed "Diabetes" & "Inactive colon" from list of OIC requirement covered condition. KPS Practice 28 . Sleep Disorders - added language that medical equipment must be obtained KPS practice from an approved home medical supplier or pharmacy 29 . Termination of Pregnancy -language moved from maternity benefit 29 . Pharmacy Benefits - clarified drugs from an ER are covered OIC clarification 31 - 32 Limitations and Exclusions #3 - added reference to Diabetic Education Equipment & supplies benefit - Clarification because orthotics are now a benefit for diabetics #37 - Added Home Health & Hospice benefit OIC Requirement 33 Continuation of Group Coverage - revision Clarification 34 Conversion Coverage - added permanent resident requirement Clarification Revised section for clarification 39 - 43 Complaints and Appeals Procedures - Revised for clarity Contract Page Language Reason Cover Remove "In Rehabilitation" & changed date to 2006 3 Premium Rate Adjustments OIC Requirement 3rd bullet - chanqed "false or misleadinq information" to "inaccurate information" 5 -12 Continuation of Inpatient Coverage Consolidation of duplicate Continuation of Coverage for a Disabled Child language between booklet Coverage During a Labor Dispute and contract Continuation of Group Coverage COBRA Individual Conversion Coverage Coordination of Benefits KPS Right of Recovery Removed Sections & reference benefit booklet MO' Page Language Reason 13 What happens if a Provider no longer participates with KPS KPS Clarification Revised to match KPS practice 1 3-14 KPS Privacy Policy Consolidation of duplicate Complaints and Appeals language between booklet Removed Sections & reference benefit booklet and contract KPS Health Plans 400 Warren Avenue P.O. Box 339 Bremerton, WA 98331-0039 Attachment B Premium Rates and Underwriting Criteria For City of Bremerton Period: January 1, 2006 - December 31,2006 Premium Rates PLAN A & RETIREES LEOFF I - Active $481 .27 Regular & LEOFF II - Active $349.47 Spouse $387.39 1 st Dependent $174.95 2nd and all other Dependents $140.81 LEOFF I Retirees Under 65 $1,259.42 Spouse $689.94 1 st Dependent $172.13 2nd and all other Dependents $137.56 PLAN B & RETIREES LEOFF I - Active N/A Regular & LEOFF II - Active $302.19 Spouse $338.50 1 st Dependent $153.99 2nd and all other Dependents $119.82 LEOFF I Retirees Under 65 N/A LEOFF I Retirees Over 65 N/A Spouse $573.04 1 st Dependent $145.65 2nd and all other Dependents $117.77 Underwriting Criteria The Premium rates quoted above for this Group Plan are based on the following underwriting criteria. KPS reserves the right to withdraw or rerate this offering if Group falls outside the scope of these criteria. ).> Active Employees must work a minimum of twenty (20) hours per week unless otherwise negotiated and agreed by both KPS and Group. ~ Subject to prior KPS approval, two (2) or more health insurance carriers, including KPS, may provide coverage to Group's Employees. ).> Subject to prior KPS approval, Group may select multiple KPS health plan offerings. ).> The minimum level of participation required is seventy-five percent (75%) of eligible Employees. KPS Health Plans, In Rehabilitation 400 Warren Avenue P.O. Box 339 Bremerton, WA 98337-0039 CITY OF BREMERTON - PLAN B COVERAGE CONTRACT Group Number: 21010,21014 Effective Date: 1/1/2004Q Renewal Month: January Open Enrollment December This Coverage Contract includes the following: Attachment A - Benefits Booklet Attachment B - Premium Rates and Underwriting Criteria Riders: N/A Optional Riders: N/A Endorsements: N/A .." KPS Health Plans, In Rehabilitation, hereinafter referred to as KPS, is a duly licensed health care services contractor (HCSC) in Washington State. In its capacity as an HCSC, KPS agrees to underwrite and provide the benefits and services described in Attachment A - Benefits Booklet, to the eligible Employees, and their Eligible Dependents, of the above-named Group, provided the Group, its eligible Employees and their Eligible Dependents, meet and comply with the provisions of this Contract. Contract Form: BREMB-22900-2004Q TABLE OF CONTENTS DEFINITIONS.................................................................................................................... ............1 CONTRACT EXAMINATION PERIOD................................................................................................. 2 EFFECTIVE DATE, DURATION AND RENEWAL.................................................................................. 2 PREMIUM PAYMENT PROViSiONS................................................................................................... 2 Payment Due Date/Grace Period ............................ ... ...... ...... ........ ..... ...................... ................ ............... 2 Prem ium Rate Adjustments...................................................................................................................... 3 Premiums Paid by Subscribers/Dependents.... .............. .......... ...... .................... ..... .............. ......... .......... 3 Prem ium Refunds.................................................................................................................................. ... 3 ELIGIBILITY AND ENROLLMENT....................................................................................................... 3 Group Eligibil ity................................................................................................................................ ......... 3 Subscriber/Dependent Eligibility Requirements ........... .................... ............... .................. .... ............... ..1,3- Enrollment........................................................................................................................... ...................... 4 Enrollment Under Special Circumstances ........................ ...... ................. ...... ............ ............ ................... 4 When Coverage Begins............................................................................................................................ 5 Coverage Waiting Periods........................................................................................................................ 5 TERMINATION OF COVERAGE......................................................................................................... 6 Continuity of Coverage............................................................................................................................. 6 Term ination of Group Contract ................................................................................................................. 6 Re-Enrollment/Reinstatement .................................................................................................................. 7 Term ination of Enrollee Coverage............................................................................................................ 7 Continuation of Inpatient Coverage .......................................... ...... .......... ....................... .... ...... ............. ~+ Continuation of Coverage for a Disabled Child ........................................................................................ 8 CONTINUATION OF COVERAGE................................................................................................... .~g Coverage During a Labor Dispute.......................................................................................................... ~g Continuation of Group Coverage .................... ................................... .... .......................... .... ..................... 9 COBRA (Consolidated Omnibus Budget Reconciliation Act -1985) ....................................................... 9 Individual Conversion Coverage............................................................................................................... 9 COORDINATION OF BENEFITS (COB) ........................................................................................... 10 General Provision............................................................................................................................... .... 10 Definitions.................................................................................................................................. ............. 10 Claim Determination Period ... .......... ............... ...................... ............. ........................ ...................... .... ... 11 Effect on Benefits............................................................................................................................. ....... 11 Order of Benefit Determination .............................. ......... ....................................................... ................. 11 Facility of Payment ........................... .......................... ...... .............................. ............................. ........... 11 Right of Recovery................................................................................................................................ ... 12 Right to Receive and Release Information .............................................................................................12 Disclosure of Coordination ............................. ....... ............... ....... .......... .......................... .... .... ............... 12 KPS' RIGHT OF RECOVERy......................................................................................................... 12 Limitations and Exclusions ...... .......... ........ ..................... ....................................................... ................. 12 Third Party Liability: Reimbursement and Subrogation .......................................................................... 12 Collection and Reimbursement by Enrollee (or the Enrollee's Representative) .................................... 13 Subrogation: Assignment of Third Party Claim to KPS ..........................................................................13 Trust and Cooperation Between the Enrollee (or the Enrollee's Representative) and KPS .................. 14 Agreement to Arbitrate............................................................................................................................ 14 Recovery of Claims Payments .......................... ......... ...... ......... ............... ..................... ........ ................. 14 SUBSCRIBER/DEPENDENT LIABILITY AND RIGHTS......................................................................... 14 Subscriber/Dependent Liability..... ..... ............. .................. .............. .......... ......................... ..................... 14 KPS Privacy Policy................................................................................................................................. 15 COMPLAINTS AND ApPEALS PROCESS......................................................................................... 17 Com plaints............................................................................................................................. ................. 17 Standard Appeals Process ...................... .......... ......... ...... ......... ...... ......... ................. ........ ...,.......... ....... 17 Expedited Appeals Process.................................................................................................................... 18 GENERAL TERMS AND CONDITIONS............................................................................................. 18 Applicable Law................................................................................................................................. ....... 18 Assignment of Benefits. ......... ............ ........ ........ ............... ......... .............. ..... ......... ................ ................. 18 DEFINITIONS Capitalized words found in the text of this section are defined below or in the Benefits Booklet section. Child means anyone of the following: (i) An unmarried natural child, adopted child, stepchild or other legally designated ward under the Limiting Age who is primarily dependent upon the Subscriber or the Subscriber's Spouse for support. (ii) An unmarried child under the Limiting Age who is legally entitled to receive medical coverage as a result of a court order binding either the Subscriber or the Subscriber's Spouse, regardless of whether or not the Subscriber or Subscriber's Spouse has legal custody of the Child. (iii) An unmarried child who has reached the Limiting Age, or is older than the Limiting Age, is incapable of self-sustaining employment due to developmental disability or physical handicap, and is primarily dependent upon the Subscriber or the Subscriber's Spouse for support and maintenance (see Continued Eligibility for a Disabled Dependent). Contract means this document and any other attachments, exhibits, Riders or Endorsements listed on the title page or otherwise described herein, and any subsequent amendments or modifications to the Contract or its attachments, exhibits, Riders or Endorsements. Contract Renewal Month means the calendar month specified on the title page of this Group Contract during which the Group may renew its coverage each year under this Group Plan. Covered Benefit or Service means those Medically Necessary services described in Attachment A - Benefits Booklet that an Enrollee is entitled to receive. Eligible Dependent means the legal Spouse or Child of an Eligible Employee, or the legal Spouse or Child of an active, full-time LEOFF I or LEOFF II firefighter. Employee means an active, full-time Employee who is not a LOEFF I or LEOFF II Employee. Endorsement means an amendment to the conditions of coverage or the benefits provided by this Group Plan. Enrollee means a person enrolled in this Group Plan. Group means the employer entity, association or other group that has entered into this Contract with KPS. Group Plan means the Benefits Booklet plus any Riders, Endorsements or other attachments that state the terms and conditions for administration of the Enrollee's benefits. Group Master Application means the application form completed by the Group and submitted to KPS prior to securing coverage under this Group Plan. The Group Master Application identifies the size, participation and contribution eligibility requirements applicable to the Group. LEOFF I Employee means an active, full-time law enforcement officer or firefighter hired prior to October 1, 1977, and who is a member of the LEOFF system as defined in Sections (3) and (4), CH 131, Law of 1972, 1 st Ex. Session LEOFF II Employee means an active, full-time law enforcement officer or firefighter hired on or after October 1,1977, and who is not a member of the LEOFF system as defined in Sections (3) and (4), CH 131, Law of 1972, 1st Ex. Session. Limiting Age means the age at which a Child may no longer be covered under this Group Plan as an Eligible Dependent of the Subscriber. The Limiting Age is specified in the Benefits Summary included in this Benefits Booklet. Medical Director means the licensed physician acting as chief medical advisor for KPS. Non-Participating Provider/Facility means any Provider or facility not contracted directly with KPS, or indirectly through First Choice Health Network, Providence Preferred Provider Organization or MultiPlan. Page 1 Open Enrollment Period means the thirty one (311 day period, or some other period agreed to by both KPS and the Group, beginning one (1) month prior to the Group's Renewal Month, or at some other mutually agreeable time, but at least annually. During the Open Enrollment Period, Subscribers may add or delete Eligible Dependents, and all eligible Employees and their Eligible Dependents have the opportunity to select from alternative health plans offered by the Group. Coverage will be effective as of the renewal date. Premium means the periodic payment made by, or on behalf of the Enrollee, as consideration for this Group Plan and in accordance with the terrris of this Contract. Premium Due Date means the scheduled, periodic dates by which Premium payments must be received by KPS as a condition for continued enrollment in this Group Plan. This date is typically the first day of each month of coverage. Provider means a licensed or certified health care practitioner acting within the scope of his/her license or certificate. Rider means an additional benefit over and above those listed in the Benefits Summary. Rider documents are attached at the back of the Benefits Booklet and provide detailed benefit information. Spouse means an individual who is living in a marital relationship with the Subscriber. The marital relationship must be legally recognized by the state of Washington. Subscriber means the primary person, generally the Employee, enrolled in this Group Plan. CONTRACT EXAMINATION PERIOD If, after examination, the Group is not satisfied with this Contract for any reason, the Group may return the Contract to KPS within ten (10) days of the date it is received. Upon receipt of the returned Contract, KPS will refund to the Group any pre-paid Premiums. The Contract shall subsequently be deemed null and void. EFFECTIVE DATE. DURATION AND RENEWAL This Contract shall begin at 12:01 a.m. Pacific Time on the Effective Date (as indicated on the title page), and shall remain in effect until the Contract Renewal Month unless terminated according to the provisions set forth herein. Thereafter, this Contract may be renewed automatically at 12:01 a.m. on the same date (month and day) in subsequent calendar years unless otherwise terminated according to the provisions set forth herein. PREMIUM PAYMENT PROVISIONS Payment Due Date/Grace Period The initial Premium payment is due and payable to KPS on or before the effective date of this Contract indicated on the title page. Thereafter, Premium payments are due and payable on or before the first day of every month ("Premium Due Date") for which coverage is provided. A roster of current enrollment and enrollment changes must accompany each Premium payment. A ten (10) day grace period following the Premium Due Date is allowed, during which time this Contract shall not be terminated. However, KPS may, at its sole discretion, elect to extend the grace period for up to sixty (60) days from the Premium Due Date, or cancel this Contract immediately, without notice to the Group if payment is not received by the end of the grace period. If KPS elects to immediately cancel this Contract due to non-payment of Premium, the effective date of cancellation will be retroactive to the last day of the month for which payment was received. No further liability for claims will accrue to KPS. Enrollees in this Group Plan shall not be entitled to benefits during any calendar month for which the Premium, on his/her behalf, was not received by KPS. Page: 2 Premium Rate Adjustments The Premium rates applicable to this Group Plan are defined in Attachment B - Premium Rates and . Underwriting Criteria. Rates are guaranteed until the Contract Renewal Month each calendar year. Notwithstanding the foregoing, KPS reserves the right to revise the rates as follows: >- As part of the annual Contract renewal process; >- As a result of any state or federal law or regulation that imposes an additional tax, new tax or other assessment on KPS revenue; and >- In the event there is a material chanQ~,.,in~~~.pa~i~YE~~y:~i8~,KPS assumed risk under this Contract. Such changes may include 1.@1~~t:91!Qli~J~~i;llngfnacciJrate information presented by the Group, changes in the benefits or other Contract terms required by statute or regulation, adverse claims or underwriting experience, or fluctuations of ten percent (10%) or more in the number of enrolled Subscribers and/or Eligible Dependents. KPS will give the Group sixty (60) days prior written notice of any change in Premium rates not associated with the annual Contract renewal process. KPS will give the Group thirty (30) days prior written notice of rate increases associated with the annual Contract renewal process. Premiums Paid by SubscriberslDependents In certain instances, Subscribers and their enrolled Eligible Dependents may be required to self-pay their Premiums in order to continue coverage. Those instances include: >- Strikes, lockouts and other labor disputes that cause a disruption in Employee benefits >- When the Subscriber and/or Eligible Dependent(s) elects to continue coverage under a COBRA provision or other coverage continuation provision available under this Group Plan The Group is required to collect self-paid Premiums for continuation coverage and forward payments to KPS on or before the Premium Due Date. In the instance of strikes, lockouts and labor disputes, the Subscriber may self-pay their Premium directly to KPS on or before the Premium Due Date. Premium Refunds KPS will refund to the Group any Premium paid, in advance, for periods after the termination date of this Group Plan. In the case of ineligible persons enrolled in this Group Plan, KPS will refund to the Group any Premium paid during a period of ineligibility that is in excess of claim payments made on behalf of the ineligible person(s) during the period of ineligibility. This refund will not exceed an amount equal to three (3) months of Premium payments. ELIGIBILITY AND ENROLLMENT Group Eligibility In order to be eligible to participate in this Group Plan, the Group must continuously meet all eligibility, participation, Group size, contribution and other requirements specified in the Group Master Application form. KPS reserves the right to audit the Group's employment, payroll and eligibility records to ensure that the Group continues to meet its participation requirements, and to ensure that eligible Employees and their Eligible Dependents are properly enrolled in this Group Plan. Page 3 SubscriberlDependent Eligibility Requirements Active, full-time Employees, as defined in the Definitions section and their Eligible Dependents, are eligible to enroll in this Group Plan. Eligible Dependents of active, full-time LEOFF I or LEOFF II firefighters, as defined in the Definitions section, are also eligible to enroll in this Group Plan. The Child of an Eligible Dependent, other than the Child of the Spouse, is not eligible to enroll in this Group Plan. Enrollment Premium payments, if applicable, must accompany all applications for coverage. Current Emplovees and their Eliqible Dependents. including Eligible Dependents of active, full-time LEOFF I and LEOFF II firefighters, are initially eligible to <;!gpl~for,~2~~"rage~eginning on the effective date of this Group Plan. Application for coverage must bem'~gQ;;i{eGeiV'e(jI!6~;~es within thirty one {31} days of initial eligibility. New Emplovees and their Eliqible Dependents, including Eligible Dependents of active, full-time LEOFF I and LEOFF II firefighters, may initially apply for coverage on t~El.f!r~t?a~(~f!hefir~tfull month following their first day of employment. Application for coverage must be :[!;!~,~::receive(jY'f)V':"~I?,S within thirty one {31} days of initial eligibility. Those Employees who do not enroll immediately following their probationary period{s) must wait until the next Open Enrollment Period. A new Spouse and the Spouse'~~hil~(rEl~),ry)<;!~irliti~lIy apply for coverage as of the date of marriage. Application for coverage must bei1'l/J:p~.rec'ei'lei'f;;oY~F2S within thirty one {31} days of initial eligibility. Newborn, Adopted Child(ren) and Child/children placed for adoption are initially eligible for coverage as follows: ~ A natural newborn Child is eligible as of the date of birth and is covered automatically for a period of three (3) weeks. In order for coverage to continue after the initial three (3) weE:lKpElri~~,thEl~hi!~ must qualify as an Eligible Dependent. If additional Premium is required, tmellappi!catlon;i"an<:l :':::::_*'}'i?i:::~::~:W{''':t. :: :,::: ~:,:,:'::"""yz:::-:-:.-:, " ',:<~W: ":':'-":::- '-~',:::,::::,:::::~::'!!::~:~"""'-'-r!::_"-: -' "__'::'w,,:wg:";""1;::-"O':":" :::::.' - -----.A..":'::~~:~:,,::w~:r::':::.:, ., "--:':ro~w,:::',:,:: '. -__' ":- :-:'.:::::::r-?~$"~'~': "',:::" ',' ---~:;Y' -",' ': ',.,.",:~''<<-. premiurm'iJor@tme Child must b~lfmtqJI~,g;:iQi:tfii~;;,~lQl,fR;~B!~Q;receivea,hViI~Fi1S' within sOOy-f60f days of birth; ~ Adopted Cmild{ren) and Child{ren) placed for adoption are eligible (i) on the date of their adoption, (ii) on the date the Employee or Spouse assumes legal obligation for total or partial support in anticipation of adoption, or (iii) on the date the Employee or Spouse acquires partial or complete legal custody. If additional Premium is required, the application for coverage must be submitted within sOOy-f60} days of the date of placement for adoption. NOTE: When additional Premium is not required, we encourage enrollment as soon as possible to prevent delays in claims processing. In the case of court-ordered coveraqe, a dependent Child becomes initially eligible on tme date the Subscriber or Spouse receives tme order to provide medical coverage for tme Cmild, even if neitmer the Subscriber nor the Spouse is tme custodial parent. Application for coverage must be submitted within tRift.y- ooe-f31} days of the date of the order. Employees and their Eligible Dependents who do not enroll wmen they are initially eligible must wait until the next Open Enr2"n:l~~t~E:l~i()d. e~cept in certain circumstances (see Enrollment Under Special Circumstances in~fl1eKBBnefitS;IIBClORiet). Enrollment Under Special Circumstances Loss of Other Coverage \Nhen Employoes ::md/or their Eligible Dependents lose cO'ler3go under 3nothor he31th pbn, they m3Y apply for COYOr3go under this Group PI:m if the following 3pplies: ['They declined initi31 enrollment in this Group Plan in writing; Page: 4 ['They lose eligibility in 3nother he31th pl3n or their covor3ge is tormin3ted; and cThey make applic3tion to enroll in this Group Plan within thirty one (31) d3Ys of losing other covor3go. Othervvise, they must w3it until the noxt Open Enrollment Poriod to 3pply for covor3ge. NOTE: Dopondents may not enroll in this Group Plan unless the Employee is a Subscriber. Ma.rriage, Birth, J\doption or Placement fer J\doption Employees who declined initi31 enrollment in this Group PI3n in '",riting, may 3pply for coverage for themselves 3nd their Eligiblo Dependonts in the ovont of m3rriage, birth of 3 Child, 3doption or pl3comont for 3doption. Applic3tion for enrollmont must be received by KPS: I'within thirty one (31) days following the d3te of m3rriage, or ::::"Nithin sixty (60) d3Ys, if 3ddition31 Premium is required, following the d3te of birth, 3doption or placemont for adoption, or Cat tho noxt Open Enrollment Period if these time fr3mes 3re not mot. NOTE: 'Nhen 3dditional Premium is not required, we encour3ge enrollment as soon 3S possible to prevont dol3ys in cl3ims processing. Court Ordered Coverage Employoos '""ho declined initbl enrollment in this Group Pl3n in 'Nriting, may subsequently apply for cover3ge for themsolvos 3nd their Eligiblo Depondents in the event they are required to provide he31th C3re coverage for an Eligible Dependont Child 3S 3 result of 3 court order. Jl.pplic3tion for enrollment must be received within thirty one (31) d3Ys following the date of tho court order, or wait until the next Open Enrollmont Poriod. When Coverage Begins Coverage for new Enrollees begins on their date of initial eligibility provided they enrolled in this Group Plan within the specified time limits (see Enrollment) and any applicable Premium amounts have been paid. If the Employee enrolls during an Open Enrollment Period the coverage will begin on the first of the month following the Open Enrollment Period. A newborn Child who meets eligibility requirements is covered automatically for a period of three (3) weeks from the date of birth, provided either the female Subscriber, or male Subscriber's Spouse, is eligible for maternity coverage under this Group Plan at the time of the Child's birth. If additional Premium is required, coverage will not extend beyond the three week period unless the Child is enrolled within sixty (60) days of the date of birth. Any applicable Premium amount must accompany the enrollment application. If additional Premium is required, coverage for an adopted Child is retroactive to the date the Child was legally placed for adoption, provided that the application and applicable Premium for the Child are receivedwa8 enrolled within &OOy---f60} days from the date of placement, and provided any applicable Premium amount has been paid by the Premium Due Date. NOTE: When additional Premium is not required, we encourage enrollment as soon as possible to prevent delays in claims processing. Coverage Waiting Periods Pre-Existing Conditions KPS imposes a three (3) month waiting period before ~pre-existing condition~ is any condition h three (3) month period. immediatel FF'J"r:Ffj"q!'?!&f"'i!JFF~'~JFV;;F' Provider recommended or rovided treatment. ...".0"'w,~""""""""""M""""="""",,"','J..,,,.....,., .........., , p Genetic information shall not be treated as a pre-existing condition unless there has been a diagnosis of the condition related to the specific genetic information. t~i waiting period may ~be reduced by the number of months of Creditable Coverage the Enrollee has accrued under Page 5 other health care programs prior to their enrollment in this Group Plan. "Creditable Coverage" means periods of other health coverage an Enrollee may use to reduce pre-existing waiting periods. These include group health coverage; Medicare; Medicaid; military health coverage; Indian Health Service or tribal """{",~~"",,, "'".,..,..,'/:',--'---__-.-.. ~ :}:":,$.fW?:'. ' ,;;:,'::yyf*"W~~:f'_-_---::y:::',2'-~-\?" c8~Elr~gEl;~tate high risk pool; federal or public health plans; Peace Corps Plan; Stalel@llildren"S'lllrlSl..lra8ee' ffir0~rfamlll'br other health insurance coverage. The Enrollee will receive credit for prior Creditable Coverage ifit was continuous and terminated no more than three (3) months immediately preceding enrollment in this Group Plan. Health coverage will be considered continuous if there was no more than a three (3) month break in creditable Coverage. No credit will be given if there was more than a three (3) month break in coverage between the Enrollee's prior plan and their effective date of enrollment in this Group Plan. Any Employer imposed probationary period will not be considered a break in coverage or creditable coverage. To request credit of the Pre-existing Condition waiting period, the Enrollee must submit a Certificate of Creditable Coverage from the prior health plan carrier with his/her enrollment application. In lieu of a Certificate of Creditable Coverage, the Enrollee must provide all of the following information: ~ The name of the prior health plan carrier ~ The dates of coverage under the prior plan ~ Proof of coverage under the prior plan that documents the coverage period(s) There are no waiting periods for: ~ Pregnancy ~ Formulas necessary for the treatment of phenylketonuria (PKU) ~ Prescription drugs included in the Pharmacy Benefit (if applicable) ~ A newborn Child or an adopted Child whose effective date of coverage is the date of birth or placement for adoption Transplant Procedures KPS provides coverage for transplant procedures only after an Enrollee has been continuously covered under this Group Plan for six (6) months. This transplant waiting period applies to the transplant procedure as well as any pre- and post-transplant care directly related to a transplant they receive while covered under this Group Plan. If the Enrollee was covered under another KPS plan immediately prior to enrolling in this Group Plan, KPS will credit to this Group Plan the portion of the transplant waiting period that was satisfied under the prior KPS plan. TERMINATION OF COVERAGE Continuity of Coverage Continuity of coverage under this Contract is guaranteed to all eligible Enrollees provided the Group continues to meet eligibility requirements and continues to pay applicable Premium payments on a timely basis. Termination of Group Contract This Group Plan may be terminated if any of the following occurs: ~ The Group fails to make full Premium payments ~ The Group violates, or refuses to comply with, the terms and conditions of this Contract ~ The Group violates, or refuses to comply with, any published KPS policies and procedures that have been approved by the Insurance Commissioner ~ There is a change to, or implementation of, federal or state law that prohibits the continued offering of this Group Plan ~ KPS replaces this Group Plan. In this case, the replacement plan will (i) include the services covered under the replaced Group Plan; (ii) be offered to the Group's eligible Employees and their Page: 6 Eligible Dependents; and (iii) not significantly limit access to the kind of services covered under the replaced Group Plan In addition, the Group may terminate this Contract, at any time, by providing tJ:HHy-f30} days written notice to KPS. If this Group Contract terminates, for any reason, coverage for all Enrollees will end automatically on the . effective date of termination, or on the last day of the last month for which the Group paid the Premium, whichever occurs first. KPS will refund to the Group any Premium paid in advance for periods after the termination date. In the case of termination or non-renewal of this Group Contract, the Group shall be responsible for providing the following information to all affected Employees and their Eligible Dependents: ~ The effective date of termination of coverage; and ~ The reason(s) for termination or non-renewal. Re-Enrollment/Reinstatement If this Group Contract has been cancelled by KPS due to non-payment of Premium, the Group automatically forfeits all rights to guaranteed renewal of coverage afforded under the Health Insurance Portability and Accountability Act (HIPAA) of 1996. Any decision to reinstate or reenroll the Group is at the sole discretion of KPS. If the Group voluntarily cancels this Group Contract prior to the Open Enrollment Period, KPS may, at its sole discretion, impose up to a 1'.\'81\'8 (12} month waiting period before the Group is eligible to reapply for coverage. Termination of Enrollee Coverage Coverage for an individual Enrollee under this Group Contract will end if anyone of the following events occurs: ~ Non-payment of any Premium amount, when Premium payment is the responsibility of the Enrollee ~ The Enrollee loses eligibility for coverage under this Group Contract ~ The Enrollee commits a fraudulent act with regard to KPS and this Group Plan ~ The Enrollee refuses to comply with the terms and conditions of this Group Plan as described in the Benefits Booklet ~ The Enrollee voluntarily disenrolls from this Group Plan ~ There is a change in either state or federal laws that no longer permit KPS from offering this Group Plan ~ This Group Contract is terminated Additionally, Eligible Dependent coverage ends if: ~ The Subscriber is no longer employed or no longer meets eligibility requirements ~ The Subscriber dies ~ The Subscriber and Spouse divorce ~ The Child reaches the Limiting Age or marries Coverage ends on the last day of the month in which the Enrollee was eligible for coverage, provided all applicable Premium amounts have been paid. In the case of non-payment of Premium, coverage ends on the last day of the month for which KPS received a Premium payment. Upon termination of coverage either KPS or the Group shall issue a Certificate of Creditable Coverage certifying the period(s) during which the Enrollee was enrolled in this Group Plan. An Enrollee who loses coverage under this Group Plan may be e!i9~~;I~t~LS.~~.titl~;~.;ss>yerage or enroll in a KPS Individual Conversion Plan (see Continuation of Coverage in.ffue;l3enefits;!3ooklet). A Subscriber who voluntarily disenrolls from this Group Plan while still an Employee will not be eligible to re- enroll in this Group Plan until the next Open Enrollment Period. See Enrollment Under Special Circumstances in~m~iB~neflts'lBObklet for exceptions to this policy. Page 7 Continuation of Inpatient Coverago An Enrollee who it: receiving care as an inpationt in an accredited general Hot:pital, or other approved facility, on the date that coverago would other"\':ise end, is eligible to continue receiving benefits under this Group Pbn provided the following conditions are met: !JKPS pre authorized the inpatient care (see Prior Authorization of Inpatient Care); and !JAil applicable Premium amounts continue to be paid KPS will continue to provide benefits, under this Group Plan, until one of the follo'Ning evonts occurs: [;The Enrolloo is no longer receiving inpationt care OThe KPS Modical Director dotormines that inpatient care is no longer Medically Necessary r-:;Tho Enrollee has exhausted the inpatient benefits offered under this Group Pbn (annual reinstatoment of benefits does not apply under this provision) [;Non payment of Premium [;Three (3) consecutive months have elapsed since the dato coverage would have other'tAse onded oThe Enrolloe enrolls in another KPS plan or in any other health plan that provides inpationt hospital benefits The Enrollee is not eligible for tho extendod coverage described above if, on the date coverage would othorwise end: [;The Enrollee is covered under any other group or individual medical pl3n with similar inpatient benefits; or [;The Enrollee is eligible for continuation of coverage under COBRA or any other continuation provision Continuation of Coverago for a Disabled Child /\n Eligible Dependent Child 'Nho has reached the Limiting /\ge remains oligible for coverage under this Group Pbn provided both of the following conditions are met: OTho Child is primarily dependent upon the Subscriber or tho Subscriber's Spouse f{)r support; and [!The Child is incapable of self sustaining employment duo to developmental disability or physical handicap. Proof of the Child't: dependence, obtained from their primary provider, must be submitted to KPS v'iithin thirty one (31) days of the date the Child reaches the Limiting /\ge. Thereafter, KPS may require periodic proof of the Child's continuing dependence. Generally this proof is requet:ted annually after the two year period following the Child's attainment of the Limiting Age. l\. disablod Child '.'ViII continuo to bo eligible for coverage until any one of the f{)lIowing events occurs: OFailure to submit proof of the Child's continuing dependence as a result of disability or physic31 handicap OKPS dotorminos that the Child is no longer devolopmentally disabled or physically h::mdic3pped (based on the evidenco submitted). oTho Subscribor is no longor covered undor this Group Plan [INon payment of Promium OKPS torminates the Group Pbn Coverage for a disablod Child ends on the bst day of the month in '""hich the disablod Child is eligible for coverage, providod any applicable Promium amounts have been paid. In the case of non payment of Premium, cover3ge ends on the bst day of tho month for v",hich KPS received a Premium p3yment. .^. dependont 'Nho is no longer eligible for coverage as a disabled Child may be oligible for cover::lge undor COBRA or 3 KPS Individual Conversion Pl3n (see Continuation of CO'lerage). Page: 8 F CO"ERAGE CONTINUATION 0 . ^ , tion of ho~lth c~re . a Labor Disput. . '"'hich c.usos . d,crup .' oloct to conlinuo Coverag.DurlRg othor I.bor d,cputo 'd Eligiblo Dopondonts m.., Ihoir Promiums. I tho ovonl of · Glrik~;, 1~~:O~tu~;criborc .nd Iho"c~~~o~f. (oj months, ~r cg: fr~~nl~.t of tho o,isling :omponO.Iio~ b~g:'~r~~p'~I.n: for. p.~~~o~~~ ~n~'pr.mium m.y nol bo. or covor"go un or d of conlinuod covorogo, 'Iuro on Iho p.rl of tho During Ih,s pono ",ium diroctly to KPg. F.~o 1.01 d.y of Iho monlh Group PI.n. . . d 10 p,y .ny apPlio.I~lo ~rr::'inalion of c""orogo .~ ~ii1 not bo roinst.lod. Tho SubSC;ib~d~:~~~?um p.ymonts t~:~~~rod"ior non p.ymonl ef Pro."u donls who mo ontitlod to Subscnbor o. ,,, p.id. Covorogo . II d Eligiblo Dopon for which Prom,u., ...s n I ' 10 Subscribers .nd the;r ~n~ c~veroge provision. This provision does not ~6~Rj\. or ~ny other continua 10 ' ue coverage under contln . 'bilit' tor covero9O (;.".r3g. d nls who lOGe elig'.. , (JJ Inonll1& CORtiRu3tioR of Group.. d Iheir e.rollod Eligiblo DOPO;or?od not 10 ",",ood threo .... ^t the Group's option, su~~c~I~~st~nextend their CO\/er3go for 3 ~'ndor this Group PI.. ., I or olhor labor dispule; er unless: , t d 3S a result of ~ strike, lockou ae "'as tormlna e ,.l Gt tRe Gmup DCovoro. .. I r ross misconuu co"orogo undor I I ' onl W<lS tormin.lod 0 g . (31) d.ys of Iho d.lo .. 01 bo .llorod fro" tho ~Emp 0,., h m.do wilhin Ih"ly ono fls and Pro""u", "0; n . "orogo musl uo . d coveFago. bono, . f,pplicat,on to~u~r~g Ihis poriod ef co.I,nuo" n Tho Group is roqu!rod to Plan ondod, Plan, , d'roclly 10 tho Group, . ds dolinod ,n Ihi<; of Ihe ox,sl,ng Group , an ' applicoblo Prom,um ~uo Dolo .nd graco par~1 in lorminalion of Tho Subscribor is r~~u:~~ ~c~~idan~o V,;I\thol:r:~~~m Prom ium pay~on~:::~~~c term inaled for non. romit preml~lm to on the p~rt of the SUb~~r~O~r'NhiCh Premium '!I~S p31 , Contr3ct. F31 urn last d~y of tho mon coverago 3S of t,he '''ill not be reinstated, paymonl of Prom'u., .. .. . R Act 1905) . mnibus Budget Reconclhatlo .. 1985 COBRA ~ct must notify 311 COBRA (Consolidated 0 I' u,ilh tho provisions, of Iho "' rago undor this Group PI.n of reCll-Jired by law to com~ Y t's' "'ho lose eligibility for cO.e C "'In\ters who are '1 'CI' 'hie Depenuen ,.. Eme", .d Iho" E 'g'. . . d 10 co"orogo ~~i~i~b;~~t~bl~:~tf~~: c~~o~~~o: ~:d:;~~:::::~;::e~:~:~~9~p~l~i. o~:: i~~~i;S~~:o~~~~~lo~n~~~i~: Eligiblo ind,v'dualsp~~~ o~s, Tho Group 's rO~U1;;;~hal oloclion, Failuro on~~~.;~ ti.,oly notificolion ollho undor Ih,o Gro~! 0 wilhin Ihirty ono (31 J da,s f Iho Group 10 p~o"'do K ';;n'inuo coverogo, un~or 'his continuation co. eralg t' n nr f.;]ilure on the p~rt 0 ~ tl-.e indi'lidu31 E right to t 'n 311 c3ses, elimln3te the l' oly 000.'0 , " "'"p'o, '" H 1(12l> ""y no" , I" part of Ie mako ?.. "1mb 0 . i~torprolod by I(P. "~..:o "ti~O'Y noli~Galion 10.. oli m inofo any obi ig.lion on 0 e'eGI,on, -'. b' Iho Group 10 pro., "rogo, It will, howo.or. ~::~~~~n~~~~~i~n ~ Pro~i~Oc~~:~~:~~~:;th~S Conlrocl KPS to provide contlnU3tl0 . e KPS Individual Convorsion '''"dual Conversion CO'lerag , be ontitlod to transfor to 3 Indl.1 'xty five (65) m3y ..,h are under ~go SI Employeos ..,,0 .. . ~4 91Gare roll in the Plan if: . r 'blo for Govorogo undor .0 bul havo oloclod nollo on UThey are not othorwlse e Igl f u3tion of Group coverage r 'blo toF con 'n on oxcop! OThoy aro Gurrontly o'g' , h . terminalod (for .ny roac . Group Plan COBRA conlinual'on Planh'I~" to pay the Premium) . h' GFGUP Plan or a 'd I's ..sponm"" , orogo 10 ii, DCovor.go undor I 'c ..:....' "'hon il is Iho indiv, ua 'd othor hoallh Garo GO" non payment of Premium, .. th Group does not prO'll e ' r> '" Plan termin3tes 3nd e !:::Thls 'Clrou!-' Employees Page 9 l\pplic3tion for cover3ge must bo m3de within thirty one (31) d3Ys of the date coverage under this Grou Plan, or other KPS continuation or COBRA pl3n ends. l\pplic3ble Premium p3yments for the first month 0 cover3ge must bo submittod 'Nith the enrollment 3pplic3tion. C Eligible Dependents may 3pply for cover3go separately under this option in tho ovent they lose cover3g under this Group Plan duo to the de3th of the Subscribor, or if the Subscriber and Spouso divorce When 3n Enrollee onrolls in 3 conversion pl3n, he/she losos cert3in protoctiom; gU3r3nteod undor tho Health Insur3nce Port3bility 3nd l\ccount3bility I\ct (HIPM) of 1996. Most not3bly, if the Enrolleo 'N3nts to tr3nsfor to a non conversion individu31 pl3n, he/she could bo denied covor3ge b3sed on :. provious or existing hcdth condition. If the Enrollee doos qU3lify for covsr3go under 3 non conversion individu:.1 pl3n, his/her cover3go will bo subioct to 3ny waiting periods for pre oxisting conditions. For more inform3tion, pl03se cont3ct KPS Mom ber Services 3t 360 -178 6796 or toll free 1 800 552 7111. Employoes \''iho 3ro 3ge sixty five (65) or older when cO'lor:.ge undor this Group Contr3ct tormin3tos m3't be eligible for cover3go under :. Medic3m Supplement Pbn. To determine Employoo eligibility for Medic3re Supploment Pbn, ple3se cont3ct KPS Member Servicos. COORDINATION OF BENEFITS (COB} General Provision Benefits are provided under this Group Pbn only to the oxtont th3t Subscribers 3nd their enrolled Eligible Dependents could not h3vo recoived benefits for the S3mo service(s) under 3ny othor Pl3n, h3d 3 cbim fo benefits been m3de. Tho purposo of this COB provision is to ensure th3t tho E:um of claim bonefits p3id by KPS 3nd 311 othor Pl3ns under which Subscribers 3nd their Eligiblo Dopendents 3m coverod doos not excood 100% of tho Allo'll3ble Expense. J\II of the benefits provided under this Group Pbn 3re subioct to this COB provision. Dofinitions "Allo'Nable Expense" me3ns the usu31, customary or reason3ble charge for 3ny necess3ry health care service or supply whon the sorvice or supply is 3 covered bonofit, 3t le3st in p3rt, under any of the PI3ns involved. When 3 Pbn pro'/ides benefits in tho form of servicos r3ther th3n c3sh p3ymonts, the re3sonable cash v31ue of eelch service provided sh311 bo considered 3n Allow3blo Expense. The difforenco bet'..voon tho cost of 3 priv3te Hospit31 room 3nd the cost of 3 somi priv3to Hospit31 room is not considorod 3n J\lIow3ble Expense under the abovo definition unleE:E: the Enrolloe's st3Y in :. priv3te Hospibl room is considered to be Medic311y Necoss3ry under 3t I03St one of the Pbns involved. "Double Cover3Qe" me3ns 'Nhen Enrollees have coverage under another Pl3n. "PI3n" means ::1 policy or contr3ct 'Nhich provides benofits or servicos for, or bec3uso of, medic31 or dont31 C3re, through one of tho following: DThis Group Pl3n W\ny group, individu31 or bbnket dis3bility insur3nco policy DAny group or individu31 contractu31 prop3yment or indomnity pl3n such as thoso issued by he31th C3ro servico contr3ctors, health m3inten3nco orgelniz3tions or other he31th c3rriors or hS31th insurors DAny bbor m3n3gement trusteed pl3n or bbor org3niz3tion pl3n [~l\ny employer org3niz3tion pl3n or Employoe benefit org3niz3tion pl3n Dl\ny government31 program CJ\ny insur:.nce cover3ge required or provided by st3tute, including 3utomobile policies which provide medic31 benefits CAny other similar source The term "PI3n" does not includo 3ccidont only cover3ge, including 8thletic injuries, for school 8go Children from Kinderg3rton through twelfth gr3de (K through 12), or fer collogo studonts, eithor on 8 21 hour b3Sis or on 3 "to 3nd from school" b3sis. P f e 3 r Page: 10 E3ch of the Plans under 't/hich the Enrollees are covered, and each benofit payable under those Plans, are considered separ3tely when benefits are coordin3ted under this provision. Claim Determination Period The claim determination period means a C310ndar Year. Effect on Benefits Whon an Enrolloo has double coverago, during 3 Calendar Year, one Plan norm311y p::lYs its bonefits in full as tho primary payor ::lnd the other Plan pays ::l roducod benofit as tho secondary payer. KPS dotormines which cover::lge is primary according to the N3tional Association of Insurance Commissioners' guidelines. When KPS is the primary payer, we will pay the benefits described in this Benefits Booklet. When KPS is the secondary payer, wo will determine the Allo'N3ble Expenso. .^.ftor the prim3ry Plan P3YS, we ';vill pay what is left of tho /\lIo\^l::lblo Expense, up to our regubr benefit. Wo will not P3Y more than our allow3nce. Order of Benefit Determination When more than one Plan contains a COB provision, tho decision as to 't/hich Plan is the primary Plan is made in the following order: OTho Plan that covers the person as a Subscriber r3thor than as an Eligiblo Dopondent is primary OVVhen an Eligiblo Dependent Child is covorod under more than one Plan, the Plan of the parent \vhose dato of birth (month 3nd d3Y only) occurs 03rlier in a C310nd3r Yoar is primary, oxcept'lihen tho Child's parents are legally divorced or sop::lr3ted OVlJhen tho p::lronts of a coverod Eligiblo Depondont Child are divorced or separated 3nd there is no court decree which establisheL financi31 rosponsibility for the modic31 or dont31 oxponsos of tho Eligible Dependent Child, then benofitL for tho Child's Covered Exponsos 3ro determinod 3S follows: OThe Pbn of the parent with custody is primary, provided tho parent with custody h3s not rom3rriod C If the parent with custody has remarried, tho order for determining the primary Plan is: (i) The Plan of p3rent 'Nith custody (ii) Tho Plan of tho stopp3ront (iii) The Plan of the parent without custody Despito tho 3bovo, if the court has determined which p3rent is financially rosponsible for the h031th care of the Eligible Dependent Child, then the Pbn of that parent is always tho primary Plan. '1l/han the above rules do not ostablish an order of determination, thon tho Pbn which h3s covered the parson for tho longer period shall be prim3ry, except th3t: OThe benefits of the Plan '""hich covers the person, on whOLe expenses the claim is b::lsed, as 3 laid off or retired Subscriber, or a Dependent of such a Subscriber, Sh311 be determined 3fter the benefits of the Plan which covers that person 3S 3 Subscriber (othor th3n as a laid off or retirod Subscriber), or the Dependent of such a. Subscriber; and o If either of the Plans does not have a provision regarding laid off or retired Subscribers, 'Nhich results in each Plan determining its benefits after the o~her, then the above provision shall not apply. If none of tho 3bovo rulos 3pply, tho PI3n th3t h3s covored tho porson for the longost poriod of timo shall be considered the prim3ry Plan. Facility of Payment Whonever another Plan makes payments th3t should have been provided under this Group Plan 3nd in ::lccordanco with this COB provision, KPS m::lY, ::It its solo discrotion, choow to roimburso tho Pbn m::lking such othor p::lymonts, tho ::lmount nOCOCC::lry to c::ltisfy tho intont of this COB provision. /\ny ::lmount paid Page 11 under this subsection shall be considered as benefits poid under this Group Pion, ond KPS sholl be fully discharged from liability to the extent of such poyments. Right of Recovory 'Nhenever KPS mokes payments that 3re in excess of the maximum amount of poyment necessary to s3tisfy this COB provision, KPS shall have the right to recover the excess payment amount from the Enrollee, from the Provider, or from another Pion, os applicable. Right to Receive and Release Information As 3 condition of receiving benefits under this Group Plan, Subscribers and their enrolled Eligible Dependent(s) agree to provide KPS with any necessory information, 3nd authorize KPS to release to or obtain from any other insurer, organization or person, any inform::ltion necessary to administer this COB provision. Oisclosuro of Coordination Failure on the port of Subscribers 3nd their enrolled Eligible Dependents to cooperate with KPS regarding this COB provision could result in the loss of benefits under this Group Pion. KPS recemmends that Subscribers ::lnd their enrolled Eligible Dependent(s) submit cloims to KPS, and e3ch other pion, ::It the S::lme time to help minimize deloys ::lnd facilitate cloims p3yment. KPS' RIGHT OF RECOVERY Limitations and Exclusions Coverage under this Group Pion is excluded f{)r expenses incurred or services rendered if tho Enrolloo's illnoss or injury is c3used (or allogod by the Enrolloe to be caused) by another party, to the extont that bonefits ore avoiloble under the torms of any other insurance covorago or source of p::lyment, including but not Iimitod to: DVohicle modic::ll, porson::ll injury protoction ("PIP"), no fault, uninsured or underinsured motorist, workers' compons::ltion insur::lnco or benefits ::lnd third porty liability insurance, or similor contract of insuranco. DHomeO'.~:ner's, proporty or any other insur3nco policy (oxcept for individuol or group health insurance). D/\n agreoment, judgmont or settlement pursuant to which ::l third party pays or ::lgrees to pay for the costs of such sorvicos from assots othor than 3 policy of im:ur::lnce. Thic exclucio~ appliec whonever any cuch contract ef incuranco, agreement, judgment or cettlement is issued to or pro'tides benefits for the Enrollee, 'Nhether or not they assert a claim ag::linst tho responsible third party or its insurers. Third Party liability: Reimbursement and Subrogation As ::l condition of KPS' agreemont to advance p::lyment to the Enrollee or their Providor for modic::l1 exponsos for illnessos or injuries caused (or ::llloged by tho Enrollee to be caused) by another party, tho Enrollee agroos to mako a cloim against, or otherwiso pursuo recovery from all responsible p::lrtios and thoir insurer(s) for all payments advancod to the Enrollee or their Provider by KPS. If the Enrollee does not make a claim or otherwise pursue recovery of KPS' payments, all such payments m:ldo by KPS m::lY bo denied or recouped. By providing benefits under this provision, KPS is fulfilling its obligations under this Group Plan. However, by so doing, KPS does not viaive any rights to reimbursement or subrogation. Provided, the benefits of this Group Plan will be advanced to the Enrollee if they are injured by a third party, before compensatien is recevered from the third porty or its insurers, only under the follo'.iving conditions: DThe Enrolloe, and their reprm:ent:ltive(s), must fully cooper:lte with KPS in recovoring p::lyment of medical bills paid, and to be p::lid by KPS, from the parties who ::lllegedly caused tho iniury or Page: 12 I' hie PIP uninsured or . any app.lcal:l, 91 . , t not limited to their li:Jbility ~n~u~~~~:e~:r~~~pensation or any other re:Jch3 e illness, including bu lic' homoownors pol,c\. .. 1 undorlnsured motonst po ;', or ~artios; . tho names and addroesos? assots 01 tho rospons,ble partl. f tho dotails of tho injury or II~noss~s of tho roeponsiblo party , nThe Enrollee noti~ies KPtS, ~ne '.'r.'eFlstl~;~~ble 3nd tho n:Jmes 3nd 3d ress t U h 18"89 -0 l:I I" " F8F(S\ mus- tho partios ue... ... th third party s rnsu. , , Insurors if known; II 0 againet tho third party."r b oKPS on tho Enrollee', boholf; , 't fI 9 9;' tho Enro e '9 F tEl 98 paid, y o ^ny claim or lawsul Ie entof bonefits p:Jld y, 0 " includo a domond for ropoym cation for tho Inodicol costs Of t ae,ign to KPS thoir right to ro~~v; ~~:;;fe:n GOueod by the third party DTho Enrolloo must :Jgroe 0 b aid by KPS 3S :J resu aid (eubrogation),. or to 0 p , id or that will bo ~oid by KPS foeponsiblo for tho 'l1jury.. KPS for the AlediGal e.~onsos po "rocoods or othor recovory tee tEl Felmburse . gomeRt Insur:Jnce I" The Enrollee mus :Jg~" m the settlement, JU ::J , C 0 rosult of tho 'nJury, fro 'third party or its insurors. :JS A ERFellee from :In, obt:Jined by tel ' Re....resentati'Je) ( thc Enrol-ce s ,... lIaction and Reimbursement by Enrolla~ o~ments from tho rosponsible third p:Jrty, they must: Co and rocovery for KPS pay . If tho Enrolloo olocts to dom t modiation, arbitration or tnal.. ortod by KPS, for tho o! any settlemon, nt o! the Iren ass II . d by DNotify KPS In advonco. t, and it. insuror(e) of tho ~mou" ry or potontial rocovory 0 ta,no I form tho rosponsible third par y thoir bohalf, againet any roco.o . On 1 ayment, mado on I e,16 ~ald by recovery 0 p , I' S involving medic3 c " or sottllng c 31m tJ:le.m.,. KPS bofore compromising Qbtain prior con,ont from n ( l or do anything olso that o ~ t with the responsiblo t~ird p3rt~ oL i,~~~~~~~rri~hts, without first obt3ining 't RY aSFeemen n 9 satlElR or relml:lo DNot onlor ,n 0 0 , I' or prejudice our su ro dical would rolo~s~.~PS n ~;nsont fr"m KPS. . mont that i, compencotion for me express pnor ..ntte, tt1ement, 3ward or Judg 1 r that port,on of tho so t ORoimllu",e KPS -0 ." b . us. . . limit, or r~achablo asso s bill, poi" an" 10 be par. I " r' for loss than the in,urance PO;'';;enefits paid on thoir bohall Enrolleo obtain' 0 sottlonwnt or :~:;::~u",o KPS lor tho full a~~:n~n~ollaa abtain, a sOUlomo~~:~ ~ t~~o lia~l~ ~;rt~o~;t~~ :ob~~~~:alod for I'th~~ ~:~~I'in~::::;' policy li,~It~a~nr~~f:~:I:::::~~d for oftor thol 0..0 ual to or groater than the 'a t that is loft aftor thoy ha.o reco"ery th:Jt IS eq b 0 KPS in tho 3moun :Jro ~nly obligatod to roim urs , upS "rior 10 ,ottling any ement trom f'< I" 9 , ursuit their loss. . muet obtoin 0 writton agro orne' foos thoy Incurro In~ ,ola Tho Enroll~~;, ort ~~~ ;:~~;;:,~~~vaO~'2qUlta~lo t~~'~b::~c::,,::oan~~i~r ":,ittanl ari~.::;~~; ~P;ha~~,'t on on cla,m ,ltho; ..a~ or raimb"""m.n! clarm. n ce our r~imbur6amon! amoun uch a roduolion will only of any e"bcogalloRormlno "'hathar or not to rodu rro" by tho Enrolloe. Howevor, s"'ill KPS' reimbureomont dlsc~ogf\~~:~ d~~y roaso~able atto;"oy ~:s.~~~es of their attorney. In nc~:o~n~;. tho Enrolloo, and KPS eqUl 3 ~ red if KPS h3t: benefited rom t (200/0) to offset :JUorney feos In be consl e , re th3n twenty percon ~ ' be reducod by mOts incurred by them, will not P3Y for cos [') Ft I Claim to KPS oonsible . ^. nment of Third ra ~ 'kin recovery from 3 resl" Subrogation: . .sslg , 'ht to KPS to pursue a c131m SOOte 7uII" with KPS in pursuing tho sisn their ngH s . ~ ~ must cooper3 J If tho Enrolloo olools tOt")"thOY and tholr ropr"eon'.ot,vo 'I dos among other things: third party or its 'nsuror s'blo partios. Such coopera!,on Inc u, r ony In tho sago ogolnst tho claim against the responsl " consistent with the tes 1m . and Iost,mon, ht '-' ' ~Providlng ov,donco . in ago;ns'. a oloim broug... n; rosponsiblo p3rtlot:, , 'n 3ny '.\'3Y, In defend 9 , R responsible p3rtles, I [~Refusing to 35SlSt t e ~ Pago 13 C::Cooperating with KPS by not t3king 3ny 3ction th3t might re/e3se, limit, reduce, or otherwise prejudice our efforts to pursuo 3 claim against any responsible third party. Trust and Cooperation Between the Enrollee (or the Enrollee's Representatiye) and KPS The Enrolleo and their reprosent3tivo(s) must d031 in good faith with KPS by 3dhoring to 311 of the conditions set forth in this section. In turn, KPS agrees to cooperate with the Enrolleo 3nd thoir represent3tive(s) in their offort to recovor roimbursoment, and 'Nill advanco payments on their beh31f for injuries or modic31 conditions c3used, or 3ssortod by thom to be c3used, by 3ny third party. The Enrollee 3nd their ropresent3tive(s) must coopor3te fully 'Nith KPS in protecting, preserving, and recovering the amounts KPS h3S paid or "",ill P3Y on their beh31f under this Group Plan. Failure to cooper3te m3Y result in the denial of cover3ge for injuries or conditions c3used, or 3ssertod by them to be c3used, by 3ny third p3rty to the extent that cover3ge or p3yment for such injuries or illnesses is, or would h3ve beon, 3v3ilable under the terms of 3ny other insur3nce cover3ge or source of p3yment. Agreement to Arbitrate Any dispute th3t 3rises botween the Enrollee 3nd KPS as a result of the preceding recovery provisions Sh311 bo sottled through 3rbitration. Both tho Enrollee and KPS sh311 be bound by tho decisions of tho 3rbitration proceedings. Disputes will be presentod to, 3nd resolvod by, 3 single arbitr3tor in 3ccord3nce with tho current rulos of the Americ3n Arbitration I\ssociation. Either tho Enrollee or KPS m3Y domand 3rbitr3tion by sorving notice of this demand on the other. Each party to tho 3rbitration 3grees to boar its own costs 3nd to sh3re oqu311y in tho fees of the 3rbitr3tor. This 3greomont to resolve disputos through 3rbitr3tion is in effect 3S of the offoctivo d3te of the Group Pion, and shall rem3in in effoct until the dispute betv.'een us h3S boon resol'.'ed. Recovery of Claims Payments Inoligible Persons If KPS knowingly or unknowingly makes any p3yment on behalf of an individual who for ::my m3wn was not eligiblo to recoivo the services 3nd benefits provided herein, KPS is entitled to full reimbursomont from such ineligible individual or from a Subscriber who applied for the ineligible benefits on behalf of such individU31. If KPS knmvingly or unknowingly receives Promium payment on beh31f of 3n individu31 who for 3ny re3son ',N3S not eligible to receivo the services 3nd benefits providod herein, KPS reserves the right to refund 3ny Premium payment(s) in oxcess of cbim8 paid for the time the individu31 was ineligible, and sh311 h3vothe right to recover the C08t of 3ny bonofit furnished while such individu31 was improperly enrolled in this Group J2Iaf+.. Incorrect Claim Payment KPS is entitled to full roimbursoment from tho p3yee for 3ny incorroct cbim p3ymont. Tho torm "incorrect cbim p3yment" includos but is not Iimitod to the following: DP3ymont to the wrong Provider []Payment of 3n incorrect 3mount [!P3yment f-or 3 servico th3t is not 3 Covored Benefit or Sorvico [[Duplicate p3yment for the same service DP3yment on bohalf of tho 'Nrong Enrollee ~ Incorrectly billed procedure or diagnosis SUBSCRIBER/DEPENDENT LIABILITY AND RIGHTS SubscriberlDependent Liability Subscribers and their Eligible Dependents who are enrolled in this Group Plan are liable for the following costs: Page: 14 ~ Deductible (defined in the Benefits Booklet) ~ Copayments (defined in the Benefits Booklet) ~ Charges for non-covered services ~ Coinsurance, up to the Coinsurance Stop loss Maximum limit {defined in .^.tbchment /\ the Benefits Booklet} ~ Charges incurred after an annual or lifetime maximum benefit, for a specific service or supply, has been exhausted (such as the annual maximum benefit for durable medical equipment) ~ Charges in excess of the amount paid by KPS to non-participating Providers If KPS fails to reimburse a Participating Provider for the cost of Medically Necessary Covered Services provided in accordance with the terms of this Contract, neither the Enrollee nor the Group shall be required to compensate the Participating Provider for such services beyond the limit of Deductibles, Copayments or Coinsurance amounts specified in the Benefits Booklet. :Jjfli1atIifff;lfJtlnVSi1ftli!feK6vTti~Plti6,1(Jnqf!;;1f.ialirf!jp'lftesfWit"flYK:FiSil KP5 Privacy Policy KPS Health Plans is committed to protecting the privacy of Enrollem:' person31 3nd he31th inform3tion. We are required by applicable federal 3nd st3te bw to m3intain tho priv3cy of personal and he31th inform3tion. KPS Health Plans is also required to give this notice to Enrollees to tell them how KPS may use 3nd give out ("disclose") their personal and he31th inrorm3tion hold by KPS He31th Pbns. Person31 3nd hSCllth information (referred to in this notice CiS "personClI information") means any information that is identifbblo CIS porsonClI inform3tion, including inform3tion rog3rding health care and tro3tment, identifiable factors such 3S the Enrollee's name, age, and address; or financial information. We may collect personal information about the Subscriber, or members covorod by KPS Health Pbns through the Subscriber, from the f-oIlO'.\'ing sources: [] Inform3tion we receivo from tho Enrollee, including inform3tion provided on applic3tions or othor fGI:ms., Olnformation 'Ne receive from the Enrollee's health care providers or othor comp::mies, €:uch as othor health insurance companies, relating to modic31 claims and billings, []GenorClI inform3tion about the health C3ro servicos tho Enrolloo h3s mcoi'/ed, such as tho quality 3nd 3v3i13bility of services. 'No rostrict 3ccess to poreonal inform3tion 3bout the Enrolloe to only those who need to know that inform3tion to provide treatment, p3yment or health care operations service€: to the Enrolleo. We m3int3in physic31, electronic, and procodural safegu3rds thClt comply with federal rogulations to guard tho Enrollee's personal information. . We do not disclose any pereonal information 3bout our mombers or former members to 3nyone, except 3S permitted or required by I a'.\'. However, KPS Health Plans 'Nill use and givo out pereonal health inform ation: nTo the Enrollee or someone who hCls the leg31 right to act for the Enrollee (their person31 reprosenbtive ), eTo the Secrot3ry of the Department of Health and Human Sar'/ices, if necessary, to m3ka sure the Enrollee's privacy is protected, eTo 13'.'1 enforcement officials when investigating and/or prosecuting 311eged civil or criminal 3ctions, aM Page 15 O'lVhere required by kl'N. KPS Health Plans has the right to use 3nd give out person::ll information to :mange for troatment, p::lyment of, ::Ind health C::lro oper3tions services, including: OMedical qU3lity reviews c/\ccounting OLegal 3nd risk m3nagement services KPS He31th Plans may use or give out person31 inform::ltion for the follO\Ning purposes under limited circumstances: OFor Government he31thcare o'/ersight activities (such as fr3ud and 3buse investig3tions) OTo avoid 3 serious 3nd imminent thre3t to he31th or safety By law, KPS Health Plans must have '.vritten permission (3n "::Iuthoriz::Ition") to use or give out personal inform::ltion for 3ny purpose th3t is not set out in this notice. The Enrollee may t3ke back ("revoke") their written permission ::It 3ny time, except if KPS h3s ::IIre3dy ::Icted based on their permission. By 13'.'1, Enrollees have tho right to: OSee and get a copy of their person31 inform3tion held by KPS He::llth Plans, except in cerbin limited situations. . OMake a reasonable request in writing to amend any of their personal information created by KPS H031th Pl3ns if they believe that it is 'Nrong or if information is missing, 3nd KPS He31th Pl:Jns agrees. If KPS Health Pl3ns disagrees, '.'Ie '..viII notify the Enrollee why in writing. Enrollees m::lY have 3 st::ltement of their disagrooment added to their persoml inform3tion. OGot 3 listing of those obt3ining their personal inform3tion from KPS H031th Pl3ns in the p3St 6 ye::lrs. The listing will not include inform::ltion: OThat was gi'.'on to tho Enrolloo or their person31 represent3tivo, oThat the Enrollee ::Iuthorized KPS He31th Plans to rolease, or oThat '''''::IS given out for law enforcement purposes, or oTh3t 'N::IS given out to P::lY for tho Enrollee's health c::lro cl3im or 3 disputed claim. ORequost in writing th::lt KPS communic::lto with thom in confidonce ::Ibout their personal inform::ltion by alternativo me3ns or to an 31ternative loc::ltion. If they 3dviso us th3t disclosure of all or ::Iny part of their personal inform3tion could ondanger them, we must comply with ::Iny re3son3ble request provided it specifies ::In ::Iltern::lti'Je me::lns or loc3tion. oAsk KPS HO::llth PI::Ins to pl3ce 3dditional restrictions on our use or disclosure of their person31 information f-or tre::ltment, p::lyment, hoalth care operations or to persons they identify. We ::Ire not required to agree to these 3dditional restrictions, but if we do, we will ::Ibide by our 3greement (except in 3n emergency). OGet a Sep3r::lte electronic or p3por copy of this notice. For moro inform3tion 3bout oxorcising their rights sot out in this notice, EnrollEles may c311 KPS H031th Plans' Mem ber Servicos dep::lrtment at (360) 178 6796 or toll freo ::It (SOD) 552 7111. They C3n ::Ilso re3ch KPS He::llth Plans' privacy official for this purpose ::It (SOD) 552 7111. If 3n Enrollee believos KPS Health Pl3ns h::ls violated their privacy rights set out in this notice, they m::lY file a compl3int with KPS Health PI::Ins 3t the f{)lIowing 3ddress: KPS Health Plans Compliance Department P.O. Box 339 Bremerton, WA 9S337 Filing a compl3int will not ::Iffoct tho Enrolleo's benefits under KPS He31th Pl3ns. Thoy m3Y ::Ilso file ::I compl3int with the Secretary of tho Dep3rtment of He::llth ::Ind Human Sorvices. KPS He::llth Pl:Jns does h3'/e the right to change the '''''3Y personal inform3tion is used 3nd given out. If KPS Health Pl3ns m3kos 3ny ch3nges, Enrollees will get a new notice by mail within 60 d3Ys of the ch3nge, 3nd th3t notice will become effective on tho d3te the revised notice is issued. Please note: Tolephone c311s to and from KPS He::llth Pbns may bo recorded for quality 3ssur3nce 3nd training purposes. If the Enrolloe is tho prim::lry Subscriber with KPS Health Pl3ns and other persons ::Ire covered by KPS He31th PI3ns through them, we suggest that the Subscriber sh3re this information '""ith each other to ensure th3t each of them is aware of our policy 3nd thoir priv3cy rights. Page: 16 Ple:Jse refer to KPS He:Jlth Pbns' 'Nebsite at V'Ni\^/.KPSHe:JlthPbm:.com for more inform3tion 3bout our pri'/acy practices. COMPLAINTS AND ApPEALS PROCESS Complaints /\11 Enrollees h3v8 the right to contact KPS 'Nhenever thoy have a question, complaint or concern regarding: DTheir benefits DTheir access to c:Jre or how to arr:Jnge for C3re Dfl.ny KPS Particip:Jting Provider ;~JService they receivo from KPS D/\ny other issue related to this Group Plan or KPS. In tho o'.'ont :In Enrollee h3s 3 compbint, KPS Member Servicos Roprosent3tives :Jm :Jv3ibble Mond:JY through Friday, from 8:00 3.m. until 5:00 p.m. Pacific Timo, oxcopt on n3tion311y rocognized holid:JYs. Although a Member Services Reprosonbtive C3n resolvo most m:Jttors, Enrolloes may choose to filo :J compbint, or request :In :Jppeal, if they are not satisfiod 'Nith the Member Services responso. The following steps outline the procedure for filing 3 complaint: The service provided by KPS Eligibility Covor:Jge or Benefits Cbims Payment /\ccess to C3re Send :J 'J'/ritton st3temont of the compbint to: KPS Hoalth Pbns Attn: Member Sorvicos Rowlution Dep:Jrtmont PO Box 339 Bromerton, IN ^ 98337 OR C:JII KPS Member Sorvicos :Jt 360 '178 6796 or toll free 3t 1 800 552 711 '1 QU:Jlity of C3re KPS Particip3ting Providers KPS Member Servicos will 'Nork with the Enrollee :Jnd try to resolve the compbint ovor tho phone. Otherv.'ise, KPS will sond :J writton responso 'Nithin 30 days of receiving tho compbint. Compl3ints :Jbout P:Jrticipating Providors :Jre invostig3ted thoroughly 3nd are roviewed periodic:Jlly. Standard Appoals Procoss Enrollees h3ve the right to 3ppe31 any decision reg3rding a complaint or 3ny aspect of their health C3re covor3ge that is not in thoir hvor. The roquost for an appeal must bo m3do 'Nithin 180 d3Ys of tho d:Jte thoy roceive an EOB, letter or other type of communication, from KPS, th3t cont3ins :In unbvor3ble docision regarding their benefits. Such decisions could :Jffect: eThe service roceived from KPS e/\ccoss to health c:Jre services or Providers e Eligibil ity for covor:Jge e Bonofit cO'Jor:Jge DTermination of coverage under this Group Plan (except termination for non payment of Premium) eNon payment of a claim, either completely or partially ell, donial or modific:Jtion of:J request for pre 3uthorization of 3ny h831th C3re service or supply e/\ deni:J1 of:J request for cover:Jge of ::m experiment31 or investig3tion31 servico or supply Page 17 To file :::m ~ppeal, the Enrollee, his/her designated representative, or his/her Provider may either c~11 or write KPS ~t the phone number or address listod above. Any documentation supporting the Enrollee's position m~y bo included with the ~ppeal. KPS ..".'ill notify the Enrolloo, in 'Nriting, that the appeal roquest h~s been received and include ~dditional information regarding the Appeals Process and the Enrollee's rights and responsibilities during an ~ppe~1. The Enrollee h~s the right to send ~n ~ppeal diroctly to an Independent Review Organization (IRa) if KPS does not respond to the Enrollee v/ithin the allotted time period, ~s foIlO'.'Is: Decisions Regarding: Days to Respond: Service Related .^.ppe~ls 30 D~ys Denbls of Experimontal and/or Investigatioml Procedures or Supplies 20 D~ys All other l\d'.'orso Determinations 11 Days Expoditod Appeals Process If the Enrollee's health c~ro Provider, or the KPS Modical Director, reasonably determines th~t by following the Standard .^.ppe~ls Process the Enrollee's lifo, health, or ability to regain maximum function would be jeopardized, KPS '.viII invoke ~n Expedited ,^.ppeals Process and m~ko ~ decision within 72 hours ~fter it is roceived. The Enrollee will receive notico of this ~ction. GENERAL TERMS AND CONDITIONS Applicable Law This Contract shall be governed by, and construed in accordance with, the laws of the state of Washington. Venue for this Contract shall be Kitsap County. Assignment of Benefits The benefits of this Contract shall accrue to Subscribers and their enrolled Eligible Dependents. Neither this Contract, nor its payments or Covered Benefits and Services are assignable to a third party. KPS reserves the right to make benefit payments to the Subscriber, the Provider, or jointly, as KPS deems necessary and appropriate, subject to federal and/or state laws. Binding Agreement This Contract is binding on KPS and the Group, and their respective executors, administrators, successors and assigns. By election of coverage or payment of applicable Premiums, or if the Group's Subscribers or their enrolled Eligible Dependents seek the services provided under this Contract, all of the terms, cevenants and conditions contained herein shall become valid and binding on the Group and its Subscribers and enrolled Eligible Dependents, notwithstanding the failure of the Group to sign this Contract. This Contract shall not bind KPS until (i) it has been executed by a person authorized by KPS, and (ii) an executed copy has been delivered to the Group. Confidentiality The underwriting and financial terms of this Contract are confidential and shall not be disclosed except as is necessary for the performance of this Contract, or as required by law. Contract Modifications Except as set forth under Premium Rate Adjustments, KPS reserves the right to modify the provisions of this Contract, or the services described in the Benefits Booklet, upon tl:J.H:t.y-{30+ days written notice to the Group. The Group may elect to reject such modifications by providing KPS with fifteen (15+ days written Page: 18 notice. However, rejection of a modification will result in the termination of this Contract as of the last day of the month for which Premium payment has been received. Lack of notification of rejection by the Group shall be interpreted as acceptance of the modification and this Contract will be renewed as modified. No modification of the terms of this Contract shall be binding upon KPS unless endorsed, in writing, and signed by an authorized officer of KPS. Such endorsement shall be deemed a part of this Contract, effective as of the effective date of the endorsement. Any amendment or Contract modification required by law or regulation shall become effective as of the effeltive date required by such law or regulation. Coverage Limits The Covered Benefits and Services offered nder this Contract are subject to the coverage limits and maximums set forth in Attachment A - Benefits ooklet. Entire Agreement This Contract, together with Attachment A Benefits Booklet; Attachment B - Premium Rates and Underwriting Criteria; and any riders and/or en orsements attached hereto, constitute the entire agreement. This Contract supersedes all previous comm~nications, representations or agreements, either verbal or written between KPS and the Group, with respect to the subject matter herein. Equity of Application l This Contract is intended to apply equally to all nrollees. Force Majeure I In the event KPS is unable to perform its oblig tions hereunder by reason of fire, casualty, lockout, strike, labor condition, riot, war, act of God or by rdinance, law, order or decree of any legally constituted authority, then this Contract may, at the optio~ of KPS, be suspended. During any period of suspension, KPS shall not be required to perform any serice hereunder, nor shall KPS be liable for any damages arising from any event that precipitated the 1uspension. If this Contract is suspended pursuant to this provision, any obligation by the Group and/or an Enrollee to make Premium payments shall also be suspended for the same period of time. Group Cooperation The Group agrees to cooperate with KPS in the administration of this Contract by: (i) Advising Subscribers and their enrolled E igible Dependents of policies and procedures applicable to this Group Plan. I (ii) Providing Subscribers and their enrolled Eligible Dependents with a Benefits Booklet, ID cards and any applicable notices or other informatioh regarding this Group Plan. I (iii) Providing information about Enrollees that is relevant to the determination of eligibility, claim reimbursement, coordination of benefits or other information required for the administration of this Contract. (iv) Making appropriate payroll deductions, if applicable, to facilitate Premium payment. Headings The headings of sections and paragraphs in this Contract are for convenience and reference purposes only and do not affect in any way the meaning or interpretation of any provision of this Contract. Misrepresentation, False or Fraudulent Information If the Group provides statements or other information on the Group Master Application form, or any other form required by KPS, that constitutes intentional misrepresentation or fraudulent misstatement of material fact, KPS may elect to immediately terminate this Contract. Page 19 t. Notices Any notice that may affect the provisions of this Contract shall be deemed delivered to the Group when deposited in the United States mail with prepaid postage, addressed to the Group at the most recent address listed for the Group. Any notice that may affect the provisions of this Contract shall be deemed delivered to KPS when deposited in the United States mail with prepaid postage, addressed to KPS at the following address: P.O. Box 339, Bremerton, WA 98337-0039. Any requirement of KPS to provide notice to Enrollees shall be fulfilled when the Group has received such notice. It is the responsibility of the Group to disseminate notices to Enrollees within thirty ono (311 days of receipt. Severability If any term, provision, endorsement or condition of this Contract is deemed invalid or unenforceable by a court of competent jurisdiction, the same shall be deemed severable from this Contract. However, the remainder of this Contract shall remain in full force and effect and shall in no way be affected, impaired or invalidated as a result of such decision. Third Party Beneficiaries There are no third party beneficiaries to this Contract. Waover of Breach Waiver of a breach of any provision of this Contract shall not be deemed to be a waiver of any other breach of the same or different provision. ilF!iease:iiJiefef:iiTJ;!tlle ""'''~:y:;::::~~::):::tt~':)?:'''<':::::~~::)~:~?G/-!r(::::.;.::?:'::;'.:V::-:::':_:-::: ,-::'>iK 13enefitsi;$ilim11iila~ C()m;mi'giii1tsllifiri<aJ~~~afSl'ijjirr0~~sS c()wrCilm;~tiomlofrlB~it)~fitsWI@'@B~ BlW;$i~m;vi:j~~7ifj0iI~M "':"~:':::":'~:~~dr::::"':::"f:"?"::::?":;:?}n,"".::',';------:-'-,.<:'V':Yi:<mW4t::WC --- f&mS:l,:FRiq mt:f0flHec0vem Page: 20 KPS Health Plans, In Rehabilitation 400 Warren Avenue P.O. Box 339 Bremerton, WA 98337-0039 CITY OF BREMERTON - PLAN A COVERAGE CONTRACT Group Number: 21001-21006 Effective Date: 1/1/20011/1/2006 Renewal Month: January Open Enrollment December This Coverage Contract includes the following: Attachment A - Benefits Booklet Attachment B - Premium Rates and Underwriting Criteria Riders: N/A Optional Riders: Occupational Injury Coverage - LEOFF I Employees Only Endorsements: N/A KPS Health Plans, In Reh3bilitation, hereinafter referred to as KPS, is a duly licensed health care services contractor (HCSC) in Washington State. In its capacity as an HCSC, KPS agrees to underwrite and provide the benefits and services described in Attachment A - Benefits Booklet, to the eligible Employees, and their Eligible Dependents, of the above-named Group, provided the Group, its eligible Employees and their Eligible Dependents, meet and comply with the provisions of this Contract. Contract Form: BREMA-22900-20042 TABLE OF CONTENTS DEFINITIONS.................................................................................................................... ............1 CONTRACT EXAMINATION PERIOD................................................................................................. 2 EFFECTIVE DATE, DURATION AND RENEWAL................................................ ..................................2 PREMIUM PAYMENT PROViSiONS.......................................................................... .-,"....... ................2 Payment Due Date/Grace Period .... .......... ...................... ................... ......... .............. ............ ................... 2 Prem ium Rate Adjustm ents...................................................................................................................... 3 Premiums Paid by Subscribers/Dependents ....... .......... ................................ ........................................... 3 Prem ium Refunds............................................................................................................................... ...... 3 ELIGIBILITY AND ENROLLMENT....................................................................................................... 3 Group Eligibility.............................................................................................................................. ........... 3 Subscriber/Dependent Eligibility Requirements .... ........................................... ............................... ......... 4 Enrollment.................................................................................................................................. ............... 4 When Coverage Begins............................................................................................................................ 5 Coverage Waiting Periods (This section does not apply to LEOFF I Employees).............................. 5 TERMINATION OF COVERAGE.................................................................................................. .......6 Continuity of Coverage............................................................................................................................. 6 Term ination of Grou p Contract................................................................................................................. 6 Re-EnrollmenUReinstatement .................................................................................................................. 7 Termination of Enrollee Coverage ............ ......... ......... ........................................... .... ......... ...................... 7 SUBSCRIBER/DEPENDENT LIABILITY AND RIGHTS .......................:................................................. 14 Subscriber/Dependent Liability............................................................................................................... 14 GENERAL TERMS AND CONDITIONS .............................................................................................18 Applicable Law.......... .............................................................................................................................. 18 Assignment of Benefits.. ..... ........................................................... ................... ......................... ...... ....... 18 Binding Agreement................................................................................................................................ . 18 Confidentiality....................................................................................................................... .................. 18 Contract Modifications............................................................................................................................ 18 Coverage Lim its........................................................................................................................... ........... 19 Entire Agreem ent.................................................................................................................................... 19 Equity of Application.. ............... ......... ....................... ........... .................... ......... ......... ...................... ....... 19 Force Majeure..................................................................................................................................... .... 19 Group Cooperation............................................................................................................................. .... 19 Head ings.............................................................................................................,............ ....................... 19 Misrepresentation, False or Fraudulent Information........ ............... ..................................... ............ ....... 19 Notices....................................................................................................................... ............................. 20 Severability.................................................................................................................................. ........... 20 Third Party Beneficiaries ........... ..... .................. ................ ................................... ...... .......... ............ ....... 20 Waiver of Breach................................................................................................................................... . 20 DEFINITIONS Capitalized words found in the text of this section are defined below or in the Benefits Booklet section. Child means anyone of the following: (i) An unmarried natural child, adopted child, stepchild or other legally designated ward under the Limiting Age who is primarily dependent upon the Subscriber or the Subscriber's Spouse for support. - (ii) An unmarried child under the Limiting Age who is legally entitled to receive medical coverage as a result of a court order binding either the Subscriber or the Subscriber's Spouse, regardless of whether or not the Subscriber or Subscriber's Spouse has legal custody of the Child. (Hi) An unmarried child who has reached the Limiting Age, or is older than the Limiting Age, is incapable of self-sustaining employment due to developmental disability or physical handicap, and is primarily dependent upon the Subscriber or the Subscriber's Spouse for support and maintenance (see Continued Eligibility for a Disabled Dependent). Contract means this document and any other attachments, exhibits, Riders or Endorsements listed on the title page or otherwise described herein, and any subsequent amendments or modifications to the Contract or its attachments, exhibits, Riders or Endorsements. Contract Renewal Month means the calendar month specified on the title page of this Group Contract during which the Group may renew its coverage each year under this Group Plan. Covered Benefit or Service means those Medically Necessary services described in Attachment A - Benefits Booklet that an Enrollee is entitled to receive. . Eligible Dependent means the legal Spouse or Child of a LEOFF I or LEOFF II law enforcement officer. Employee means (a) LEOFF I employees who are full-time law enforcement officers or firefighters hired prior to October 1,1977, and who are members of the LEOFF system as defined in Sections (3) and (4), CH 131, Law of 1972, 1st Ex. Session; or (b) LEOFF II employees who are full-time law enforcement officers or firefighters hired on or after October 1, 1977, and who are not members of the LEOFF system as defined in Sections (3) and (4), CH 131, Law of 1972, 1st Ex. Session. Endorsement means an amendment to the conditions of coverage or the benefits provided by this Group Plan. Enrollee means a person enrolled in this Group Plan. Group means the employer entity, association or other group that has entered into this Contract with KPS. :Gro .:neflt$.ci1:osen!o::iate(j:~lh ~ttadtJn(jerwrHin ia:~jf3.iP$irs, Fffiit!2Ql1:\fQr\eliaibility~aHCl:t s!h~JiJ:tnt:Q! COy Group Master Application means the application form completed by the Group and submitted to KPS prior to securing coverage under this Group Plan. The Group Master Application identifies the size, participation and contribution eligibility requirements applicable to the Group. Limiting Age means the age at which a Child may no longer be covered under this Group Plan as an Eligible Dependent of the Subscriber. The Limiting Age is specified in the Benefits Summary included in this Benefits Booklet. Medical Director means the licensed physician acting as chief medical advisor for KPS. Non-Participating Provider/Facility means any Provider or facility not contracted directly with KPS, or indirectly through First Choice Health Network, Providence Preferred Provider Organization or MultiPlan. Page 1 Open Enrollment Period means the thirty one (31j day period, or some other period agreed to by both KPS and the Group, beginning one (1) month prior to the Group's Renewal Month, or at some other mutually agreeable time, but at least annually. During the Open Enrollment Period, Subscribers may add or delete Eligible Dependents, and all eligible Employees and their Eligible Dependents have the opportunity to select from alternative health plans offered by the Group. Coverage will be effective as of the renewal date. Premium means the periodic payment made by, or on behalf of the Enrollee, as consideration for this Group Plan and in accordance with the terms of this Contract. Premium Due Date means the scheduled, periodic dates by which Premium payments must be received by KPS as a condition for continued enrollment in this Group Plan. This date is typically the first day of each month of coverage. Provider means a licensed or certified health care practitioner acting within the scope of his/her license or certificate. Rider means an additional benefit over and above those listed in the Benefits Summary. Rider documents are attached at the back of the Benefits Booklet and provide detailed benefit information. Spouse means an individual who is living in a marital relationship with the Subscriber. The marital relationship must be legally recognized by the state of Washington. Subscriber means the primary person, generally the Employee, enrolled in this Group Plan. CONTRACT EXAMINATION PERIOD If, after examination, the Group is not satisfied with this Contract for any reason, the Group may return the Contract to KPS within ten (10) days of the date it is received. Upon receipt of the returned Contract, KPS will refund to the Group any pre-paid Premiums. The Contract shall subsequently be deemed null and void. EFFECTIVE DATE. DURATION AND RENEWAL This Contract shall begin at 12:01 a.m. Pacific Time on the Effective Date (as indicated on the title page), and shall remain in effect until the Contract Renewal Month unless terminated according to the provisions set forth herein. Thereafter, this Contract may be renewed automatically at 12:01 a.m. on the same date (month and day) in subsequent calendar years unless otherwise terminated according to the provisions set forth ,herein. PREMIUM PAYMENT PROVISIONS Payment Due Date/Grace Period The initial Premium payment is due and payable to KPS on or before the effective date of this Contract indicated on the title page. Thereafter, Premium payments are due and payable on or before the first day of every month ("Premium Due Date") for which coverage is provided. A roster of current enrollment and enrollment changes must accompany each Premium payment. A ten (10) day grace peri9gf9119"'(i~g~h~,.Fr~~il1~.Pl1~p~~~mi~?II()~veg.,.911rin~ .~~i8~tir~~,t~is Contract shall not be terminated. 8Q\!/EJYEJE!i(pavmEmfis~n'ot,recejvea:wlthin..tne'.ten,(j0}idaycidlce.perioCl': KPS may, at its sole discretion, elect to extend the grace period for up to sOOy-fBOj da~~,fr9~ ,~h.~Frern!~,~ 9~e 9.?t~: or this Contract immediately, without notice to the Groupifl~~Yl]eQt.l~Ln9tXEJg~j'lEJ.Cl!Jy{t~.g ''':?:'-, '.i'. ',~::::: :," ':;:":::,,:,:"".:---'_:., <'_: 'C",:,';""-::""_":,::::.< If KPS ~1~sts~()i~~e~.i?t~ly~qQ9EJlteikrlinate this Contract due to non-payment of Premium, the effective date of ~;ih9EJllati()t)iermiflati6n will be retroactive to the last day of the month for which payment was received. No further liability for claims will accrue to KPS. Enrollees in this Group Plan shall not be entitled to benefits during any calendar month for which the Premium, on his/her behalf, was not received by KPS. Page: 2 Premium Rate Adjustments The Premium rates applicable to this Group Plan are defined in Attachment B - Premium Rates and Underwriting Criteria. Rates are guaranteed until the Contract Renewal Month each calendar year. Notwithstanding the foregoing, KPS reserves the right to revise the rates as follows: ~ As part of the annual Contract renewal process; ~ As a result of any state or federal law or regulation that imposes an additional tax, new tax or other assessment on KPS revenue; and ~ In the event there is a material change in the basis upon which KPS assumed risk under this Contract. Such changes may include !9ls~::9r};:migIQ~:~Ifilgjnac'cutate information presente~r,~ytQ~ (?~,8~p}S~~ng~~,in..tQ~~~n~fi!~8.~2!h~rSo~tr~st.!~\rl')..~,required by statute or regulation, ;39:{~~~~ ,t;lq}m~gr::9:ttq~r.y~i!iQ9;'g2<p~rfQnf~ur1ld~rwritrnQQ8iCJelir1E~S, or fluctuations of ten percent (10%) or more in the number of enrolled Subscribers and/or Eligible Dependents. KPS will give the Group sWy-fBOj days prior written notice of any change in Premium rates not associated with the annual Contract renewal process. KPS will give the Group tJ::HJ:ty-f30j days prior written notice of rate increases associated with the annual Contract renewal process. Premiums Paid by Subscribers/Dependents In certain instances, Subscribers and their enrolled Eligible Dependents may be required to self-pay their Premiums in order to continue coverage. Those instances include: ~ Strikes, lockouts and other labor disputes that cause a disruption in Employee benefits ~ When the Subscriber and/or Eligible Dependent(s) elects to continue coverage under a COBRA provision or other coverage continuation provision available under this Group Plan The Group is required to collect self-paid Premiums for continuation coverage and forward payments to KPS on or before the Premium Due Date. In the instance of strikes, lockouts and labor disputes, the Subscriber may self-pay their Premium directly to KPS on or before the Premium Due Date. Premium Refunds KPS will refund to the Group any Premium paid, in advance, for periods after the termination date of this Group Plan. In the case of ineligible persons enrolled in this Group Plan, KPS will refund to the Group any Premium paid during a period of ineligibility that is in excess of claim payments made on behalf of the ineligible person(s) during the period of ineligibility. This refund will not exceed an amount equal to three (3) months of Premium payments. ELIGIBILITY AND ENROLLMENT Group Eligibility In order to be eligible to participate in this Group Plan, the Group must continuously meet all eligibility, participation, Group size, contribution and other requirements specified in the Group Master Application form. KPS reserves the right to audit the Group's employment, payroll and eligibility records to ensure that the Group continues to meet its participation requirements, and to ensure that eligible Employees and their Eligible Dependents are properly enrolled in this Group Plan. Page 3 Subscriber/Dependent Eligibility Requirements Active, full-time LEOFF I and LEOFF II Employees, as defined in the Definitions section are eligible to enroll in this Group Plan. Eligible Dependents of an active, full-time LEOFF I or LEOFF II law enforcement officer, as defined in the Definitions section, are also eligible to enroll in this Group Plan. The Child of an Eligible Dependent, other than the Child ofthe Spouse, is not eligible to enroll in this Group Plan. Enrollment Premium payments, if applicable, must accompany all applications for coverage. Current LEOFF I and LEOFF II Employees, including Eligible Dependents of active, full-time LEOFF I and LEOFF II law enforcement officers, are initially eligiblet~a88Ixf~r~~xe~~~E3beginning on the effective date of this Group Plan. Application for coverage must be 'i!l]Q!3:receiveBbv!KPS within thirty one (31} days of initial eligibility. New LEOFF II Employees, including Eligible Dependents of active, full-time LEOFF I and LEOFF II law enforcement officers, may initially apply for coverage 0~t~~fi~st~aY9ft~E3first full month following their first day of employment. Application for coverage must be :l]qQ~rec~iveCl;j5Y;KPS' within thirty one (31} days of initial eligibility. Those Employees who do not enroll immediately following their probationary period(s) must wait until the next Open Enrollment Period. A new Spouse and the Spouse'sc;hild(r:~~rn~xirlitiC3l1y apply for coverage as of the date of marriage. Application for coverage must be m;3Qli:)'feceive'diOVtl\:f?S within thirty one (31} days of initial eligibility. Newborn. Adopted Child(ren) and Child/children placed for adoption are initially eligible for coverage as follows: ~ A natural newborn Child is eligible as of the date of birth and is covered automatically for a period of three (3) weeks. In order for coverage to continue after the initial three (3) weE3~p:~i9d,th:c;hiI9 TUs! .9~~lify as an Eligible D:p:n9:rlt....lf,C3dditi.9.rl~IF)r:.T.iuT., isrE3quired, the.application:TahCl Dremiumfor the Child must be~ncqIIEl'~ln tl1i!>&~q9R81~nreceive(!l)VKPS within sOOy--f60} days of birth; ~ Adopted Child(ren) and Child(ren) placed for adoption are eligible (i) on the date of their adoption, (ii) on the date the Employee or Spouse assumes legal obligation for total or partial support in anticipation of adoption, or (iii) on the date the Employee or Spouse acquires partial or complete legal custody. If additional Premium is required, the application for coverage must be submitted within &ixty-f60} days of the date of placement for adoption. NOTE: When additional Premium is not required, we encourage enrollment as soon as possible to prevent delays in claims processing. In the case of court-ordered coveraqe, a dependent Child becomes initially eligible on the date the Subscriber or Spouse receives the order to provide medical coverage for the Child, even if neither the Subscriber nor the Spouse is the custodial parent. Application for coverage must be submitted within tJ::W:ty- ooe-f31} days of the date of the order. Employees and their Eligible Dependents who do not enroll when they are initially eligible must wait until the next Open Enrollment Period except in certain circumstances (see Enrollment Under Special Circumstances in the Benefits Booklet). Enrollment Under Special Circumstancos Loss of Other Coverage When Employees 3ndJor their Eligible Dependents lose cover3ge under 3nother health plan, they may 3pply for coverage under this Group Plan if the following 3pplios: . 'They declined initial enrollment in this Group Plan in 't/riting; =:They lose eligibility in another health plan or their covorage is terminated; and 'They m3ke application to enroll in this Group Pl3n 'Nithin thirty one (31) d3Ys of losing other COVElr3ge. Page: 4 Otherwise, they must 'l/3it until the next Open Enrollment Period to apply for coverage. NOTE: Dependents may not enroll in this Group Pbn unless thG EmployeG is 3 Subscriber. Marriage, Birth, /\doption or Placement for /\doption Employees who declined initi31 enrollment in this Group Pbn in writing, R13Y 3pply for cover3ge for themselves and thGir Eligiblo Dependents in thG avant of marri3ge, birth of a Child, 3doption or placement for adoption. .^.pplication for enrollment must be received by KPS: ='within thirty one (31) days following the date of m3rrbge, or "within sixty (60) days, if addition:J1 Premium is required, following the date of birth, :Jdoption or pbcement for :Jdoption, or =~:Jt the next Open Enrollment Period if thesa time frames arc not met. NOTE: When addition31 Premium is not roquimd, we encour3ge enrollment as soon as possible to prevont delays in cl3ims processing. Court Ordered Coverage Employees who declined initi:J1 enrollment in this Group Pl3n in writing, m:JY subsequently apply for coverage for themselves and their Eligible Dependents in the event they aro requirod to provide h03lth C3ro cover:Jge for an EligiblG DGpendent Child 3S 3 rosult of 3 court order. Application for enrollment must be received 'Nithin thirty one (31) d3Ys following the d3te of the court order, or wait until the next Open Enrollment Poriod. When Coverage Begins Coverage for new Enrollees begins on their date of initial eligibility provided they enrolled in this Group Plan within the specified time limits (see Enrollment) and any applicable Premium amounts have been paid. If the Employee enrolls during an Open Enrollment Period the coverage will begin on the first of the month following the Open Enrollment Period. A newborn Child who meets eligibility requirements is covered automatically for a period of three (3) weeks from the date of birth, provided either the female Subscriber, or male Subscriber's Spouse, is eligible for maternity coverage under this Group Plan at the time of the Child's birth. If additional Premium is required, coverage will not extend beyond the three week period unless the Child is enrolled within sixty (60) days of the date of birth. Any applicable Premium amount must accompany the enrollment application. If additional Premium is required, cO:VE3ragef~~a~~d~ptedSbP.dis rE3tr8~,~ti:VE3!~Jhe date the Child.'C'~s 1E39~!lypla~E3d for adoption, provided tbafthea"'ilcatio"riiranda' 'tTRrhmicim'for the Child eived ~Fw:~nrolt~g;.""i!binsix!y (~~t?~y~!r()~thE3..d~te of placement ~iJJ.()~.P~... b.~~;;~ee[l..ps~I~~y.!n~"I?r~ffi.i\!mPu~.!;;),~lEl.r NOTE: When additional Premium is not required, we encourage enrollment as soon as possible to prevent delays in claims processing. Coverage Waiting Periods (This section does not apply to LEOFF I Employees) Pre-Existing Conditions KPS imposes a three (3) month waitingpE3~i8~.... bE3!ore providiQ~~8:VE3~~gE3.!8r. a. .pre~E3~i~ting.condition. A ~pre-existing condition~ is any condition" ''','; '.; '\'r~[re~j~~ceiv~dm~dical\aavice, duringthE3 thrE3e(3)~~QmpE3ri~d .imll'lE3di~tE3ly............ eimdate';of'snrollment in this Group Plan;.,~n' EBfol!ElElt~9~N~clQ'1edic~I~~d~1ge,.()t;ffo Provider recommended or provided treatment: Genetic information shall not be treated as a pre-existing condition unless there has been a diagnosis of the condition related to the specific genetic information. allee' com<Tefa o.'er>Im"YoseHr61J'ati5nar erioCle f robi3ti6nar'Xefi6lli;I J{ .... ....,dJTl:jj$;{.\i\r~i!il'lgJl?erib9rn'~yi~lso be reduced by the number of months of Creditable Coverage the Enrollee has accrued under other health care programs prior to their enrollment in this Group Plan. "Creditable Coverage" means periods of other health coverage an Enrollee may use to reduce pre-exis'ting waiting periods. These include group health coverage; Medicare; Medicaid; military health coverage; Indian Health Service or tribal coverage; state high Page 5 risk pool; federal or public health plans; Peace Corps Plan; State:@nHdran'sHealthillrisUrani::e),PrBlZlrarri,iIBR other health insurance coverage. The Enrollee will receive credit for prior Creditable Coverage if it was continuous and terminated no more than three (3) months immediately preceding enrollment in this Group Plan. Health coverage will be considered continuous if there was no more than a three (3) month break in Creditable Coverage. No credit will be given if there was more than a three (3) month break in coverage between the Enrollee's prior plan and their effective date of enrollment in this Group Plan. Any Employer imposed probationary period will not be considered a break in coverage or creditable coverage. To request credit of the Pre-existing Condition waiting period, the Enrollee must submit a Certificate of Creditable Coverage from the prior health plan carrier with his/her enrollment application. In lieu of a Certificate of Creditable Coverage, the Enrollee must provide all of the following information: >> The name of the prior health plan carrier >> The dates of coverage under the prior plan >> Proof of coverage under the prior plan that documents the coverage period(s) There are no waiting periods for: >> Pregnancy >> Formulas necessary for the treatment of phenylketonuria (PKU) >> Prescription drugs included in the Pharmacy Benefit (if applicable) >> A newborn Child or an adopted Child whose effective date of coverage is the date of birth or placement for adoption Transplant Procedures KPS provides coverage for transplant procedures only after an Enrollee has been continuously covered under this Group Plan for six (6) months. This transplant waiting period applies to the transplant procedure as well as any pre- and post-transplant care directly related to a transplant they receive while covered under this Group Plan. If the Enrollee was covered under. another KPS plan immediately prior to enrolling in this Group Plan, KPS will credit to this Group Plan the portion of the transplant waiting period that was satisfied under the prior KPS plan. TERMINATION OF COVERAGE Continuity of Coverage Continuity of coverage under this Contract is guaranteed to all eligible Enrollees provided the Group continues to meet eligibility requirements and continues to pay applicable Premium payments on a timely basis. Termination of :~tg:ij~R Contract This ~Y29R~!~QeOnil"act may be terminated asOf!tHe,Hate'0'n~~ffichlt any of the following occurs: >> The Group fails to make full Premium payments >> The Group violates, or refuses to comply with, the terms and conditions of this Contract ,_ ,- ,--' :' ',: >{ -'.' -," '::':':"}::':-;-"_' '-h: ,...",,>>:.;, ':'01':" :"7:''::-: :-': ,',,' :: "", . '- -": ' ';T,'<'~::':":': ":' '-'-_:','-,<::,~,::: - --rr- -',-: ',' -: - -r '<.':': ~::>~' :..<te:: :.:' ", -.--' ",:~::, '<7': (~ '::,"-:"~ ;:' '-: ,/. -~" "; ;':-'~:'?'-~- .,:.: :::;T:: :''''::'' r,:)-'Z~-,::~,::::<t:._,. .~: ""':"'U'<"::,' "-': '_~-_ : :-'<:'\>-, - ':':-" :_\;;/::: ': :----e;::,:::, --' :'C~::":":",:' ":'.: ::q~::<-"'-;\3'" '.':,::' :' :::'; (';-:',:,,: ' ;;.. -The:Grollp1proVioes.-.anihfel''ltlonalmateriahmisrepreseY'ltatibd:oriJianiaoplication.orclaim-jn;:oroerJo obtain'coVera~e :r'-he;Gr61li'p;~orrrmit~':a:fraUau.ll:int!!8ct;WlfhU~edatdtto,KPSand;'H1IS.Gl"OO'P1Pla.n: >> The Group violates, or refuses to comply with, any published KPS policies and procedures that have been approved by the Insurance Commissioner >> There is a change to, or implementation of, federal or state law that prohibits the continued offering of this Group Plan >> KPS replaces this Group Plan. In this case, the replacement plan will (i) include the services covered under the replaced Group Plan; (ii) be offered to the Group's eligible Employees and their Eligible Dependents; and (iii) not significantly limit access to the kind of services covered under the replaced Group Plan Page: 6 In addition, the Group may terminate this Contract, at any time, by providing tfl.ift.y-f30} days written notice to KPS. If this ~r(),~p Contract lli-terminateQ&, for any reason, coverage for all Enrollees will end automatically on the effective date of termination, or on the last day of the last month for which the Group paid the Premium, whichever occurs first. KPS will refund to the Group any Premium paid in advance for periods after the termination date. In the case of termination or non-renewal of this Group Contract, ~69'::~,[o9P~RS, shall be responsible for providing the following information to all affected Employees and their Eligible Dependents: ~ The effective date of termination of coverage; and ~ The reason(s) for termination or non-renewal. Re-EnrollmentlReinstatement If this Group Contract has been cancelled by KPS due to non-payment of Premium, the Group automatically forfeits all rights to guaranteed renewal of coverage afforded under the Health Insurance Portability and Accountability Act (HIPAA) of 1996. Any decision to reinstate or reenroll the Group is at the sole discretion of KPS. If the Group voluntarily cancels this Group Contract prior to the Open Enrollment Period, KPS may, at its sole discretion, impose up to a tV:81v8 (12} month waiting period before the Group is eligible to reapply for coverage. Termination of Enrollee Coverage , ~'",:,,\:::>:, .:-..... -";:'JW,"::,- '-"'- -, '-.:o:---':{ ,.r"?1@:t/';;;;:~':-::':"';;i:;-- ::,:",7;-, Coverage for an individual Enrollee under this Group Contract will endigasoftl1edateron:wnicn anyone of the following events occurs: ~ Non-payment of any Premium amount, when Premium payment is the responsibility of the Enrollee ~ The Enrollee loses eligibility for coverage under this Group Contract ).;. lEn nrae~,\'gh':\intenHdhal.'materrtn';mi$re'le~effitaflon~ohair{1:~'jjtatrbnl:orCIaim'In'~0rder too inCov e ~ The Enrollee commits a fraudulent act with regard to KPS and this Group Plan ~ The Enrollee refuses to comply with the terms and conditions of this Group Plan as described in the Benefits Booklet ~ The Enrollee voluntarily disenrolls from this Group Plan ~ There is a change in either state or federal laws that no longer permit KPS from offering this Group Plan ~ This Group Contract is terminated Additionally, Eligible Dependent coverage ends if: ~ The Subscriber is no longer employed or no longer meets eligibility requirements ~ The Subscriber dies ~ The Subscriber and Spouse divorce ~ The Child reaches the Limiting Age or marries Coverage ends on the last day of the month in which the Enrollee was eligible for coverage, provided all applicable Premium amounts have been paid. In the case of non-payme~t of Pr~~ium, coverage ends on the}~~!~ay of the mo~,!~,f~~I,\I~i.~~~~.~....re~~iy~d~~r~~iu~p~x~ent~;... Will . claiths"aerVlces'~rece!ved:tl';the2e'nro[iee:aftef:"thErItermination Been.r"fici' Upon termination of coverage either KPS or the Group shall issue a Certificate of Creditable Coverage certifying the period(s) during which the Enrollee was enrolled in this Group Plan. An Enrollee who loses coverage under this Group Plan may be ~1!~JW~t9,~,9n!.i~.u~.coverage or enroll in a KPS Individual Conversion Plan (see Continuation of CoverageintheBetl'efits'!3ookfet). Page 7 A Subscriber who voluntarily disenrolls from this Group Plan while still an Employee will not be eligible to re- enroll in this Gr8ug.~I~~~~tili.th~next Open Enrollment. Period. See Enrollment Under Special Circumstances intlig;l:)enefitsBooklet for exceptions to this policy. Continuation of Inpatient Coverage An Enrollee 'Nho is receiving C3re 3S 3n inp3tiont in 3n 3ccreditod gener31 Hospit31, or other 3pprovod facility, on the dato th3t co'.'er3ge would otherwiso ond, is eligiblo to continue receiving benefits under this Group Pl3n provided the follO'.ving conditions 3re met: DKPS pre 3uthorizod the inpatient care (see Prior Authorization of Inpatient Care); 3nd [1/\11 3pplicable Premium amounts continuo to be p3id KPS 'Nill continue to provide benofits, under thic Group Plan, until ono of the following events occurs: [~The Enrolloo is no longor roceiving inp3tiont C3re DTho KPS Medic31 Director determines that inpatient care is no longer Medic311y Necocs3ry DTho Enrollee h3s oxhausted the inp3tient bonofits offered under this Group Plan (annual reinstatement of benefits does not apply under this provision) Or-Jon p3yment of Premium DThree (3) consecutive months h3ve elapsed since the date covor3ge v\'ould h3ve othorwise ondod I!The Enrollee enrolls in 3nother KPS pbn or in 3ny other he31th pl3n that provides inp3tient hospit31 benefits The Enrollee is not eligible for the extended cover3ge described ::ibove if, on the dato cover3ge would otherwise end: 'The Enrollee is covered undor any other group or individual medic31 pl::m with similarinp3tient benefits; or "Tho Enrollee it: eligible for continuation of coverage under COBRA or 3ny other continu3tion pro'licion Continuation of Covorage for a Disabled Child An Eligible Dependent Child who has re3ched the Limiting Age remains eligible for coverage under this Group Pl3n providod both of tho following conditions are met: DThe Child is primarily dependent upon the Subscriber or the Subscriber's Spouse for support; 3nd DThe Child is inc3pable of self sust3ining employment due to devolopment31 disability or physic31 h3ndic3p. Proof of the Child's dependence, obt3ined from their primary provider, must be submitted to KPS 'Nithin thirty one (31) d3Ys of tho d3te the Child reaches tho Limiting Age. Thereafter, KPS m3Y require periodic proof of tho Child's continuing dopondence. Gener311y this proof is roquestod 3nnu311y 3fter the two YS3r period following tho Child's att3inment of the Limiting .^.ge. f\. dis3bled Child will continue to be eligiblo for coverage until anyone of the following ovents occurs: OFailure to cubmit proof of the Child's continuing dopcmdence 3S a result of disability or physic31 h::mdicap CKPS determines th3t the Child is no longer developmentally dic3bled or physic311y h3ndic3ppod (b3sed on tho evidenco submittod). CThe Subscriber is no longer covered under this Group PI3n DNon p3yment of Premium r:::KPS terminates the Group Plan Cover3ge for a dis:Jbled Child onds on the I3st day of the month in 't/hich the disabled Child is eligible for coverago, provided any :Jpplicablo Premium amounts have been paid. In the case of non payment of Premium, coverage ends on the I3st day of the month for which KPS received 3 Premium p3yment. 1\ dependent who is no longer eligible for coverage as 3 disabled Child may be eligible for cover3ge under COBPJ\ or a KPS Individual Conversion PI3n (seo Continuation of Covorage}. Page: 8 CONTINUATION OF COVERAGE Coverage During a Labor Dispute In the event of 3 strike, lockout or other bbor disputo which C3USOS 3 disruption of h031th care compensation benefits or wagos, Subscribers and their enrolled Eligible Dopendents may oloct to continuo covor3ge under this Group PI::m, for :3 period not to exceed six (6) months, by self paying their Premiums. During this period of continued coverago, benefits and Premium may not be altered from th3t of the existing Group Pbn. The Subscribor is required to pay 3ny 3pplicablo Promium directly to KPS. F3iluro on the part of the Subscriber to make Premium payments '.viII result in termination of cover3ge as of tho I3st day of tho month for 'Nhich Promium 'Nas paid. Cover::1ge terminatod for non paymont of Premium will not be reinstatod. This provision does not apply to Subscribers ::1nd their enrollod Eligible Dependonts 'Nho ::1re entitled to continue cover::1ge under COBRA or 3ny other continuation of covorage provision. Continuation of Group Coverage At tho Group's option, Subscribers and their enrolled Eligible Dependents 'I.'ho loso eligibility for co'.'erago under this Group Plan m::1Y elect to oxtend their covor::1ge for a period not to excoed throe (3) months unless: ;-'Coverage W3S termin3ted 3S ::1 result of::1 strike, lockout or other labor dispute; or ;-'Employmont was terminated for gross misconduct Application for covor::1ge must bo mado within thirty ono (31) d3Ys of tho d::1to cover3ge under the Group Pl3n ended. During this poriod of continued coverage, bonofits and Premium m::1Y not 00 31tered from th3t of the existing Group Plan. Tho Subscribor is required to pay any ::1pplicable Premium directly to the Group. The Group is required to remit Premium to KPS in ::1ccordanco vvith tho Premium Due Date and gr::ice periods dofined in this Contract. F::1ilure on the p3rt of tho Subscribor to mako Premium payments will result in termination of coverage as of the bst day of the month f{)r \-vhich Premium Il'.'as p::1id. Cover3go terminated for non p3yment of Premium will not be reinstated. COBRA (Consolidated Omnibus Budget Reconciliation Act 1985) Employers ,-,,-,ho are required by bw to comply '.\lith the provisiens of the 1985 COBRA act must notify all eligible Employees, and their Eligible Dependents, 'Nho lose eligibility for coverage under this Group Plan of their right to continue coverage undor this provision. Eligible individuals are required to apply for continued co'/arage vvithin sixty (60) d::1Ys of the date covor3ge under this Group Plan ends. The Group is required to notify KPS of e3ch individual's election of COBR^. continu3tion coverago within thirty one (31) days of that eloction. Failure on the part of tho eligible individual to mako a timely election, or failure on the p::1rt of the Group to provide KPS '."lith timely notific::1tion of the election, 'Nill be intorpreted by KPS as a w3iver of the individual's right to continue coverage under this provision. Failuro by the Group to provide timely notification to KPS may not, in 311 cases, eliminate the Group's obligation to provide continuation cover::1ge. It will, however, eliminate any obligation on the part of KPS to provide continuation cover::1ge under this Contract. Individual Conversion Co':erage Employees who 3ra under ago sixty five (65) may be entitlod to transfer to ::1 KPS Individual Conversion ~ DThey ::1re not othervvise eligible for coverage under Medicare DThey are currently eligible for continuation of Group cover3ge but have elected not to enroll in the Group PI3n [lCoverage under this Group PI3n or 3 COBRl\ continu3tiCln pl::m has termin3ted (for 3ny reason except non payment of Premium, 't/hen it is the individual's responsibility to pay tho Premium) CThis Group Plan terminates and the Group does not provide other health care cover3ge to its Employees Page 9 Application for cpver3go must be m3de '.Nithin thirty one (31) d3Ys of the d3te cover3ge under this Grou Pl3n, or other KPS continu3tion or COBRA plan ends. Applicablo Premium p3ymonts for the first month 0 coverage must be submitted with the enrollment applic3tion. r Eligiblo Dopondonts m3Y 3pply for covor3ge separ3toly undor this option in the evont they lose coverag under this Group PI3n due to the death of the Subscriber, or if the Subscriber and Spouse divorce 'Nhen 3n Enrolloo enrolls in 3 comorsion pl3n, he/she loses cert3in protections gU3r3nteed under the Health Insur3nce Port3bility 3nd /\ccount3bility ,^.ct (HIPM) of 1996. Most not3bly, if the Enrollee wants to tr3nsf-er to 3 non cOn'lersion individu31 pbn, ho/sho could bo deniod cover3ge b3sed on 3 pre':ious or existing health condition. If tho Enrolloo does qU31ify f{)r covor3ge under 3 non conversion individu31 pl3n, his/her cover3go ',,,,ill be subjoct to 3ny v'iaiting periods for pre existing conditions. For more inform3tion, pl03so cont:Jct KPS Member Servicos 3t 360 178 6796 or toll free 1 800552 7111. Employees 'Nho 3ro 3ge sixty five (65) or older vl'hen coverago under this Group Contr3ct termin3tes m3) bo oligiblo for cover3ge under 3 Modic3re Supplomont P13n. To dotormino Employee eligibility for Medic3re Supplemont P13n, ple3se cont3ct KPS Member Services. COORDINATION OF BENEFITS (COB} General Provision Benefits 3re provided under this Group Pbn only to the extent th3t Subscribers 3nd their enrollod Eligible Dopendents could not have received benefits for tho S3me service(sfunder ::my othor Pl3n, had 3 c13im fo benefits been m3do. The purpose of this COB provision is to onsure th3t the sum of c13im benefits p3id b, KPS 3nd 311 other Plans under which Subscribers 3nd their Eligible Dependonts 3re covered does no excood 100% of the .^.Ilo'1.'3ble Exponse. All of thO bonefits provided undor this Group Plan 3re subject to this COB provision. Definitions "AIlO'A'3blo Expense" moons the usu31, custom3ry or re3somblo ch3rge for any necess3ry he31th care service or supply when the sorvice or supply is a covered benefit, at 103st in part, under any of the Pbns involvod. When 3 Plan provides benefits in the f-orm of services r3thor th3n c3sh p3yments, the reasonable c3sh v31ue of each service provided sh311 be considered 3n AIIow3ble Exponse. The difference between the cost of a privote Hospit31 room 3nd the cost of a semi priv3te Hospital room is not considered an /\1I0'N3ble Expense under the 3bove dofinition unless the Enrolloo's St3Y in 3 privato Hospit31 room is considered to be Medic311y l'Jecess3ry under 3t 103St one of the Pbns involved. "Double COVOr3Qe" m03ns whon Enrollees h3ve cover3ge under another Pl3n. "Plan" m03ns 3 policy or contr3ct '""hich providos benefits or services for, or because of, medic31 or dent31 C3re, through one of tho following: DThis Group PI3n [!Any group, individu31 or blanket disability insuranco policy D^ny group or individual contractu:)1 prepayment or indemnity plan such 3S those issued by health care service contr3ctors, health mainton3nce organiz3tions or other health c3rriers or he31th insurers D^ny labor m3nagement trusteed pl3n or bbor organiz3tion plan D/\ny employer organiz3tion pbn or Employee benefit organiz3tion plan LJ/\ny governmental progr3m [J,^.ny insurance cover3ge required or provided by st3tute, including 3utomobile policies which provide medic31 benefits C:,^.ny other simil3r source The term "Plan" does not include accident only coverage, including 3thletic injuries, for school age Children from Kinderg3rten through tv:olfth grade (K through 12), or for collegestudonts, either on :) 21 hour basis or on a "to and from school" basis. P f e :) r Page: 10 E3Ch of the Plans under which tho Enrollees 3m covered, and each benefit payable under those Plans, are considered separately when benefits ::1re coordinated under this provision. Claim Determination Period The cbim determination period means 3 Calendar Ye3r. Effect on Benofits When an Enrollee h3s double co'/er3ge, during ::1 C310ndar Y03r, one Plan norm311y pays its benefits in full 3S the primary payor and the othor Pbn p::1YS 3 roduced benofit 3S the sacond3ry p3yer. KPS determinos which covor3ge is primary 3ccording to the I'btion31 ^SSOci3tion of Insurance Commissioners' guidelines. When KPS is the primary payer, we will pay the benefits described in this Benefits Booklet. Whon KPS is the secondary p3yer, W8 will detormine tho /'.lIo'Nable Expanse. After the primary Pbn P3YS, we ,..viII P::1Y 'Nhat is left of the /\lIo't/able Expenso, up to our regubr benefit. We will not pay more than our 3I1o\'\'ance. Order of Benefit Determination VI/hen more than one Plan contains 3 COB provision, the decision 3S to which Plan is the prim3ry Pbn is made in the following order: cThe Pbn that covers tho perwn 3S 3 Subscribor r3thor than as an Eligible Dopendent is primary oWhon 3n Eligiblo Dependent Child is covered under moreth3n one Plan, tho Pbn of the p3rent whose d3to of birth (month and d3Y only) occurs earlier in 3 C31ond3r Ye3r is prim3ry, oxcept when tho Child's paronts 3ro legally divorced or sep3r3tod oWhen the paronts of 3 cove rod Eligiblo Dopondont Child 3re divorced or sep3rated 3nd thero is no court docree which est::1blishes fin3nci31 responsibility for the medic31 or dont31 expenses of the Eligible Depandent Child, then benefits for the Child's Covorod Expenses 3re determinod 3S foIlO'.'\'s: []The Plan of the p3rent withctlstody is prim::lry, provided the parent '.vith custody has not rem::mied D If the p3rent with custody has rem3rried, the order f-or determining the prim3ry Pbn is: (i) The PI3n of pment ',Nith custody Oi) The PI3n of tho stepparent (iii) The Pl3n of tho p3rent without custody Despite the above, if the court has determined which parent is financially responsiblo for the health care of tho Eligiblo Dopendent Child, thcln the Pl3n of that p3rent is 31w3Ys the primary Plan. Whon tho 3bo'/o rules do not establish an order of determin3tion, then tho Plan 'Nhich h3S covered the person for the longor period sh311 bo primary, oxcopt th3t: [:The benefits of the Plan which covers the person, on ',Ivhose oxpenses the claim is based, 38 3 bid off or retired Subscriber, or a Dependent of such a Subscribar, Sh311 be detormined after the benefits of the Pl3n which covors th3t person as a Subscriber (other than 3S a bid off or rotired Subscriber), or the Dependant of such 3 Subscriber; and C If either of the Pl3ns does not have a provision reg3rding bid off or rotired Subscribers, which results in each Plan determining its benefits after the other, then the above provision shall not apply. If none of the abovo rules apply, tho Pl3n th3t h3S covered the person for the longest period of time shall be considered the primary Pbn. Facility of Payment Whene'.'er ~mother Pl3n m3kos p::lyments th::lt 8hould h3VO boen providod undor this Group PI3n and in 3ccord3nce with this COB provision, KPS m3Y, :Jt its sole discretion, choose to reimburse the Pl3n making such other payments, tho 3mount necessary to s3tisfy the intent of this COB provision. ^ny amount p:Jid Page 11 under this subsection shall be considered as benefits paid under this Group Plan, ::lnd KPS shall be fully discharged from liability to the extent of such payments. Right of Reco'lery Whenevor KPS makes payments that are in excess of the maximum amount of payment necessary to satisfy this COB provision, KPS shall have the right to recover the excess payment amount from the Enrollee, from the Provider, or from another Pbn, as applicable. Right to Receive and Release Information l\& a condition of recei'/ing benefits under this Group Plan, Subscribers and their enrolled Eligible Dependent(s) agree to provide KPS 'Nith any necessary inf-ormation, and authorize KPS to releace to or obtain from any other insurer, organization or person, any information necessary to administer thi& COB provision. Disclosure of Coordination F3ilure on the part of Subscribers and their enrolled Eligible Dependents to cooperato 'I:ith KPS regarding this COB provision could rewlt in the loss of benefits under this Group Plan. KPS recommends th3t Subscribors and thoir onrolled Eligiblo Dependent(s) submit claims to KPS, and o:Jch other plan, at tho same time to help minimize debys 3nd facilit3te claims p:Jyment. KPS' RIGHT OF RECOVERY limitations and Exclusions Cover3ge under this Group Pbn is oxcluded for expensos incurred or servicos rendered if the Enrollee's illnos& or injury is causod (or alleged by the ,Enrollee to be caused) by another party, to the extent that bonefits are :Jv:Jil3ble under the terms of any other insurance coverage or source of payment, including but not limited to: DVehicle medical, personal injury protection ("PIP"), no fault, uninsured or underinsured motorist, workers' compensation insurance or benefits and third party liability insurance, or similar contract of insurance. o Homeo'Nner's, property or :Jny other insurance policy (except for individual or group health insurance). D/\n agreement, judgmont or settlement pur&u:Jnt to which :J third party p:JYs or agrees to pay for tho em:ts of guch gervices from agsetg other th3n a policy of im;urance, This exclusion applies whenover any such contr:Jct of insurance, agreement, judgment or settlement is iswed to or provides benefits for the Enrollee, whether or not thoy assert :J cbim agaim:t tho responsible third party or its insurers. Third Party liability: Reimbursement and Subrogation .^.s a condition of KPS' agreement to advance payment to the Enrollee or their Provider for medical expenses for illnesses or injuries caused (or alleged by the Enrollee to be caused) by another party, the Enrollee agrees to make a claim against, or otherwise pursue recovery from all responsible parties and their insurer(s) for :J1l payments advanced to the Enrollee or their Provider by KPS. If the Enrollee does not make a claim or otherwise pursue recovery of KPS' payments, all such payments made by KPS may be denied or recouped. By providing benefits under this provision, KPS is fulfilling its oblig:Jtions under this Group Plan. Howover, by so doing, KPS does not waivo 3ny rights to reimbursement or subrogation. ... Provided, the benefits of this Group Plan will be advanced to the Enrollee if they are injured by a third party, before compensation is recovered from the third party or its insurers, only under the following conditions: cThe Enrollee, :Jnd their representativo(&), must fully cooperote v:ith KPS in recovering payment of medical bills paid, :md to be paid by KPS, from the parties who allegedly causod the injury or illness, including but not limited to their liability insurance c3rriers, any 3pplic3ble PIP, uninsured or Page: 12 , ther re3chable ens3tion or ::m~ 0 r ' workers comp . , homoownors po 'G" " 0 aodroGsos of lorisl pol'G" .. . . Iho namos an. rty's undorinsu,"d mo .010 porly or part'os, . f Iho injury or ,lInos., . f Iho rosponG,ole pa sols of Ihe ro.pons,. Tn" of Iho dolails 0 and oddrossos 0 as . . KPS In wn" 0' . d Iho nomos ) usl IJTho Enrol::: n:~::::Od I; bo ro.pons,ble on . I" or Iho Ihir. porty'~ in:I~;~~~sbo~alf; Iho par'. . I Iho Ih"o par , KPS on Iho Em insurors, if known,. , Iho Enrolloo ago'ns 'or to bo poio, by I. or lawsuil fll.d b, nl of bonof,ls pOld b" Ih m.diGal Gosts (JAny G OIm d.mand for repaymo " Gomponsolion for '~hO Ihir~ party 'nGludo a '. KPS Ihoir Fight t. rOGo,:; injurios Gausoo b, OF roo 00 ass'gn 10 'KPS as a rosull . , KPS · Enrolloo must ag to be pa,d, b, n al"'i11 bo pa,d b, eTh paid (SU~I':i~rl~~~'inj:ry. KPS for tho mod iool oxpo;:r~~::i~:G~~dS" or othor rOGovery rosponG' 10 roim"u"o I lu.gmenl, In II fflblst 3groo tRe settlemen, J eTho Enro.... ""i"tAo injury, from 'h'rd porly or it6 inGurors. os a ro:~: t~o Enrolloo fF<lm on, t I , Ro"rosomalive) oblo'no ( r Iho iRrolloo 5 . t, Ihoy mUG!: nt by Enrollee \0 ponsible third p3r ), . and Roimbursemo S' 3ymonts from tho res CollodIon mand rOGovery for KP p.. itralion or Iriol. b' KPS, for tho If the ERroll.o el.GIs 10 de f any solUomonl, mod,al,on, ~rl~O amount of Iho lion ~s~~:o~o~ obtained by DNolify KPS in advonoo oh' 0 party and its insuror(~i~SI any reGovory or polon 10 . , . Ihe reepons,blo I" d on thoir behalf, og . di",,1 Gost. pa,d b, o Inform 'f "oyAlonls mo 0 ... 13ims involving me reGovory 0 · .. or sortllng G - KPS boforo Gompromlslng roo anything 0160 that cObtain prior consent from . I third p3rty or its im;ur~r(':)ht~ 'Nithout first obtaining . R esponslb e . 9l:lFSOmOnt r1:;J . KI'&,. 'a ,"omonl wilh !: 0 r ur subrogation or ro'm..... . modiGal o Not onlor ,nOO on~p~' lion or prOjuo'~~s I thai Is GomponsollOn for woulo rOloose,,,. on Gonsont fr.m . a"'ord or juogmon ox pross pnor ..nil tlon of Ihe soIU.m.nl, " Ghable as.e.. . KPS for Ihol por liGY limile or roo . boholf n RO~~:~:i: and to be pais by "SroGovery for lo.s Ihah I~: ;::If';;;~~~i'~ b~nof~foin~d :~o\~:~ .nl o~ . e.llIomonlor . bUrGo KPS for tho Enrollee 0 bl assols, Iho, If Iho Enrolloo ~~a:~:: aro obligaloo ::or:,~ Ihoir loss., If,. h:;;:;, policy limils or r:~:~o:ponsaloo for of Iho IIa~I::,~ boon fully GOmpOR~~on Iho lioblo party. '~:r, oft.r th.y ho"" boon aftor IhO'thOI 'is .~"oIOO or groa~~s in Iho amounllhol,s . 10 sottliRg any roGovory .. 0 10 ",imbu",o 10"' KPS pnor . ursuil or. only obl'galo.. blaiR a wrillOR ogreom~::R:Y foos Ihoy Ineur~d~; i~ 6010 Ihoir loes. oir ropr.senlolivo(s), ~~:::basis, any roosona~i~r o~<i.on agroome:; t~Psharo, on on Tho Enrolloo, or ~PS 10 share, OR an ol~u~ In Iho aboenG. 0: a ~monl amounl ,n ':;d roouolioR will only Glaim :fl~:;~;~~~n or rOi,,:.~~r~~::;e~rl ~O~'I~ reduoe :u;/~~~ E~~olleo HO'NO:'::~ls~~1 :PS' roimburs:~~~ of an'li:n will dolorm,ne ~ ~o altornoy foos 'nG~rre of Ihelr artornoy. I~ no ~od by Iho Enrolleo, an :~~i~:bIO 'basis, ~';t;~~:o~~nolilod from II~~;~);~O:lfl;el allornoy foes ,RGU be considered If re th3n twenty porcen be reduced by m~ts incurred by thom. will not pay for GO . 10 KPS a rooponsiblo nhir<l Party ClaIm. . so.king roGovery from ursuing Iho 'OR: J'.ssignmoRI 0 S 00 pursuo a olo'm mle fully with KPS 'R P Subrogall 0 assign Iheir righls Ie :onlali'lO(S) musl GOo~o olhor Ihingo: If Ihe Enrolloo oloGls I (s) thoy and thOlr rop oralion inoludos, amo g A case againsl Ihe Ihird party or ils ineure~SiblO portios. SUGh GOOp . I I "'Ilh Iho loelimony in I e Gloim ogolnsl Iho rospo 0 10sIimony Gons,.-on .. . a claim broughl by .ri.no evidonoe an dofonding aga,nGI C Prov,", "lies . RY "'ay ,n ~ rosponsiblo par.... . nsible porlioo, ,n a .. , . or olhorwiso 'Refusing 10 asei'l the r.opo . might releaso, Iim'l; roduoo, I KI'&,_ . ns bv nollokingany OGI'~:~~~~.ponCiblelhird part,. Page 13 t' CJ '^'Ith KF J slalm agalns [Coopera.In:;1.. Horts to pursue a prejudice our e Trust and Cooperation Between the Enrollee (or tho Enrollee's Representative) and KPS Tho Enrolleo ::md their represent3tive(s) mList d031 in good bith with KPS by adhoring to 311 of the conditions set forth in this section. In turn, KPS 3grees to cooperate with tho Enrolloe and their represent3tive(s) in their effort to recover reimbursement, and will 3dv3nce p3yments on their behalf for injuries or medical conditions caused, or asserted by them to be c::lused, by any third party. The Enrollee and their representative(s) must cooperate fully "''lith KPS in protecting, preserving, 3nd recovering the amounts KPS has p3id or will P3Y on their beh31f undor this Group Plan. Failure to cooper3te m3Y result in the denial of coverage for ittjurim: or conditions c3usod, or 3sserted by them to be caused, by any third party to tho oxtent th3t covor::lge or payment for !;:uch injurios or illno!;:ses is, or '.'\'ould h3vo boon, 3v3i13ble under the terms of ::Iny other insurance cover3ge or source of payment. Agreement to Arbitrate Any dispute that arism: between the Enrolleo and KPS as a result of the preceding recovery provisions sh311 be settled through arbitration. Both the Enrollee and KPS shall be bound by the decisions of the arbitration proceedings. Disputes will bo presented to, 3nd resolved by, a singlo arbitrator in accordance with the current rulos of the Amorican Arbitration I\ssociation. Eithor the Enrolloe or KPS may demand arbitration by serving notice of this demand on the other. Each party to the arbitration agrees to bear its own costs and to share equally in the faos of the arbitr3tor. This agreement to resolve disputes through arbitration is in effect as of the effective d3te of the Group Pl3n, and shall remain in effect until the dispute bet'Neen us has been resolved. Recovery of Claims Payments Ineligible Parsons If KPS knowingly or unknowingly makes any payment on beh31f of 3n individual who for any re3son was not oligible to recei'.'e tho sorvices and bonofit!;: providod herein, KPS is entitled to full reimbursement from such inoligible individual or from a Subscriber who appliod for the ineligible benefits on behalf of such individu31. If KPS knowingly or unkno'Ningly receives Premium paymont on behalf of an individual who for any reason was not eligible to receive the services and benefits provided heroin, KPS reserves the right to rofund 3ny Premium p3yment(s) in excoss of cl3ims paid for the time tho individu:31 .'.'\'3S ineligible, 3nd shall h3'/e the right to recover the cost of any benefit furnishod while such indi'.'idual 'Nas improperly enrolled in this Group PJ.a.Fh. m{;orrect Ctaim p,ayment KPS is ontitled to full reimbursement from the payee for any incorrect claim paymont. The term "incorrect cl3im p3yment" includes but is not limited to tho following: o P3yment to tho wrong Provider DPayment of an incorrect 3mount DP:3yment for:3 sorvice that i!;: not::l Covered Benefit or Sorvico [!Duplic3te payment for tho S:3me service [~P3ymont on beh:3lf of the '>'.'rong Enrollee [J Incorrectly billed proceduro or diagnosis SUBSCRIBER/DEPENDENT LIABILITY AND RIGHTS SubscriberlDependent Liability Subscribers and their Eligible Dependents who are enrolled in this Group Plan are liable for the following costs: >- Deductible (defined in the Benefits Booklet) >- Copayments (defined in the Benefits Booklet) Page: 14 >- Charges for non-covered services >- Coinsurance, up to the Coinsurance Stoploss Maximum limit (defined in ^ttachment ^ Benefits Booklet} >- Charges incurred after an annual or lifetime maximum benefit, for a specific service or supply, has been exhausted (such as the annual maximum benefit for durable medical equipment) >- Charges in excess of the amount paid by KPS to non-participating Providers If KPS fails to reimburse a Participating Provider for the cost of Medically Necessary Covered Services provided in accordance with the terms of this Contract, neither the Enrollee nor the Group shall be required to compensate the Participating Provider for such services beyond the limit of Deductibles, Copayments or Coinsurance amounts specified in the Benefits Booklet. KPS Privacy Policy KPS He31th Pbns is committed to protocting the priv3cy of Enrolleos' per!>on31 3nd he31th inform3tion. 'No 3re required by 3pplicable foder31 3nd St3t8 bw to m3int3in tho priv3cy of person31 3nd he31th inform3tion. KPS He31th PI3ns is 3180 required to give this notice to Enrollees to toll them ho'o\' KPS m3Y use 3nd gi'lo out ("discloso") thoir person31 3nd he31th inform3tion held by KPS H031th Pbns. Pen>onal and he31th inform3tion (referred to 'in this notice a8 "porsonal information") me3ns any information that is idontifiable 3S person31 information, including inform3tion regarding health care 3nd treatment, identifiable factors such 3S the Enrollee's name, 3ge, 3nd address; or fin3ncial inform3tion. VI/o m3Y coli oct person31 inform3tion 3bout the Subscriber, or membors co'/ared by KPS He31th P13m: through tho Subscriber, from tho follo'.ving sources: [; Inform3tion we roceive from the Enrollee, including inf-orm3tion provided on 3pplic3tions or other fGI:ms, [] Inf-orm:ltion 'Ne rocoivo from tho Enrolloo's hO:llth caro providers or othor companies, such 3S other h031th insur::mce companies, robting to modic31 c13ims and billings, [lGoner31 information about tho health care services the Enrolleo h3s rocoived, such 3S tho qU31ity 3nd 3'13ilability of sorvices. We restrict access to person31 inform3tion about the Enrollee to only those ','",ho need to know that information to provide treatment, p3yment or health C3re operations services to the Enrollee. 'No m3intain physical, electronic, and procedur:J1 safeguards th:Jt comply with feder:J1 regulations to gU3rd the Enrollee's personal inform3tion. We do not disclose ::my person31 inform3tion 3bout our membors or f-ormer membors to 3nyone, oxcept as permitted or required by 13'1/. However, KPS H031th Plans will use :::md give out personal heolth information: ::::ITo tho Enrollee or someone who has the .leg31 right to. :Jct for the Enrolloe (thoir personal represent3tiv8 ), C::To the SocretJry of the Department of Health and Human Services, if necessary, to make sure tho Enrollee's priv3cy is protected, c::To law enforcement officials 'J'lhen investig3ting and/or prosecuting alleged civil or crimin31 :Jctions, aA4 Page 15 eWhere required by law. KPS Heellth Plans has the right to usa elnd give out person::ll information to :Jrr~lngo for treatment, payment of, and health C::lre oper::ltions services, including: eMedic::l1 qUellity ro'/iel/is CAccounting [! Leg31 ::lnd risk manClgoment services KPS HOellth Pbns may use or give out porsonal inform3tion for the f-ollowing purposes under limited circumstances: o For Government he31thc3re oversight 3ctivities (such 3S fraud and abuse investigations) eTo avoid 3 serious ::lnd imminent thre3t to health or s::lf-oty By law, KPS H031th Pbns must h3ve written permission (an "authorization") to use or give out person31 information for ::lny purpose that is not set out in this notico. Tho Enrollee may t::lko b3ck ("revoke") their 'I'Jritton pormission at any timo, oxcept if KPS hel!; 31ready 3cted b::lsod on their pormission. By bw, Enrollees have the right to: m,;oo and get 3 copy of their personal information held by KPS HO::llth Pbns, except in cert3in limited situ::ltions. CM3ke a ro3son3ble request in writing to amend 3ny of their porwnCll inform::ltion cro3tod by KPS H03lth PI:ms if they boliovo th3t it is wrong or if inform3tion is missing, and KPS He:.:lIth Pbns agrees. If KPS Heellth Plans dis3greos, '110 will notify tho Enrollee why in \'vriting. Enrollees may h3vo 3 st3tomont of their dis3greement ::lddod to their personal information. eGot a listing of those obtaining their personal inform3tion from KPS HOellth Plans in the p3st 6 years. The listing will not include information: IJThat 'l/3S given to the Enrollee or their person31 roprowntativo, oTh3t the Enrollee authorized KPS He31th PI3ns to rele3se, or. CThat 'N3S given out for la'.\I enforcement purposos, or cTh::lt '1.'3S given out to pay f-or the Enrollee's h031th care claim or a disputod c1::lim. oRoquest in 'Nriting that KPS communicate '."lith them in confidence ::lbout their person31 inform::ltion by alternative means or to an alternative loc3tion. If they advise us that disclosuro of all or any part of their personal inform3tion could end::lngor thom, we must comply with any roelsonable request provided it specifio!; ::In alternative means or loc::ltion. CAsk KPS HO::llth Pbns to place additional restrictions on our use or disclosure of their personal information for treatment, payment, health C3re operations or to persons they identify. We are not required to agree to these additional restrictions, but if we do, we will abide by our 3greement (except in an emergency). cGet a separate electronic or paper copy of this notice. For more inf-ormation about exercising their rights set out in this notice, Enrollees may call KPS Health Plans' Member Servicos department at (360) 178 6796 or toll free at (800) 552 7111. Thoy C::ln also reach KPS Health Plans' privacy official for this purpose at (800) 552 7114. If an Enrolloe bolieves KPS Hoalth PI3ns has viol3ted their privacy rights set out in this notice, they m3Y fila a complaint with KPS He::llth Plans 3t the following address: KPS Health Plans Compl!ance Dopartment P.O. Box 339 Bremerton, IN fI. 98337 Filing 3 compbint 'Ifill not 3ffect the Enrollee's bonofits under KPS HO::llth Pbns. They may ::llso file 3 compbint '/fith the Secretary of the Dep3rtment of He31th and Human Services. KPS Health Plans does havo tho right to ch::lngo tho '."'elY personal inform3tion is usod ::lnd gi'.'on out. If KPS Health Plans m3kes any changes, Enrollees '.vill get a new notice by mail within 60 delYs of the change, and th3t notice will become effective on the d3to the revised notice is issuod. Please note: Telephone calle to and from KPS Health Plans may be recorded for quality aesurance and training purposes. Page: 16 If the Enrollee is the prim3ry Subscriber \vith KPS Health PI3 d th Health Plans tl:1 1:1 1:1 \A' - . ns 3n 0 er persons 3re covered by KPS th3t e3ch of th ro~g ,:, em, f,e sugg?st th3t the. Su?scnb~r sh3re this inform3tion with each other to ensure em IS 3..3re 0 our policy and their pnv3cy nghts. PI~ase refer to KPS He31th Pl3ns' website 3t 'Nww.KPSHo3IthPl3n f . f . . pnV::lcy pr::lctices. s.com 9r more In ormation about our COMPLAINTS AND ApPEALS PROCESS Complaints All Enroll~es havo tho right to cont3ct KPS '.vhenever they have ::l question, compl3int or concern reg3rding: DThelr benefits DThoir 3ecoss to caro or how to 3rr3nge for care DAny KPS P3rticipating Provider o Service they recoive from KPS DAny other issue rol3ted to this Group Plan or KPS. In the event an Enrollee h3s ::l c9ffl[;)laiRt KP~ M 9 ~ . through Frid::lY, from 8:00 3.m. until 5'00 pm P e~f erT ervlces Roprosent~tivos are 3vai13ble Mond3Y Although a Member Services Represe~tativ~ ~3n ar~sl~I"elm:~s~x~e~tt on n::ltlon311y recognized holidays. compl3int, or request an 3ppeal, if thoy 3re not satisfied \A:ith the Me:heO~S~eErn.rcolloos may choose to file 3 n , rnl:l r g ,'I es response. The following steps outline tho proceduro for filing 3 complaint: The service provided by KPS Eligibility Covor::lge or Benofits Cl3ims Payment Access to C3re QU31ity of Care KPS P3rticip3ting Providors Send 3 written statement of . the complaint to: KPS He31th Pl3ns .^.ttn: Member Services Rosolution Dep3rtment PO Box 339 Bremerton, WI\, 98337 OR C311 KPS Member Servicos 3t 360 178 6796 or toll froo 3t 1 800 552 7111 KPS Membor Services will work with the Enrolloe and try to resolve tho complaint over the phone. Otherwise, KPS 'Ni/l send 3 'Nritten rosponso 'J'/ithin 30 days of receiving the complaint. Complaints 3bout Particip3ting Providers 3re invostig3ted thoroughly and 3re reviewed periodically. Standard J'.ppeals Process Enrollees h3ve the right to appe31 an;' decision ro El" I . coverage that is not in their bvor Tho roquest for a;::Jr Ing 13 co~ ~ :lInt or a~y. 3spect of their health care recoive an EOB lottor or othor t' e of co . ?ppea mus e mado '.",thln 180 days of the d3te they reg3rding their b~nefits. Such de~i~ions co~:~~~~~~lon, from KPS, th3t cont3ins 3n unfavorablo docision ['Tho sorvice received from KPS D^ccess to health C3re services or Providers o Eligibility for coverage [J Benefit coverage r=,Termin3tion of cover~ge under this Group Pl3n (except termination for non p3yment of Premium) l~Non payment of 3 c13Im, either completely or p3rti311y [, ~ g . I El'f r ....... enla or mo I Ica Ion of a request for pre authorization of any he::llth care servico or supply Page 17 =^ deni:::ll of a request for cover3ge of 3n experiment:::ll or investig3tion31 service or supply To file an appe:::ll, the Enrollee, his/her design3ted represent3tive, or his/her Providor may either call or write KPS at the phonE) number or 3ddress listod :::Ibovo. /\ny documontltion supporting tho EnrolleE)'s position m3Y be included '.\lith the appeal. KPS will notify the Enrolloe, in writing, th3t the :::Ippeal requost h3s boon received 3nd include additional inf-ormation reg3rding the /\ppe3ls Process ::md the Enrollee's rights 3nd responsibilities during 3n appeal. The Enrolleo h3s the right to send :::In :::Ippeal directly to an Independent Review Organization (IRO) if KPS does not respond to the Enrollee within the 311ottod timo period, 3S follmvs: Decisions Regarding: Days to Rospond: Servico Related Appe31s 30 Days Denials of Experimental and/or Investigation31 Procedures or Supplies 20 D3Ys ^II other Adverse Determinations 1 -1 Days Expedited .^.ppeals Process If the Enrollee's health C3ro Provider, or the KPS Medic31 Dimctor, reason3bly determines that by follO'.\'ing the Stmd3rd I\ppoals Process the Enrollee's lifo, hoalth, or ability to rog3in m3ximum function would be jeopardized, KPS will invoke 3n Expedited .^.ppe:::lls ProcoLL 3nd m:::lke a decision within 72 hourL 3ftor it is received. The Enrollee will receive notice of this action. GENERAL TERMS AND CONDITIONS Applicable Law This Contract shall be governed by, and construed in accordance with, the laws of the state of Washington. Venue for this Contract shall be Kitsap County. Assignment of Benefits The benefits of this Contract shall accrue to Subscribers and their enrolled Eligible Dependents. Neither this Contract, nor its payments or Covered Benefits and Services are assignable to a third party. KPS reserves the right to make benefit payments to the Subscriber, the Provider, or jointly, as KPS deems necessary and appropriate, subject to federal and/or state laws. Binding Agreement This Contract is binding on KPS and the Group, and their respective executors, administrators, successors and assigns. By election of coverage or payment of applicable Premiums, or if the Group's Subscribers or their enrolled Eligible Dependents seek the services provided under this Contract, all of the terms, covenants and conditions contained herein shall become valid and binding on the Group and its Subscribers and enrolled Eligible Dependents, notwithstanding the failure of the Group to sign this Contract. This Contract shall not bind KPS until (i) it has been executed by a person authorized by KPS, and (ii) an executed copy has been delivered to the Group. Confidentiality The underwriting and financial terms of this Contract are confidential and shall not be disclosed except as is necessary for the performance of this Contract, or as required by law. Contract Modifications Except as set forth under Premium Rate Adjustments, KPS reserves the right to modify the provisions of this Contract, or the services described in the Benefits Booklet, upon ~30} days written notice to the Page: 18 Group. The Group may elect to reject such modifications by providing KPS with fifteen (15j days written notice. However, rejection of a modification will result in the termination of this Contract as of the last day of the month for which Premium payment has been received. lack of notification of rejection by the Group shall be interpreted as acceptance of the modification and this Contract will be renewed as modified. No modification of the terms of this Contract shall be binding upon KPS unless endorsed, in writing, and signed by an authorized officer of KPS. Such endorsement shall be deemed a part of this Contract, effective as of the effective date of the endorsement. Any amendment or Contract modification required by law or regulation shall become effective as of the effective date required by such law or regulation. Coverage Limits The Covered Benefits and Services offered under this Contract are subject to the coverage limits and maximums set forth in Attachment A - Benefits Booklet. Entire Agreement This Contract, together with Attachment A - Benefits Booklet; Attachment B - Premium Rates and Underwriting Criteria; and any riders and/or endorsements attached hereto, constitute the entire agreement. This Contract supersedes all previous communications, representations or agreements, either verbal or written between KPS and the Group, with respect to the subject matter herein. Equity of Application This Contract is intended to apply equally to all Enrollees. Force Majeure In the event KPS is unable to perform its obiigations hereunder by reason of fire, casualty, lockout, strike, labor condition, riot, war, act of God or by ordinance, law, order or decree of any legally constituted authority, then this Contract may, at the option of KPS, be suspended. During any period of suspension, KPS shall not- be required to perform any service hereunder, nor shall KPS be liable for any damages arising from any event that precipitated the suspension. If this Contract is suspended pursuant to this provision, any obligation by the Group and/or an Enrollee to make Premium payments shall also be suspended for the same period of time. Group Cooperation The Group agrees to cooperate with KPS in the administration of this Contract by: (i) Advising Subscribers and their enrolled Eligible Dependents of policies and procedures applicable to this Group Plan. (ii) Providing Subscribers and their enrolled Eligible Dependents with a Benefits Booklet, 10 cards and any applicable notices or other information regarding this Group Plan. (iii) Providing information about Enrollees that is relevant to the determination of eligibility, claim reimbursement, coordination of benefits or other information required for the administration of this Contract. (iv) Making appropriate payroll deductions, if applicable, to facilitate Premium payment. Headings The headings of sections and paragraphs in this Contract are for convenience and reference purposes only and do not affect in any way the meaning or interpretation of any provision of this Contract. Misrepresentation, False or Fraudulent Information If the Group provides statements or other information on the Group Master Application form, or any other form required by KPS, that constitutes intentional misrepresentation or fraudulent misstatement of material fact, KPS may elect to immediately terminate this Contract. Page 19 Notices Any notice that may affect the provisions of this Contract shall be deemed delivered to the Group when deposited in the United States mail with prepaid postage, addressed to the Group at the most recent address listed for the Group. Any notice that may affect the provisions of this Contract shall be deemed delivered to KPS when deposited in the United States mail with prepaid postage, addressed to KPS at the following address: P.O. Box 339, Bremerton, WA 98337-0039. Any requirement of KPS to provide notice to Enrollees shall be fulfilled when the Group has received such notice. It is the responsibility of the Group to disseminate notices to Enrollees within thirty one (31j days of receipt. Severability If'tT1ehtiQGcqn~itiq6rqf'fPlr~/qqfitr?~f:~ '" y:~."amH3: ttl~msame shalrhe deemed severable from this Contract. However, the remainder of this Contract shall remain in full force and effect and shall in no way be affected, impaired or invalidated as a result of such decision. Third Party Beneficiaries There are no third party beneficiaries to this Contract. Waiver of Breach Waiver of a breach of any provision of this Contract shall not be deemed to be a waiver of any other breach of the same or different provision. The followina topics are described' in detail in the Benefits Booklet. Please refer to the Benefits Booklet Table of Contents to locate each section. Benefits Summary Complaints and Appeals Process Continuation of Coveraqe . Continuation of Inpatient Coveraqe . Continued Eliqibility for a Disabled Child . Coveraqe Durinq a Labor Dispute . -Continuation of Group Coveraqe . COBRA (Consolidated Omnibus Budqet Reconciliation Act - 1985) . Conversion Coveraqe Coordination of Benefits (COB) KPS Privacy Policy KPS' Riqht of Recovery Page: 20 KPS Health Plans, In Rehabilit3tion 400 Warren Avenue P.O. Box 339 Bremerton, WA 98337-0039 CITY OF BREMERTON - PLAN A COVERAGE CONTRACT Group Number: 21001-21006 Effective Date: 1/1/20042. Renewal Month: January Open Enrollment Decem ber This Coverage Contract includes the following: Attachment A - Benefits Booklet Attachment B - Premium Rates and Underwriting Criteria Riders: N/A Optional Riders: Occupationallrijury Coverage - LEOFF I Employees Only Endorsements: N/A This Contract is entered into and delivered in the state of Washington and is governed by Washington State laws, except to the extent state laws are preempted by federal law. Signature by a qualified Group representative or payment of the Premium shall constitute acceptance of the terms and conditions set forth herein. FOR KPS: FOR GROUP: Elizabeth A. Gilje, President and CEO Signature Print Name Date Title Date KPS Health Plans, In Rehabilitation 400 Warren Avenue P.O. Box 339 Bremerton, WA 98337-0039 CITY OF BREMERTON - UNDER 65 LEOFF I RETIREES (SUBSCRIBERS ONL V) COVERAGE CONTRACT Group Number: 21001-21006 Effective Date: 1/1/2002,4 Renewal Month: January Open Enrollment December This Coverage Contract includes the following: Attachment A - Benefits Booklet Attachment B - Premium Rates and Underwriting Criteria Riders: N/A Optional Riders: N/A Endorsements: N/A KPS Health Plans, In Roh3bilit3tion, hereinafter referred to as KPS, is a duly licensed health care services contractor (HCSC) in Washington State. In its capacity as an HCSC, KPS agrees to underwrite and provide the benefits and services described in Attachment A - Benefits Booklet, to the eligible Employees, and their Eligible Dependents, of the above-named Group, provided the Group, its eligible Employees and their Eligible Dependents, meet and comply with the provisions of this Contract. Contract Form: BREMRET -22900-20042 TABLE OF CONTENTS DEFI NITIONS ................................................................................................................................ 1 CONTRACT EXAMINATION PERIOD ....... ... ... .......... ... ........ ...... ... ........ ......... ............ ..... .,. ....... ..........2 EFFECTIVE DATE, DURATION AND RENEWAL........................................................ .......................... 2 PREMIUM PAYMENT PROViSiONS................................................................................................... 2 Payment Due Date/Grace Period...... ........... ........ ......... ..... ........ ......... ............ ......... .............. ......... ......... 2 Premium Rate Adjustments ....... .............................. ............................. ............ ........ .............. ........ .......... 2 Premiums Paid by Subscribers/Dependents ........ ............... ...... ............. .......... ......... ...................... ......... 3 Premium Refunds..................................................................................................................................... 3 ELIGIBILITY AND ENROLLMENT ............ ....... ........ .......... ........... .......... ........ ............ ........ .................3 Group Eligibil ity..................................................................................................................................... .... 3 Subscriber/Dependent Eligibility Requirements ....... ........... ........ ........ ............ ............ ............. ......... ....... 3 Enrollment............................................................................................................................... .................. 4 Enrollment Under Special Circumstances.. ............ ........... ........ ............. ........ ........... ............. ........... ....... 4 When Coverage Begins. .......... .......... .......... ........................ ........ ......... ........... ............ ........... ......... ......... 4 TERMINATION OF COVERAGE.... .......... ........ ....... .......... ........... ............ ........ ......... .......... ...... .... ...... 4 Continuity of Coverage ...................... ......... ....... .... ... ......... ......... ........... ......... .................... .... ........ .... ...... 4 Termination of Group Contract. ......... ......... .............. ......... .................... ......... ........... ......... ............. ......... 4 Re-Enrollment/Reinstatement .................................................................................................................. 5 Termination of Enrollee Coverage...... ......... ............. ........... ...........:..... .......... ............. ........... ........... ....... 5 SUBSCRIBER/DEPENDENT LIABILITY AND RIGHTS ......................................................................... 12 Subscriber/Dependent Liability........ ............ ............. ........... ........ ........... .......... ............ ......... ........... ...... 12 GENERAL TERMS AND CONDITIONS ....'......................................................................................... 16 Applicable Law.......................... ................................................................................................. .............. 16 Assignment of Benefits...... ................ ......... .............. ......... ......... ........... .......... ......... ...................... ........ 16 Binding Agreement ......... ......... ........ ............ ........... ............. ............ ....... ......... .......... ............. ......... ....... 16 Confidentiality...................................................................................................................... ................... 16 Contract Modifications.. ............ ......... .......... ........... ................................. ........ ............ ........... ................ 16 Coverage Limits.......... .... ........ ..................... ........... ............. ....... ......... ............ ......... ................ ...... ........ 17 Entire Agreement .......... ............. ....... ........... ... ........ ....... .... .................. .... ... ....... ...... ................. ... ... ........ 17 Equity of Application ....... .......... ................... ........... ....... .......................... .......... ..................... ......... ....... 17 Force Majeure................................................................................................................................ ......... 17 Group Cooperation... ................ ..... ............. ............ .................... ............. .......... ........... ....... .......... ......... 17 Headings................................................................................................................................. ................ 17 Misrepresentation, False or Fraudulent Information............................................................................... 17 Notices....................................................................................................................... ............................. 1 8 Severability.......................................................................................................................... ................... 18 Third Party Beneficiaries ............... ............... ............ ...... ...................... ............ ............. ......... ........... ..... 18 Waiver of Breach .......... ............................. .................... .... ........ ............ ......... ......... ...... .......... .......... ..... 18 DEFINITIONS Capitalized words found in the text of this section are defined below or in the Benefits Booklet section. Child means anyone of the following: (i) An unmarried natural child, adopted child, stepchild or other legally designated ward under the Limiting Age who is primarily dependent upon the Subscriber or the Subscriber's Spouse for support. (ii) An unmarried child under the Limiting Age who is legally entitled to receive medical coverage as a result of a court order binding either the Subscriber or the Subscriber's Spouse, regardless of whether or not the Subscriber or Subscriber's Spouse has legal custody of the Child. (Hi) An unmarried child who has reached the Limiting Age, or is older than the Limiting Age, is incapable of self-sustaining employment due to developmental disability or physical handicap, and is primarily dependent upon the Subscriber or the Subscriber's Spouse for support and maintenance (see Continued Eligibility for a Disabled Dependent). Contract means this document and any other attachments, exhibits, Riders or Endorsements listed on the title page or otherwise described herein, and any subsequent amendments or modifications to the Contract or its attachments, exhibits, Riders or Endorsements. Contract Renewal Month means the calendar month specified on the title page of this Group Contract during which the Group may renew its coverage each year under this Group Plan. Covered Benefit or Service means those Medically Necessary services described in Attachment A - Benefits Booklet that an Enrollee is entitled to receive. Eligible Dependent means the Subscriber's legal Spouse or Child. Employee means a retired LEOFF I Employee who is under the age 65 and who is eligible for a Premium contribution by his/her payroll office. Endorsement means an amendment to the conditions of coverage or the benefits provided by this Group Plan. Enrollee means a person enrolled in this Group Plan. Group means the employer entity, association or other group that has entered into this Contract with KPS. Group Plan means the Benefits Booklet plus any Riders, Endorsements or other attachments that state the terms and conditions for administration of the Enrollee's benefits. Group Master Application means the application form completed by the Group and submitted to KPS prior to securing coverage under this Group Plan. The Group Master Application identifies the size, participation and contribution eligibility requirements applicable to the Group. LEOFF I Employee means a full-time law enforcement officer or firefighter hired prior to October 1, 1977, alld who is a member of the LEOFF system as defined in Sections (3) and (4), CH 131, Law of 1972, 1 sl Ex. Session Limiting Age means the age at which a Child may no longer be covered under this Group Plan as an Eligible Dependent of the Subscriber. The Limiting Age is specified in the Benefits Summary included in this Benefits Booklet. Medical Director means the licensed physician acting as chief medical advisor for KPS. Non-Participating Provider/Facility means any Provider or facility not contracted directly with KPS, or indirectly through First Choice Health Network, Providence Preferred Provider Organization or MultiPlan. Open Enrollment Period means the thirty ono (311 day period, or some other period agreed to by both KPS and the Group, beginning one (1) month prior to the Group's Renewal Month, or at some other mutually agreeable time, but at least annually. During the Open Enrollment Period, Subscribers may add or delete Eligible Dependents, and all eligible Employees and their Eligible Dependents have the opportunity to select from alternative health plans offered by the Group. Coverage will be effective as of the renewal date. Page 1 Premium means the periodic payment made by, or on behalf of the Enrollee, as consideration for this Group Plan and in accordance with the terms of this Contract. Premium Due Date means the scheduled, periodic dates by which Premium payments must be received by KPS as a condition for continued enrollment in this Group Plan. This date is typically the first day of each month of coverage. Provider means a licensed or certified health care practitioner acting within the scope of his/her license or certificate. Rider means an additional benefit over and above those listed in the Benefits Summary. Rider documents are attached at the back of the Benefits Booklet and provide detailed benefit information. Spouse means an individual who is living in a marital relationship with the Subscriber. The marital relationship must be legally recognized by the state of Washington. Subscriber means the primary person, generally the Employee, enrolled in this Group Plan. CONTRACT EXAMINATION PERIOD If, after examination, the Group is not satisfied with this Contract for any reason, the Group may return the Contract to KPS within ten (10) days of the date it is received. Upon receipt of the returned Contract, KPS will refund to the Group any pre-paid Premiums. The Contract shall subsequently be deemed null and void. EFFECTIVE DATE. DURATION AND RENEWAL This Contract shall begin at 12:01 a.m. Pacific Time on the Effective Date (as indicated on the title page), and shall remain in effect until the Contract Renewal Month unless terminated according to the provisions set forth herein. Thereafter,.this Contract may be renewed automatically at 12:01 a.m. on the same date (month and day) in subsequent calendar years unless otherwise terminated according to the provisions set forth herein. PREMIUM PAYMENT PROVISIONS Payment Due Date/Grace Period The initial Premium payment is due and payable to KPS on or before the effective date of this Contract indicated on the title page. Thereafter, Premium payments are due and payable on or before the first day of every month ("Premium Due Date") for which coverage is provided. A roster of current enrollment and enrollment changes must accompany each Premium payment. A ten (10) day grace period following the Premium Due Date is allowed, during which time this Contract shall not be terminated. However, KPS may, at its sole discretion, elect to extend the grace period for up to &Wy-f60j days from the Premium Due Date, or cancel this Contract immediately, without notice to the Group if payment is not received by the end of the grace period. If KPS elects to immediately cancel this Contract due to non-payment of Premium, the effective date of cancellation will be retroactive to the last day of the month for which payment was received. No further liability for claims will accrue to KPS. Enrollees in this Group Plan shall not be entitled to benefits during any calendar month for which the Premium, on his/her behalf, was not received by KPS. Premium Rate Adjustments The Premium rates applicable to this Group Plan are defined in Attachment B - Premium .Rates and Underwriting Criteria. Rates are guaranteed until the Contract Renewal Month each calendar year. Page: 2 Notwithstanding the foregoing, KPS reserves the right to revise the rates as follows: ~ As part of the annual Contract renewal process; ~ As a result of any state or federal law or regulation that imposes an additional tax, new tax or other assessment on KPS revenue; and ~ In the event there is a material change.in.tQ~b.~si~.~8.~Q.~hi9h.KPS assumed risk under this Contract. Such changes may include f~I~~<,,l~t;~lJJi~J~9~iqgiriaccurat'e information presented by the Group, changes in the benefits or other Contract terms required by statute or regulation, adverse claims or underwriting experience, or fluctuations of ten percent (10%) or more in the number of enrolled Subscribers and/or Eligible Dependents. KPS will give the Group sOOy-fBO} days prior written notice of any change in Premium rates not associated with the annual Contract renewal process. KPS will give the Group tflH:t.y-f30} days prior written notice of rate increases associated with the annual Contract renewal process. Premiums Paid by SubscriberslDependents In certain instances, Subscribers and their enrolled Eligible Dependents may be required to self-pay their Premiums in order to continue coverage. Those instances include: ~ Strikes, lockouts and other labor disputes that cause a disruption in Employee benefits ~ When the Subscriber and/or Eligible Dependent(s) elects to continue coverage under a COBRA provision or other coverage continuation provision available under this Group Plan The Group is required to collect self-paid Premiums for continuation coverage and forward payments to KPS on or before the Premium Due Date. In the instance of strikes, lockouts and labor disputes, the Subscriber may self-pay their Premium directly to KPS on or before the Premium Due Date. Premium Refunds KPS will refund to the Group any Premium paid, in advance, for periods after the termination date of this Group Plan. In the case of ineligible persons enrolled in this Group Plan, KPS will refund to the Group any Premium paid during a period of ineligibility that is in excess of claim payments made on behalf of the ineligible person(s) during the period of ineligibility. This refund will not exceed an amount equal to three (3) months of Premium payments. ELIGIBILITY AND ENROLLMENT Group Eligibility In order to be eligible to participate in this Group Plan, the Group must continuously meet all eligibility, participation, Group size, contribution and other requirements specified in the Group Master Application form. KPS reserves the right to audit the Group's employment, payroll and eligibility records to ensure that the Group continues to meet its participation requirements, and to ensure that eligible Employees and their Eligible Dependents are properly enrolled in this Group Plan. SubscriberlDependent Eligibility Requirements Retired LEOFF I Employees, as defined in the Definitions section, are eligible to enroll in this Group Plan. As of March 1, 2001, Eligible Dependents of retired LEOFF I Employees are no longer eligible to enroll in this Group Plan. Eligible Dependents who enrolled prior to March 1,2001, may remain on this Group Plan. Page 3 Enrollment Premium payments, if applicable, must accompany all applications for coverage. Currently retired LEOFF I Employees, are initially eligible to apply for coverage beginning on the effective date of this Group Plan. Application for coverage must be made within thirty ons (311 days of initial eligibil ity. Newly retired LEOFF I Employees, may initially apply for coverage on their effective date of retirement. Application for coverage must be made within thirty one (311 days of initial eligibility. Retired LEOFF I Employees who do not enroll when they are initially eligible may not apply for coverage at a later date except in certain circumstances (see Enrollment Under Special Circumstances). Enrollment Under Special Circumstances Retired LEOFF I Employees who, when they were initially eligible to enroll, declined coverage in this Group Plan, in '.Nriting, based on existing coverage under another health plan, may apply for coverage under this Group Plan if they lose eligibility for coverage under their other health plan, or if the other health plan terminates. Retired LEOFF I Employees must apply for coverage within thirty ons (311 days of losing coverage under their prior plan. When Coverage Begins Coverage for new Enrollees begins on their date of initial eligibility provided they enrolled in this Group Plan within the specified time limits (see Enrollment) and any applicable Premium amounts have been paid. TERMINATION OF COVERAGE Continuity of Coverage Continuity of coverage under this Contract is guaranteed to all eligible Enrollees provided the Group continues to meet eligibility requirements and continues to pay applicable Premium payments on a timely basis. Termination of Group Contract This Group Plan may be terminated if any of the following occurs: ~ The Group fails to make full Premium payments > The Group violates, or refuses to comply with, the terms and conditions of this Contract ~ The Group violates, or refuses to comply with, any published KPS policies and procedures that have been approved by the Insurance Commissioner ~ There is a change to, or implementation of, federal or state law that prohibits the continued offering of this Group Plan ~ KPS replaces this Group Plan. In this case, the replacement plan will (i) include the services covered under the replaced Group Plan; (ii) be offered to the Group's eligible Employees and their Eligible Dependents; and (iii) not significantly limit access to the kind of services covered under the replaced Group Plan In addition, the Group may terminate this Contract, at any time, by providing Ulift.y-f301 days written notice to KPS. If this Group Contract terminates, for any reason, coverage for all Enrollees will end automatically on the effective date of termination, or on the last day of the last month for which the Group paid the Premium, whichever occurs first. KPS will refund to the Group any Premium paid in advance for periods after the termination date. Page: 4 In the case of termination or non-renewal of this Group Contract, the Group shall be responsible for providing the following information to all affected Employees and their Eligible Dependents: ~ The effective date of termination of coverage; arid ~ The reason(s) for termination or non-renewal. Re-En roll mentlRei nstatement If this Group Contract has been cancelled by KPS due to non-payment of Premium, the Group automatically forfeits all rights to guaranteed renewal of coverage afforded under the Health Insurance Portability and Accountability Act (HIPAA) of 1996. Any decision to reinstate or reenroll the Group is at the sole discretion of KPS. If the Group voluntarily cancels this Group Contract prior to the Open Enrollment Period, KPS may, at its sole discretion, impose up to a twelve (12} month waiting period before the Group is eligible to reapply for coverage. Termination of Enrollee Coverage Coverage for an individual Enrollee under this Group Contract will end if anyone of the following events occurs: ~ Non-payment of any Premium amount, when Premium payment is the responsibility of the Enrollee ~ The Enrollee loses eligibility for coverage under this Group Contract ~ The Enrollee commits a fraudulent act with regard to KPS and this Group Plan ~ The Enrollee refuses to comply with the terms and conditions of this Group Plan as described in the Benefits Booklet ~ The Enrollee voluntarily disenrolls from this Group Plan ~ There is a change in either state or federal laws that no longer permit KPS from offering this Group Plan ~ This Group Contract is terminated Additionally, Eligible Dependent coverage ends if: ~ The Subscriber is no longer employed or no longer meets eligibility requirements ~ The Subscriber dies ~ The Subscriber and Spouse divorce ~ The Child reaches the Limiting Age or marries Coverage ends on the last day of the month in which the Enrollee was eligible for coverage, provided all applicable Premium amounts have been paid. In the case of non-payment of Premium, coverage ends on the last day of the month for which KPS received a Premium payment. Upon termination of coverage either KPS or the Group shall issue a Certificate of Creditable Coverage certifying the period(s) during which the Enrollee was enrolled in this Group Plan. An Enrollee who loses coverage under this Group Plan may be eligible to continue coverage or enroll in a KPS Individual Conversion Plan (see Continuation of Coverage in the Benefits Booklet). A Subscriber who voluntarily disenrolls from this Group Plan while still an Employee will not be eligible to re- enroll in this Group Plan until the next Open Enrollment Period. See Enrollment Under Special Circumstances for exceptions to this policy. Continuation of Inpatient Coverage An Enrollee who is receiving care as 3n inp3tient in an 3ccredited gener31 Hospital, or other 3pproved f3cility, on tho d::lte that covor::lgo would otherwiGo and, is eligible to continue receiving benefits under thiG Group PI::In provided the following conditions ::Ire met: CKPS pre authorized the inpatient care (8ee Prior Authorization of Inpatient Care); and r:AII applicable Premium amounts continuo to be paid Page 5 KPS will continue to provide benefits, under this Group Plan, until one of the following events occurs: DThe Enrollee is no longer receiving inpationt care [:The KPS Medical Director dotermines that inpatient care is no longer Medic:::llly Necessary liThe Enrollee has exhausted the inp:::ltient benefits offered under this Group PI:::ln (annuol reinstotement of benefits does not apply under this provision) IJNon payment of Premium DThree (3) consecutive months have elapsed sinco the dote coverogo '.'",ould havo othorwise ended DTho Enrolloo onrolls in anothor KPS pkm or in ony othor hoolth plan thot provides inpotient hospital benefits Tho Enrollee is not eligiblo f-or the extended coverage described above if, on tho dote coveroge would other\vise end: ~The Enrollee is covered undor any other group or individual medicol plan with similar inpatient benefits; or "Tho Enrollee is eligible for continuotion of covorage under COBRA. or any other continuotion provision Continuation of Covorage for a Disabled Child An Eligible Dependent Child who has reached tho Limiting Age rem:::linc oligiblo for coverage under this Group Plan provided both of the fdlo'Ning conditions are mot: . DThe Child is primarily dependent upon tho Subscriber or tho Subccriber's Spouso for support; ond [-:Tho Child is inc3poble of self sustJining employmont due to developmental disobility or physical handicop. Proof of tho Child's depondonce, obt:::liriod from their primary provider, must be .submitted to KPS 'Nithin thirty one (31 ) d3l'S of the date the Child reaches tho Limiting /\ge. Thoroofter, KPS mol' require periodic proof of the Child's continuing dependence. Gonerally this proof is requested annually after tho two year period follovii'ing the Child's attainment of the Limiting /\ge. ^ dis:::lblod Child will continuo to be oligiblo for coverago until ony one of the follO'.ving events occurs: C:::Failure to submit proof of the Child's continuing dopendenceas a result of disability or physicol. handicap DKPS determines that the Child is no longer dovelopmentally disobled or physic:::llly handic3pped (basod on the e'/idonco submitted). C:::The Subscribor is no longer covered under this Group Plan [:Non paymont of Premium DKPS termimtos tho Group Plan Cov.erage for 3 dis3bled Child ends on the last d3Y of the month in which the disabled Child is eligible for coverage, provided any applicable Premium amounts hove beon paid. In the case of non p3yment of Premium, cover3ge onds on tho 13st d3Y of the month f-or which KPS recoived 0 Premium p3ymont. .^. dependent who is no longer eligible for coverogo 3S 3 disobled Child may be oligible for covor3ge under COBR.I\. or a KPS Individual Conversion Plan (see Continuation of Coverage). CONTINUATION OF COVERAGE Covorage During a labor Dispute In the event of 3 strike, lockout or other labor dispute which causes a disruption of hoalth care compens3tion benefits or \'Voges, Subscribers and thoir enrolled Eligible Dependents may elect to continue coverage under this Group Plan, for a period not to exceed six (6) months, by self paying their Premiums. During this period of continued coveroge, bonofits and Promiummoy not be altered from that of tho oxisting Group Plan. The Subscriber is required to pay any applicable Premium directly to KPS. Failure on the part of tho Subscriber to make Premium payments will result in termination of coverage as of the last day of the month fGJ:-wl:1ich Premium "Nas paid. Coverage-teJ:minated'~ payment of Promium '..viII not be reinst:::ltod. Page: 6 This provision does not apply to Subscribers and their enrolled Eligible Dependents '""ho 3re entitled to continue cover3ge under COBRA or ~my other continu3tion of coverage provision. Continuation of Group Coverage N the Group's option, Subscribers and their enrolled Eligible Dependents vvho lose eligibility for coverage under this Group Pl3n may elect te extend their cover3ge for 3 period not te exceed three (3) months unless: "Cover3ge was termin3ted :::IS a rosult of a strike, lockout or other labor dispute; or "Employment was tormin3tod for gross misconduct ^pplic:::ltion for covor3ge must bo m3do 'A'ithin thirty one (31) d:::lYs of the d:::lto covor3ge under the Group Pl3n ended. During this period of continued cover3ge, benefits 3nd Premium may not be altered from that of the existing Group Plan. The Subscriber is required to P3Y 3ny 3pplic3ble Premium directly to the Group. Tho Group is required to remit Premium to KPS in 3ccordanco with tho Promium Due D3te and graco periods definod in this Contract. Failure on the part of tho Subscriber to make Premium paymonts will result in termin3tion of coverago 3S of the I3st day of the month for which Premium 'N3S p3id. Covor3go torminated for non payment of Premium will not be roinstated. COBRJ\ (Consolidated Omnibus Budget Roconciliation Act 1985) Employors who aro required by 13'N to comply '.'vith tho provisiom; of the 1985 COBR/\ act must notify 311 eligible Employoos, and their Eligiblo Dependonts, who lose oligibility for coverago under this Group Pl3n of their right to continue covor3ge under this provision. Eligible individuals 3re roquired to apply for continued coverago within sixty (60) days of the date cover3go under this Group Plan ends. The Group is required to notify KPS of each individual's election of COBRI', continu3tion co'/orage within thirty one (31) d3Ys of th3t election. Failure on tho part of the eligible individual to make a timely election, or biluro. on tho p3rt of the Group to provide KPS 'Nith timely notific3tion of the election, will be interpreted by KPS 3S 3 waivor of the individu31's right to continuo coverage under this provision. F3ilure by the Group to provido timely notific3tion to KPS may not, in all C3S0S, oliminate the Group's oblig3tion to provido continu3tion covor3ge. It will, hO'.vevor, elimin3te any obligation on tho p3rt of KPS to provide continu3tion coverago under this Contract. Individual COIwersion Coverage Employees who are under age sixty five (65) m3Y be entitled to transfer to 3 KPS .Indi'/idual Conversion Plan if: [;Thoy 3re not otherwiso eligible for cover3ge under Modicare DThey are currently eligible for continuation of Group co'/or3ge but h3vo elected not to enroll in the Greup Plan [!COVer3ge under this Group Pl3n or 3 COBR/\ continuation pbn has termin3tod (for ~my r03son except non p3yment of Premium, when it is the individual's rosponsibility to P3Y the Premium) DThis Group Plan terminates and the Group does not provide other health care coverage to its Employees Application for cO'ler3ge must be m3do within thirty ono (31) d3Ys of the d3te covor3ge under this Group Plan, or other KPS continu3tion or COBRA pl3n ends. I\pplicablo Premium payments for the first month of cover3ge must be submitted 'Nith tho enrollment application. I:Eligible Dependents may 3pply for cO'ler3ge sep3r3tely undor this option in tho e'/ont they lose cover3ge under this Group Pl3n due to the de3th of the Subscriber, or if the Subscriber 3nd Spouse divorce Page 7 When on Enrollee enrolls in a conversion pl3n, he/she loses certain protections guor3nteed under the Health Insur3nce Portability and Accountability Act (HIP/V\) of 1996. Most notably, if the Enrollee w3nts to transfer to 3 non cOn'lersion individuol plan, he/she could be donied coverage b3sed on 3 previous or existing he31th condition. If the Enrolloo does quolify for cover3ge under a non conversion individu31 pl3n, his/her covorage will be subject to 3ny 'A'3iting periods for pro oxicting conditions. For more inf-orm3tion, ple3se contact KPS Member Services at 360 '178 6796 or toll free 1 800 552 7111. Employeos who 3re 3ge sixty fi'Jo (65) or older vihen cover3ge under this Group Contr3ct terminates m3Y be eligible for cover3ge under 3 Medicare Supplement P13n. To -aotormino Employoo eligibility fur 0 Medicare Supplement Plan, please contact KPS Membor Sorvices. COORDINATION OF BENEFITS (COB~ General Provision Benefits are provided under this Group Plan only to the extent that Subscribers 3nd their enrolled Eligible Dependents could not have received benefits for the S3me service(s) under any other Pl3n, had 3 claim for benefits boon m3do. Tho purpose of this COB provision is to ensure that tho sum of claim bonefits p3id by KPS and all other PI3ns undor 't/hich Subscribers and their Eligible Dependents 3re covered does not oxcood 100% of the 1\lIowablo Expense. All of the benefits provided under this Group Pl3n are subject to this COB provision. Definitions "Allowable Expense" means the usu31, custom3ry or ro3sonable ch3rge for any nocoss3ry he31th C3ro- service or supply when the service or supply is 3 cove rod benefit, 3t least in part, under any of the Pl3ns -- involved. When a Plan provides benefits in the form of corvicos r3ther th::m cash p3ymentc, the reasonable cash value of e3ch service provided Sh311 be considered 3n AIIow3ble Expense. The difference between the cost of 3 priv3te Hospit31' room and tho cost of 3 semi priv3te Hospitol room is not considered 3n Allowable Expense under tho obovedefinition unless tho Enrolloe's stay in a private Hospitol room is considered to be Medically Necess3ry under at 1038t one of the PI::ms involved, "Double COver3QO" mo::ms when Enrolleos havo covoroge undor 3nothor Pl3n. "E!;m" me:ms ::I policy or contract which pro'.'ides benefits or servicoc fnr, or becauso of, medic::ll or dontal C3m, through one of the following: CThis Group Pl3n DAny group, individu::ll or bl3nket disability insurance policy c/\ny group or indi'lidu:::I1 contr3ctual prepaymont or indemnity pl3n wch :::IS those issued by he:::llth C3ro servico contr3ctors, health mainton3nco organizationc or other heolth corriers or health insurers D/\ny labor management trusteed pl3n or labor organiz3tion pl3n C:l\ny employer organization pl3n or Employee benefit organization pl3n D/\ny government31 program DAny insur::mce covor3go requirod or providod by statute, including 3utomobilo policies which pro'/ido medic31 benefits D/\ny other similar source The term "Plan" does not include accident only coverage, including 3thletic injuries, fnr school age Children from Kindergarten through twelfth grade (K through 12), or for college students, either on 3 2'1 hour basis or on a "to and from school" basis. E3Ch of the PI3ns under v\'hich the Enrollees are covered, 3nd each benefit payable under those Plans, are considered separatel)'when benefits are coordinated under this provision, Page: 8 Claim Determination Period The cl3im determin::ltion period me::lng a C31end3r Ye3r. Eff-oct on Benefits When an Enrollee has double coverago, during 3 Calend3r Year, one Pbn norm311y P3YS its benefits i~ full as the primary p3yer 3nd the other PI3n pays a reduced benefit 38 the secondary ~a~er. K~S ?et~rmlnes 'Nhich cover3ge is primary according to the Nation31 ^ssQci::ltion of Insurance CommlSSlonors gUidelines. When KPS is the prim3ry p::3Yor, we will P3Y the benofitg described in this Benefits Booklet. \^Ihen KPS is the secondary payor, we will determino the I\lIm'\lablo Expense. Aftor tho primary Pbn pays, we '.~fill P::3Y what is left of the /\lIo'1i3ble Expense, up to our regul3r benefit. We will not pay more th3n our allow3nce. Order of Benefit Determination 'Nhen more th3n ono Plan cont::3ins 3 COB provision, the decision as to which Pbn is tho primary PI3n is m3de in the following order: nThe Pl3n th3t covers the person 3S 3 Subscriber rather than 3S 3n Eligible Dependont is primary C'IlJhen 3n Eligible Dependent Child is covored under more than one Plan, .tho .P13n of the parent whoso dato of birth (month and d3Y only) occurs o3rlier in ::3 C31end3r Ye3r IS primary, except when the Child's parents 3re leg311y divorcod or sep3r3ted CVVhon the parentg of 3 covered Eligible Dependont Child ;:m~ divorcod or sep3r3ted ::md thoro ig no court decree which ogt3blighes fin3nci31 rosponsibility for the medic31 or dent31 oxpenses of the Eligible Dependent Child, then benefits for the Child's Covered Expensos 3re determined ag follows: nTho Pbn of the p3rent with custody is prim3ry, pro'/ided the p::3rent 'Nith cugtody h::38 not rem3rried [~If the p3rent with custody h3S rem::3rriod, the order for determining the prim::3ry Plan is: (i) The Pbn of parent with custody (ii) The Pbn of the stepparent (iii) The Pl3n of the parent 'Nithout custody Despite the ::3bove, if the court h3s determined which parent ig fin3ncblly respom:iblo fer tho he 31th C3re of the Eligible Dependent Child, then the Pl3n of th::3t p::3ront is 3hN3YS the primary Pl3n. When the 3bo'lo rules do not establish ::m order of determin3tion, then the Plan which has cove rod the pergon for the longer poriod sh311 be primary, oxcept th3t: ClTho benefits of the PI:.:m 'Nhich covers thG person, on whoge expenses the claim is based, ::lS a l::lid off or retired Subscribor, or ::3 Dependent of guch ::3 Subscribor, sh:all be determinod 3ftor tho benofit!:: of the PI::3n which covers th3t person 3S ::3 Subscriber (other th3n 3S 3 13id off or retired Subscriber), or the Dependont of 8Uch a Subscriber; 3nd fllf either of the PI3ns does not h3vo ::3 provision reg3rding bid off or retirod Subscribers, 'Nhich rosults in e3ch Pl3n determining its benefits ::3fter the othor, then the 3bo'/o provision shall not 3pply. If none of the 3bove rules apply, the Pbn th3t has covered the pergon for the longegt period of time shall be censidered the primary Pbn. Facility of Paymont VlJhenever ::3nother PI3n makes payments th::3t should h3ve been provided under this Group Plan and. in accordance with this COB provision, KPS m::3Y, at its sole discretion, choose to reimburse the Plan makl~g such other payments, the 3mount necessary to satisfy the intent of this COB provision. Any amount p::3ld under this subsection shall be considered a8 benefits paid under this Group PI3n, and KPS Sh311 be fully discharged from li3bility to the extent of such payments. Page 9 Right of Recovery Whenever KPS makes payments that 3re in excess of tho maximum amount of payment necessary to satisfy this COB provision, KPS sh311 h3v8 the right to recover the excess p3yment amount from the Enrollee, from tho Provider, or from another Pbn, as 3pplicable. Right to Recei'J9 and Release Information .^.s a condition of receiving benefits under this Group Plan, Subscribers :md their enrolled Eligible Dependent(s) 3gree to provide KPS with 3ny necessary information, ::md authorize KPS to release to or obtain from any other insurer, org3nization or person, any information necess3ry to administer this COB provision. Disclosure of Coordination F3iluro on the p::lrt of Subscribers 3nd thoir enrolled Eligible Dependents to cooperate 'A'ith KPS regarding this COB provision could result in the loss of benefits under this Group Pbn. KPS recommends that Subscribers and their onrolled Eligible Dependent(s) submit claims to KPS, and e3ch other pl3n, at the S3me time to help minimizo dolays ~md facilitate cbims p3ymont. KPS' RIGHT OF RECOVERY Limitations and Exclusions Coverage under this Group Plan is exduded for expenses incurred er sorvices rendered if the Enrollee's illness or injury is caused (or alleged by the Enrollee to be caused) by another party, to the extent that benefits 3ro aV::libble under the terms of any other insur::mce coverage or source of payment, including but not limited to: CVehicle medic31, person31 injury protection ("PIP"), no f::lult, uninsured or underinsured motorist, workers' cemponsation insurance or benofits 3nd third p::lrty liability insur3nco, or simibr contract of insurance. CHomeowner's, property or any other insurance policy (except for individual or group he31th insuranco). DAn 3groement, judgment or settlement pursu3nt to 'Nhich 3 third party pays or 3groes to P::lY for the costs of such services from assets othor than 3 policy of insur3nce. This exclusion ::lpplios whenever any such contract of insurance, agreement, judgment or settlement is issued to or provides benefits fm the Enrollee, whether or not they assert a claim against the responsible third party or its insurers. Third Party liability: Reimbursemont and Subrogation /\s 3 condition of KPS' agreement to 3d'l3nce paymont to the Enrollee or thoir Provider for medic::l1 expenses for illnesses or injuries c3used (or alleged by the Enrolleo to be caused) by 3nother party, the Enrollee 3grees to m3ke 3 cbim 3g3im~t, or otherwise pursue recovery from all responsible partios and thoir insurer(s) for 311 payments ::ldv3nced to tho Enrollee or their Provider by KPS. If the Enrollee does not make a claim er otherwise pursue recovery of KPS' p3yments, all such payments made by KPS m:Jy be denied or recouped. By providing bonefits under this provision, KPS is fulfilling its obligations under this Group Plan. However, by so doing, KPS does not waive any rights to reimbursement or subrog3tion. Pro'/ided, the benefits of this Group Plan will be adv::mced to the Enrollee if they are injured by a third party, before compensation is recovered from the third p::lrty or its insurers, only under the follo\iving conditions: [~The Enrollee, and their representative(s), must fully cooperate with KPS in rocovering p::lyment of medical bills paid, ::md to be paid by KPS, from the partios 'Nho allegedly caused tho injury or illness, including but not limited to their liability insurance carriers, any applicable PIP, uninsured or underinsured motorist policy, homeowners policy, 'Norkers compensation or any other reachable ::lssots of the responsible p3rty or p3rtio8; Page: 10 [!The Enrolleo notifies KPS, in \,-,riting of the dobils ' , ~he p3rties believed to be respo~sible 3nd th of the Injury or illness, the names and 3ddress Insurers, if known; e names and addressos of the responsible p cAny claim or lawsuit filed by the Enrollee 3gainst the' , ' Include a demand for repayment of benefit 'd b' third p3rty ,or the third party's insurer(s) GF s pal y, or to be paid, by KPS on the Enrollee's be OThe ~nrollee must agree to 3ssign to KPS th' , paid (subrogation), or to bo p3id by KP~r right to recovor componsation for the medical c responsiblo for -the injury, ' as a rosult of injuries c3used by the third CTil E P e nrolloe must agree to reimburse KPS for the' , as a, result of the injury, from the settlement ~~dlcal ox~ensos paid or that will be paid by K obtained by the Enrolleo from any third party 0 "tJU, gmont, Insurance proceeds or othor roco' r I s Insurors. Collection and Reimbursement by Enrollee (or the Enrollee's Representati"e If tho Enrollee elects to demand reco"ery for KPS' . ) " payments from tAe FeB III ' I~Notify KPS in ad"a . ponsl e third party, thoy must: C!lnform th " ~co of any sottlement, mediation, arbitration or trial . e responSible third party and its insurer( ) . recovery of payments made on their beh If s , of the 3mount of the lien asserted by KPS for 'h~~ a , aQ31nst any FeS8"ep' G t f I ' ~ " J r po en la recovery obtained nObtain prior consent from KPS 9 f ~ e ore compromising or settling claims involving medical costs paid C!Not enter into any agreement with tho ros ' , would releaso KPS' lion or p";ojudice ou~~~~~~IO ~~Ird p3rt~ or its insuror(s), or do anything elso th expross prior v:ritton consent from KPS. ga Ion or reimbursement rights, 'Nithout first obtainin CRei~burso KPS for that portion of the settlomon ,.. ' bills paid and to bo p3id by us, . t, a..ard or Judgment that is compensation for medic If the E,nrolleo obtains a sottlement or reco"er ' for ' Oit tile lIa.lo party, they oro obllgatod to rOi'm~uroo 1~,::;;I~an I~o ;n.urnnoo polley limit. or roaohablo aoso a er they havo been fully componsated f.or their I or e ull amount of benofits paid on their beha recovery th~t is oqual to or gre:Jtor than the liable oss'" If" howovor, th~ E~rolloe obt3ins a settlement 0 :~o only obllgaled to roimb"r.o KP:;; in the amo"nr:~t. '~o~rnnoo polloy limit. or reachablo a..ot. tho olr loss, a IS e t aftor they ha"o been fully c ' " ompens3tod fo The Enrollee, or their representati"e(s) mu ' , claim if they 'I/ant KPS to sh:Jre, on "an eqUita~~eO~~~lin 3 'Mitten agreement from KPS prior to settling an of any.u.rogation or roim bur.omenl claim. In tho :b any roa.onablo allornoy feo. thoy inoorred in puro"1 discretion, Will detormine whother or not t d sence of a prior ",mtten agreement KPS at 't I 't 91 9 ' .. 0 re uce 8tlF Fe' 9 ' , I S so e equl a ~ 3SIS, any reawnablo attornoy f-ees incurre 1m ursement amount in order to share on an ~o CO;.'dored if KP:;; has bonofited from Iho .0Nicos ~~ih the ~trolloe. Howover, such a roduetion ~ill onl\ ~ ro uced by more than twenty percent (2001.) olr 3 orney. In no evont will KPS' reimbursemen WIll Ret pay for Go.I. ineurred by Ihom. - " . to offsot allorney foos incu rred by the Enrolleo, and KPi es of arty' s must half; osts arty PS .'ery the by by 3t g 31 ts If r y r , t , Subrogati9R" ASS' . . . Ignment of Third Party Claim to KPS If ,tho Enrollee elects to assign their rights to KPS ' thlr,d part~ or its insurer(s),they 3nd their re res to ~,ursue a claim seoking recovery from a responsible claim against the responsible parties, Such c;ope~n:,atl"~(S? must coopor3te fully 'Nith KPS in pursuing the _ , , a Ion Inc udes, among other thin S' C!Provldlng evidonce and testimon' cons' '" ' g , responsible parties, ) Istent ..Ith the testimony in tho case against the [: Refusing to 3ssist tho FeB 'hi ,,' . ~ ponslu e parties, In any ",:ay in defend' , . , ' Ing against a claim brought by r-~Cooperating with KPS by not takin an" , .. prejudice our efforts to pursue a cI~i y a?t1on th:Jt might releaBe, limit, reduce, or otherwise _ .. m against any responsible third party, Page 11 Trust and Cooperation Between the Enrollee '(or the Enrollee's Representative) and KPS The Enrollee ~md their represent:Jtive(s) must deal in good faith vvith KPS by adhering to all of the conditions set f.orth in this section. In turn,KPS agreeg to cooperate with the Enrollee and their representative(s) in their effort to recover reimbursement, and will advanca payments on their bohalf for injuries or medical conditions caused, or assorted by them to be caused, by any third party. Tho EnrollE:lE:l and their representative(s) must cooperate fully with KPS in protecting, preserving, and rocovoring the amounts KPS has paid or will P3Y on their behalf under thi5 Group Plan. F3ilure to cooper3te m3Y result in the deni31 of cover:Jge for injuria5 or condition5 c3used, or 3sserted by them to bo caused, by any third p3rty to the extent that cO'fer3ge or payment for such iniuries or illnesses is, or '>lIould have boon, 3vailable under the terms of any other insuranco coverage or 50urce of payment. Agreement to Arbitrate Any dispute that ari5es bet\'-,oon the Enrollee and KPS a5 3 result of tho preceding recovery provisions shall be 5ettled through arbitration. Both tho Enrolleo and KPS sh:J11 bo bound by the doci5ions of tho arbitr:Jtion proceedings. Di5puto5 '.viII be pret;entod to, and re50lved by, a 5ingle arbitrator in accordance vvith the current rules of the American Arbitration ^5sociation. Either the Enrollee or KPS m:JY demand arbitration by 5erving notice of this demand on the other. Each party to the arbitration agrees to bear its O'Nn C05tS and to share equally in the fees of the arbitrator. This agreement to resolve disputes through arbitration is in effect as of the effective date of the Group Pbn, and shall remain in effect until the dispute between us has been re50lved. Reco'Jory of Claims Payments Ineligible Persons If KPS knowingly or unknowingly mako5 ::iny payment on behalf of an individual who for any re3son 'Nas not eligible to recoi'/o the services and benofits provided herein, KPS it; ontitled to full roimbursement from 5uch ineligible individual or from a Subscriber 'Nho applied for tho ineligible benofits on boh:Jlf of such individual. If KPS kno'Ningly or unknmllJingly recei'/oc Promium payment on behalf of an individu31 who for any reason Vlat; not oligiblo to receive"the servicosand benefits provided heroin, KPS resorve5 the right to refund any Premium payment(s) in eXC8SS of claims paid for the time the individual was ineligible, and shall have tho right to recover the cost of any benefit furnished while such individu31 was improperly enrolled in this Group J2Ia.A., Incorrect Claim Payment KPS is entitled to full reimbursement from the payee for any incorrect claim payment. The term "incorrect claim p3ymont" includes but i5 not limitod to the follo'Ning: [:Paymont to the ''''rong Provider o Payment of an incorrect 3mount CPayment for 3 service that is not a Covered Benefit or Service [JDuplicate payment for the 5ame service [jPaymont on bohalf of tho "'-'rang Enrolloe o Incorrectly billed procedure or di:::lgnosis SUBSCRIBER/DEPENDENT LIABILITY AND RIGHTS Subscriber/Dependent Liability Subscribers and their Eligible Dependents who are enrolled in this Group Plan are liable for the following costs: ~ Deductible (defined in the Benefits Booklet) ,. Copayments (defined in the Benefits Booklet) Page: 12 ? Charges for non-covered services ? Coinsurance, up to the Coinsurance Stoplos!) Maximum limit {defined in ^ttachment ^ the I' Benefits Booklet} ? Charges incurred after an annual or lifetime maximum benefit, for a specific service or supply, has been exhausted (such as the annual maximum benefit for durable medical equipment) >- Charges in excess of the amount paid by KPS to non-participating Providers If KPS fails to reimburse a Participating Provider for the cost of Medically Necessary Covered Services provided in accordance with the terms of this Contract, neither the Enrollee nor the Group shall be required to compensate the Participating Provider for such services beyond the limit of Deductibles, Copayments or Coinsurance amounts specified in the Benefits Booklet. ,V,'_"_:"""_:_:"'_ -: . - -:':---''}::t:' ':, -____-.:::-- ",,,,,-:,:-:,, :-:t'}::::_/<---- -, <':}:~ - ":C:< ',t":>__"c y,:':: >:>::,:",,:::.:,::;:,:,:,_,:-:\_::. : " .,.,--:::," ":_':-' -,:--,:~:__"-'-, .<-::-. ,----. ': _'0_ .:}:'__::-;:" -::: __ ;-:-'--:r:~'-'-:'- .co-_ '.-.'::':"':::....--'" - ">'-'-".'-'-" - WhafhapfJenscifaxProviaerinodom:ier;parlic;patesiwith,KBS2 It);a",,""'.'Rarficl' Enrol'leesi.ht:;t icoU'rs€i"oftrea KPS Privacy Policy KPS Health Plans is committed to protecting the privacy of Enrollees' perwnal and he:Jlth information. INe :Jre requirod by :Jpplicable fedar31 and state 13'.'1 to m3int3in tho privacy of porsonal and health inform3tion. KPS Health Plans is also required to give this notice to Enrollees to tell them how KPS m3Y uso 3nd give out ("disclose") their person:Jland health information held by KPS Health Pl3ns. Person31 and health inform3tion (referred to'in this notice as "personal information") m03ns::my information that is identifiable as personal inf.ormation, including information regarding health care and tro:Jtment, identifiablo factors such as the Enrollee's name, age, 3nd address; or financial information. We m3Y colloct personal information about the Subscribor, or members covered by KPS Health Plans through the Subscriber, from the following sources: o Information we receive from tho Enrollee, including information provided on 3pplic3tions or other fufm&;- ::Information we receive from the Enrollee's health care providers or other companies, such as othor he31th insurance comp::mies, rebting to medic31 cbims and billings, DGonoral information about the health C3re sorvicos the Enrollee h:Js rocoivod, such 3S tho qU31ity 3nd availability of services. We restrict access to personal infarm3tion :Jbout the Enrolleo to only those who nood to know that information to provide treatment, p3yment or he3lth core operations services to the Enrollee. We mointain physicol, olectronic, and procedur31 safeguards thot comply 'Nith foderal regubtions to guard the Enrolloe's person31 information. We do not disclose any personal information 3bout our members or former members to anyone, except as permittod or required by bw. However, KPS Health Plans will use 3nd give out personal heolth information: [:To the Enrollee or someone who has the legal right to act for the Enrollee (their personal reprosontative ), DTo tho Secretary of tho Department of Health and Human Services, if necessary, to moke sure tho Enrollee's privacy is protected, [no law enforcement officials ','",hen investigating and/or prosecuting alleged civil or criminal actions, aM :JWhere required by I3w. Page 13 KPS Health Plans has the right to use and give out personal information to 3rr3nge for tre3tment, payment of, and health care oper3tions services, including: OModic31 qU:llity revie'Ns O/\ccounting r:!Legal 3nd risk man3gement sorvices KPS Health Pl3ns may use or give out person31 information for tho following purposos under limitod circumstances: ~For Go.vernme.nt he3lth?3re oversight 3ctivities (such 3S fraud 3nd abuse investigations) I iTo aVOid 3 serious 3nd Imminent threat to he31th or safety ~y la'.'I/, ,KPS Health Plans must h3ve written permission (an "3uthoriz3tion") to use or give out personal Inf?rm3tlon ~or .any purpo~e that is no~ sot out in this notice. The Enrollee m3Y t3ko b3Ck ("revoke") thoir written permission at any time, except If KPS has already 3cted based on their permission. By law, Enrollees have the right to: OSeo and get a copy of their personal inform3tion held by KPS Health Plans except in certain limited situ3tions. ' [JMake 3 re3son3blo requost in writing to 3mend 3ny of their personal inform3tion created by KPS H031th Pl3ns if thoy believe th3t it is wrong or if information is missing, 3nd KPS Health Plans 3groos. If KPS He31th .PI~ns disagroes, we will notify the Enrolloo why in writing. Enrolloos may have 3 statement of their dls3greement 3dded to thoir personal inform3tion, rlGet a listing of those obt3ining their person31 inform3tion from KPS He31th PI3ns in the p3St 6 ye3rs. The listing '.'Jill not include inform3tion: C::That was given to the Enrollee or their person31 representative, OThat the Enrollee authorized KPS Health Pl3ns to release or LJThat W3S given out f-or 13'.'1 onforcement purposes, or ' oTh3t 't/3S gi'lon out to P3Y f-or tho Enrollee's h031th care claim or 3 disputod claim. o Requost i~ writing th3t KPS communic3to with them in confidence 3bout their porson31 inform3tion by 3lt~rn3tlve me3.ns or to.::In 31tern3tive location. If they advise us th3t disclosure of all or 3ny p3rt of tholr. por~on31 1~~orm3tloncou!dend3ngor them, 'NO must comply with 3ny re3son3ble requost proVided it spoclfles an 31tern3tlve me3ns or loc3tion. c::/\s,k KPS ~ealth Pl3ns to pl3ce 3ddition31 restrictions on our use or disclosura of their porsonal Infor~3tlon for tre3tment, p3yment, health care opor3tions or to persons they identify, We 3re not raqulrad to 3grao to thow 3dditional restrictions, but if we do, '.'10 will 3bide by our 3grooment (oxcopt in an emergency). OGet 3 soparate electronic or p3per copy of this notice. For mora information 3bout oxorcising thoir rights set out in this notico, Enrolloos may call KPS Health Plans' Momber Servicos dop3rtmont 3t (360) 178 6796 or toll free 3t (800) 552 7114. They can 31so reach KPS He31th Plans' priv3cy official for this purpose at (800) 552 7111. If an Enr~lIeo ,believes KPS H031th Pbns h3s violated thoir priv3cy rights wt out in this notice, they may file a compblnt With KPS Health Plans at the following address: KPS Health Plans Compliance Dep3rtment P.O. Box 339 Bremerton, IJIJ 1\ 98337 Filing 3 compl3int will not affoct tho Enrollee's benefits under KPS He31th Plans. They m3Y 31so file 3 complaint 'Nith the Secretary of the Department of Health and Human Services. KPS H031th Plans does h3VO tho right to ch3nge the V'iay personal information is used and given out. If KPS He31th Plans ~3ke~ 3ny changes, . Enrollees will get 3 new notice by m3il within 60 d3Ys of the ch::mge, 3nd th3t notice '.'1111 become effective on the d:lte the revised notice is issued. PI~a~e note: Telephone calls to and from KPS Health Plans may be recorded for quality assurance and training purposes. If the Enrollee is the prim:lry Subscriber vvith KPS Health PI:lns and other persons 3re covered by KPS He31th PI::ms through them, we suggest th3t the Subscriber share this inform3tion 'Nith e3ch othor to ensure that each of them is a'Hare of our policy and their privacy rights. Please refer to KPS Health Plans' 'Nebsite at '.p/w\N.KPSHealthPlans.com for more information :lbout our privacy practices. Page: 14 COMPLAINTS AND ApPEALS PROCESS Complaints All Enrollees have the right to cont3ct KPS 'Nhenever they helVe 3 question, compl3int or concern regarding: UTheir benefits L~Their access to C3re or how to arr3nge for care DAny KPS P3rticip3ting Provider CService they receive from KPS CAny other issue rol3tod to this Group PI3n or KPS. In the ovent 3n Enrolloe h3s a complaint, KPS Member Services Represent3tives are available Monday through Friday, from 8:00 a.m. until 5:00 p.m. Pacific Time, except on mtionally recognizod holidays. Although a Membor Services Representative C3n rosolve most matters, Enrolloos may choose to file a compl3int, or roquest an appeal, if thoy aro not satisfiod '.'vith the Membor Services responso. The following steps outline the proceduro for filing a compl3int: The sor'/ico provided by KPS Eligibility Coverago or Benefits Cl3ims Payment .A.CCOSS to Care Send a written statoment of the compl3int to: KPS Hoalth Plans Attn: Member Services Resolution Departmont PO Box 339 Bromorton, VI/.A. 98337 KPS Member Services '""ill 'Nork ',Vith the Enrollee and try to resolve the compl3int over the phone. Other.'Vise, KPS will send 3 written rosponse within 3Q days of receiving the compl3int. Quality of Care KPS Participating Providors OR Complaints about P3rticipating Providers 3re investigated thoroughly and 3ro roviewed poriodically. Call KPS Member Services at 360 178 6796 or toll free at 1 800 552 7114 Standard Appeals Process Enrollees have the right to appeal any decision regarding 3 complaint or any aspect of their health care coverage that is not in their bvor. The request for an appoal must be mado within 180 days of the date they receive an EOB, letter or other type of communication, from KPS, that contains an unfavorable decision regarding their benefits. Such decisions could affect: CThe service received from KPS C/\CC8SS to health C3ro sorvices or Providers [J Eligibility for coverage DBenefit coverage CTermin:3tion of coverage under this Group Pl3n (except termination for non payment of Premium) IJNon payment of a claim, either completely or partially C/\ denial or modification of:3 roquest for pre authoriz3tion of any h031th C3re service or supply [;/\ denial of a request for coverage of an experiment31 or investigational service or supply Page 15 To file an 3ppe31, the Enrollee, his/her desigmted representative, or his/her Provider m3Y either call or write KPS at the phone number or address listed above. Any document3tion supporting the Enrollee's position m3Y be included with the 3ppeal. KPS will notify tho Enrollee, in 't/riting, th3t the 3ppe31 request h3s been received and include 3ddition31 inform3tion rogarding tho Appe31s Process 3nd the Enrolleo's rights 3nd respom:ibilities during an appo31. The Enrollee has the right to send 3n 3ppe::ll directly to 3n Independent Roview Org3niz::Ition (IRO) if KPS doos not rospond to the Enrolleo within the allotted timo period, 3S foIlO'."/s: Decisions Regarding: Days to Rospond: Service Rol3tod .'\ppo3Is 30 D3YS Denials of Experiment31 and/or Investig3tion31 Procoduros or Supplies 20 D3YS All other Adverse Determinations 11 Days Expedited Appeals Process If the Enrollee's he31th C3re Provider, or the KPS Medic31 Director, re3sonably determines that by following the Standard I\ppea/s Process the Enrollee's life, h03lth, or ability to regain maximum function 'J'Iould be jeop3rdized, KPS 'Nill invoke ::In Expedited J\ppe3ls Process and make a decision within 72 hours after it is rocoivod. The Enrollee '.!'1ill receive notice of this action. GENERAL TERMS AND CONDITIONS Applicable Law This Contract shall be governed by, and construed in accordance with, the laws of the state of Washington. Venue for this Contract shall be Kitsap County. Assignment of Benefits The benefits of this Contract shall accrue to Subscribers and their enrolled Eligible Dependents. Neither this Contract, nor its payments or Covered Benefits and Services are assignable to a third party. KPS reserves the right to make benefit payments to the Subscriber, the Provider, or jointly, as KPS deems necessary and appropriate, subject to federal and/or state laws. Binding Agreement This Contract is binding on KPS and the Group, and their respective executors, administrators, successors and.assigns. By election of coverage or payment of applicable Premiums, or if the Group's Subscribers or their enrolled Eligible Dependents seek the services provided under this Contract, all of the terms, covenants and conditions contained herein shall become valid and binding on the Group and its Subscribers and enrolled Eligible Dependents, notwithstanding the failure of the Group to sign this Contract. This Contract shall not bind KPS until (i) it has been executed by a person authorized by KPS, and (ii) an executed copy has been delivered to the Group. Confidentiality The underwriting and financial terms of this Contract are confidential and shall not be disclosed except as is necessary for the performance of this Contract, or as required by law. Contract Modifications Except as set forth under Premium Rate Adjustments, KPS reserves the right to modify the provisions of this Contract, or the services described in the Benefits Booklet, upon t4ifty-f30j days written notice to the Group. The Group may elect to reject such modifications by providing KPS with fifteen (15j days written Page: 16 notice. However, rejection of a modification will result in the termination of this Contract as of the last day of the month for which Premium payment has been received. Lack of notification of rejection by the Group shall be interpreted as acceptance of the modification and this Contract will be renewed as modified. No modification of the terms of this Contract shall be binding upon KPS unless endorsed, in writing, and signed by an authorized officer of KPS. Such endorsement shall be deemed a part of this Contract, effective as of the effective date of the endorsement. Any amendment or Contract modification required by law or regulation shall become effective as of the effective date required by such law or regulation. Coverage Limits The Covered Benefits and Services offered under this Contract are subject to the coverage limits and maximums set forth in Attachment A - Benefits Booklet. Entire Agreement This Contract, together with Attachment A - Benefits Booklet; Attachment B - Premium Rates and Underwriting Criteria; and any riders and/or endorsements attached hereto, constitute the entire agreement. This Contract supersedes all previous communications, representations or agreements, either verbal or written between KPS and the Group, with respect to the subject matter herein. Equity of Application This Contract is intended to apply equally to all Enrollees. Force Majeure In the event KPS is unable to perform its obligations hereunder by reason of fire, casualty, lockout, strike, labor condition, riot, war, act of God or by ordinance, law, order or decree of any legally constituted authority, then this Contract may,.at the option of KPS, be suspended. During any period of suspension, KPS shall not be required to perform any service hereunder, nor shall KPS be liable for any damages arising from any event that precipitated the suspension. If this Contract is suspended pursuant to this provision, any obligation by the Group and/or an Enrollee to make Premium payments shall also be suspended for the same period of time. Group Cooperation The Group agrees to cooperate with KPS in the administration of this Contract by: (i) Advising Subscribers and their enrolled Eligible Dependents of policies and procedures applicable to this Group Plan. (ii) Providing Subscribers and their enrolled Eligible Dependents with a Benefits Booklet, ID cards and any applicable notices or other information regarding this Group Plan. (iii) Providing information about Enrollees that is relevant to the determination of eligibility, claim reimbursement, coordination of benefits or other information required for the administration of this Contract. (iv) Making appropriate payroll deductions, if applicable, to facilitate Premium payment. Headings The headings of sections and paragraphs in this Contract are for convenience and reference purposes only and do not affect in any way the meaning or interpretation of any provision of this Contract. Misrepresentation, False or Fraudulent Information If the Group provides statements or other information on the Group Master Application form, or any other form required by KPS, that constitutes intentional misrepresentation or fraudulent misstatement of material fact, KPS may elect to immediately terminate this Contract. . Page 17 Notices Any notice that may affect the provisions of this Contract shall be deemed delivered to the Group when deposited in the United States mail with prepaid postage, addressed to the Group at the most recent address listed for the Group. Any notice that may affect the provisions of this Contract shall be deemed delivered to KPS when deposited in the United States mail with prepaid postage, addressed to KPS at the following address: P.O. Box 339, Bremerton, WA 98337-0039. Any requirement of KPS to provide notice to Enrollees shall be fulfilled when the Group has received such notice. It is the responsibility of the Group to disseminate notices to Enrollees within thirty one (311 days of receipt. Severability If any term, provision, endorsement or condition of this Contract is deemed invalid or unenforceable by a court of competent jurisdiction, the same shall be deemed severable from this Contract. However, the remainder of this Contract shall remain in full force and effect and shall in no way be affected, impaired or invalidated as a result of such decision. Third Party Beneficiaries There are no third party beneficiaries to this Contract. Waiver of Breach Waiver of a breach of any provision of this Contract shall not be deemed to be a waiver of any other breach of the same or different provision. The followina topics .are described in detail in the Benefits Booklet. Please refer to the Benefits Booklet Table of Contents to locate each section. Benefits Summary Complaints and Appeals Process Continuation of Coveraqe. . Continuation of Inpatient Coveraqe . Continued Eliqibility for a Disabled Child . Coveraqe Durinq a Labor Dispute . Continuation of Group Coveraqe . COBRA (Consolidated Omnibus Budqet Reconciliation Act - 1985) . Conversion Coveraqe Coordination of Benefits (COB) KPS Privacy Policy KPS' Riqht of Recovery Page: 18 KPS Health Plans, In Roh3bilit3tion 400 Warren Avenue P.O. Box 339 Bremerton, W A 98337-0039 CITY OF BREMERTON UNDER 65 LEOFF I RETIREES (SUBSCRIBERS ONL V) COVERAGE CONTRACT Group Number: 21001-21006 Effective Date: 1/1/20049, Renewal Month: January Open Enrollment Decem ber This Coverage Contract includes the following: Attachment A - Benefits Booklet Attachment B - Premium Rates and Underwriting Criteria Riders: N/A Optional Riders: N/A Endorsements: N/A This Contract is entered into and delivered in the state of Washington and is governed by Washington State laws, except to the extent state laws are preempted by federal law. Signature by a qualified Group representative or payment of the Premium shall constitute acceptance of the terms and conditions set forth herein. FOR KPS: FOR GROUP: Elizabeth A. Gilje, President and CEO Signature Date Print Name Title Date DATE SUBMITTED: March 15,2006 AGENDA BILL CITY OF BREMERTON CITY COUNCIL BILL # OCroeof 4f ........................................................................................ SUBJECT: Public Safety Bond Issue, Professional Services Agreement with Arai Jackson for architectural services for new Courts Building on lot at 10th and Park. Committee Meeting Date: March 22, 2006 COUNCIL MEETING Date: March 29, 2006 Department: Economic Developmnt. Presenter: Gary Sexton Phone: 360-473-5282 SUMMARY: Staff is recommending that the City of Bremerton enter into a professional services agreement with Arai Jackson Ellison Murakami LLP for architectural and engineering base services for schematics, design development, construction documents, bidding and site visits for the construction of a new one story court building at 10th and Park at a cost not to exceed $87,500. ATTACHMENTS: Arai Jackson Professional Services Agreement FISCAL IMP ACTS (Include Budgeted Amount): Expenditure is provided for in the 2006 Public Safety Bond Fund budget as requested to be amended and increased by $500,000. The budget amendment is part of the requested Council action on the purchase of PSE property as the site for this new court building. APPROVALS: DEP ARTMENT DIRECTOR: CITY ATTORNEY: FINANCE DIRECTOR: MA YOR: --------.....--......".......' FISCAL/BUDGET: OPERA nONS: COUNCIL PRESIDENT: RECOMMENDED MoTION: Move to approve the professional services agreement with Arai Jackson for architectual/engineering services for a new court building at 10th and Park and authorize the Mayor to execute these documents in substantially the same form as presented. I CONSENT AGENDA ~/ r COUNCIL ACTION: D Approve D Deny D Table D Continue D No Action o ara; jadt1un etli:sGln murakamj LIJ'> 4"'~)':.HI ,;~r.:,"Y'!,r.; I unfll'" Ot.SII'3~'I'IJ"; r~fflrJn5 March 16, 2006 Mr. Gary Sexton, Director of Economic Development City of Bremerton 239 Fourth Street Bremerton, WA 98337-1806 Re: City ofBremerton Courthouse - Architectural and Engineering Services Proposal Dear Mr. Sexton: Arai Jackson Ellison Murakami is pleased to furnish this proposal to provide the necessary architectural and engineering services to accomplish the design, documentation and construction phase services for the City of Bremerton Courthouse. This proposal reflects the request to separate the Courts from the Police, and provide architectural and engineering services for, a courts only facility in a new building on the current Puget Sound Energy site at the corner of 10th Street and Park Avenue. The architectural and engineering services for the police facility in the renovated and expanded former Kitsap Federal Credit Union Building were previously, contracted, and are currently in the Design Development Phase. Using a conservative $140 per square foot estimated construction cost, a new Courthouse of 6,200 square feet, which is the area assigned to the new courts building, would cost $868,000. Improvements to the existing parking lot on site to provide the thirty nine (39) required parking stalls would add $87,750 to the cost (39 stalls x 450 s.f./stall = 17,550 s.f. x $5 per square foot = $87,750). These two costs bring the estimated MACC to $955,750. This MACC is the construction cost only, other j'soft costs" such as fees, taxes and contingency would be needed to appropriately increase the project budget. Fee Proposal Arai Jackson Ellison Murakami proposes to accomplish the architectural and engineering services generally described in the attached Professional Services Agreement, dated March 16, 2006. Based on a Maximum Allowable Construction Cost (MAC C) of $955,750, we hereby propose the basic service fee of Eighty Seven Thousand Five Hundred Dollars ($87,500). This sum does not include AlE Extra Services or Reimbursable Expenses. For purposes of establishing a percentage for determining future extra services fees, that fee percentage is 10.50%. AlE Extra Services are itemized below. Please refer to the attached Fee Proposal Summary for additional detail. AlE Extra Services Arai Jackson Ellison Murakami proposes the addition of the following NE Extra Services to the fee: 1. Landscape Architecture: generally consists of planting layout and irrigation system design and documentation to meet code required landscaping buffer around parking lots. As with the original project design at the US Bank site, the cost of the landscape improvements are not included in the construction cost, with the assumption that the work would be accomplished by the City. 2. Cost Estimating: generally consists of providing one (1) detailed estimate of probable construction cost at each phase of the work: Schematic Design, Design Development, and Contract Documents. 2300 seventh avenue seattle wa 98121 v 2063238800 f 2063238518 www.arauackson.com PARTNERS: Sleven ara;. cliffjackson . bruce ellison . richard murakami. frank silkwood PRINCIPALS: mark spitzer. ben dayOl ASSOCIATES: connie cadag . gary oppenheimer. ben pongprol . 9re9 ransom Mr. Gary Sexton, Director of Economic Development City of Bremerton Courthouse - Architectural and Engineering Services Proposal March 16, 2006 3. Interior Design: generally consists of identification of furniture requirements, working with a City approved vendor to select furniture, fixtures, and equipment not included in the MACC, and development and presentation of a finishes and color board.- 4. Record Drawings: generally consists of preparing reproducible record drawings showing significant changes in the Work made during construction based on marked-up drawings furnished to AJEM by the Contractor. AlE Extra Services Held in Reserve 1. Security, AudioNisual, Data/Communications: generally consists of providing design and documentation of these systems to meet Owner program needs. Other Consultants Arai Jackson Ellison Murakami hereby agrees to incorporate the work of other consultant services that will be separately furnished and paid for by the City as indicated in the Professional Services Agreement including Land Surveying; Geotechnical Engineering; Legal, Accounting and Insurance Counseling Services; Specialty Consultant Services such as Acoustic, Hazardous Materials, Indoor Air Quality, or similar; and Testing Services During Construction, as indicated in the current Professional Services Agreement. Reimbursable Expenses Arai Jackson Ellison Murakami proposes a reimbursable handling fee of 7.5% in lieu of the indicated 5%. In addition, we propose the reimbursement of ferry expenses and the cost of special deliveries, not including postage for first class mailings. We have not included a proposed total amount for reimbursement. Documents and Data Arai Jackson Ellison Murakami proposes use of AutoCAD 2000 in lieu of the indicated version 12-14. We also propose adding the following sentence: "The City shall protect and hold the Architect harmless from any and all liability should the City use the documents, drawings, reports, electronic files and other information prepared under the Agreement for another project or in a manner not consistent with their intended purpose." Schedule of Performance Arai Jackson Ellison Murakami proposes the attached Schedule of Performance for Basic and NE Extra Services - Schedule B. Please review this fee proposal and attached backup, and contact me if you have any questions regarding this information. We are pleased to discuss further any aspect of the foregoing proposal for architectural and engineering services by Arai Jackson Ellison Murakami, LLP. Ben Dayot, Guy Thomsen and I look forward to working with you and other key staff, administration, and officials of the City of Bremerton to successfully . complete this important civic project. Sincerely, ~ Arai Jackson Ellison Murakami, LLP Steve Arai, AlA, Partner Attachments cc: File Page 2 Professional Services Agreement A. Project Owner: City of Bremerton, 345 Sixth Street, Bremerton, WA 98337, phone - (360) 473-5234, fax - (360) 473-5398. B. Architect: Arai Jackson Ellison Murakami LLP 2300 ih Ave., Seattle, WA 98121 C. Time for Performance: Per Article II - Schedule of Performance D. Compensation for Services: Eighty Seven Thousand Five Hundred Dollars ($87,500.00) as set forth in Attachment A E. Architects Authorized Basic Representative: Steve Ar~i, ALA F. City's Representative: Gary Sexton, Director of Economic Development The parties listed as authorized representatives have authority, make decisions and on behalf of the respective party. THIS AGREEMENT IS MADE SUBJECT TO THE TERMS AND CONDITIONS SET FORTH ON THE FOLLOWING PAGES HEREOF. THE ARCHITECT SPECIFICALLY AGREES THAT THE INDEMNIFICATION AND SAVE HARMLESS PROVISIONS OF SUCH AGREEMENT, TOGETHER WITH THE ARCHITECT'S WAIVER OR IMMUNITY UNDER WASHINGTON RCW TITLE 51, WERE SPECIFICALLY REVIEWED AND MUTUALLY NEGOTIATED, INCLUDING BUT NOT LIMITED TO PARAGRAPH 9. Arai Jackson Ellison Murakami LLP City of Bremerton By: By: Steven Arai Cary Bozeman Title: Partner Title: Mayor Date: Date: Arai Jackson Ellison Murakami, LLP Page I of 15 3116/06 I. Consultants: The Architect shall, in a timely manner, designate and appoint sub-consultants after conferring with the City. The Architect shall not appoint any sub-consultants to which the City has a reasonable objection. The Architect shall incorporate the provisions of this agreement, the scope of work, and the requirements of the project into the contracts with sub-consultants. The Architect shall not change consultants on this project without the express written approval of the owner project representative, which approval shall not unreasonably be withheld. II. Schedule of Performance Schedule of performance, Basic Services, Courthouse: Schematic Design Design Development Contract Documents Permit Bidding Contracts Construction Closeout Start date: March 16, 2006 April 8, 2006 May 6, 2006 May 26, 2006 June 12, 2006 July 6, 2006 August 1, 2006 February 1,2007 Ill. Scope Completed by: April 7, 2006 May 5, 2006 June 9, 2006 June 16,2006 July 5, 2006 July 31, 2006 January 31, 2007 February 21, 2007 The Architect will perform architectural and engineering base services for Schematic Design, Design Development, Construction Documents, Bidding and site visits for the construction phase as set forth in Attachment A, "City of Bremerton Courthouse, Architectural and Engineering Services Proposal dated March 16, 2006". The Courthouse project includes a new one story courts building of 6,200 square feet at the corner of 10th Street and Park Avenue. Minor modifications to the existing parking lot on the site will also be required. The Architect shall review information provided by the City and shall coordinate an overall set of consistent drawings, specifications and other contract documents. The Architect may reasonably rely upon the accuracy and completeness of City furnished information, surveys and reports. In such cases, authorship of such documents will be clearly identified. The Architect shall provide to the City four (4) copies of project documents upon completion of each of the Schematic Design, Design Development and Construction Document phases. Project documents shall be in a fOrIll and style suitable for presentation, review and reproduction. Arai Jackson Ellison Murakami, LLP Page 2 of 15 3/16/06 The City shall submit the Architect's documents for obtaining a building permit and other permits or approvals required for the project. Upon application for such permits, the Architect shall reply to all inquiries from governing agencies forwarded by the City, shall make any necessary or appropriate changes to the Contract Documents approved by the City and assist the City in expediting the issuance of all such permits or approvals. The Architect shall meet with City as reasonably requested to ensure that the developing design is meeting the City's requirements and shall conduct presentations of the Project to the City Councilor other groups as requested by the City, limited to one such presentation at the completion of each phase of servIce. A detailed list of the documents to be prepared for each scope of work is attached hereto as Attachment B. Through the design process, the Architect shall assist City with analyzing the project scope, design alternatives, schedule and budget options to keep the project within the Maximum Allowable Construction Cost (MACe). If the construction cost estimate exceeds the MACC, the Architect shall analyze design alternatives and submit cost saving opti~ns for the City's consideration. City shall furnish required information, approvals and services as expeditiously as necessary for the orderly progress of the work. Architect shall promptly notify the City in writing in the event orderly progress of the work is disrupted by failure of the City to provide such information, approvals or services, and the project schedule shall be adjusted as mutually agreed. The City shall separately furnish the following services: . Land survey of the site, prepared by a registered land surveyor. . Geotechnical engineering of the site, which includes test borings and soil bearing values, and which may include test pits, and air and water pollution tests. . Hazardous materials survey of the site, prepared by a registered hazardous materials consultant. . Testing services during construction that are reasonably required. . Legal, accounting, and insurance counseling services reasonably required. Arai Jackson Ellison Murakami, LLP Page 3 of 15 3/16/06 The City shall arrange and pay for the required advertisements for bid and other legal notices. A. Schematic Design Phase 1. Based upon the City's previously approved program created in consultation with the Architect (Program Space Needs Study, updated June 2003), the Architect shall prepare the general and detailed requirements for the Project for the City's approval. The Schematic Design Phase shall consist of two parts: a) Conceptual Design Alternatives and b) Schematic Design Documents. Upon approval of the Conceptual Design by the City, the Architect shall prepare the Schematic Design Documents. 2. The Architect shall submit to the City a Construction Cost Estimate projected to the expected time of bid, itemized by major categories, to give reasonable assurance that construction costs will not exceed the MACC. The format of the estimate shall be based on format approved by the City. The Construction Cost estimate shall establish a preliminary schedule setting forth the expected period of time required for completion of construction. 3. The Architect shall provide a timely written response, in accordance with the schedule, to City review comments, and shall secure the City's written approval of the Schematic Documents. B. Design Development Phase 1. Upon written authorization to proceed from City, the Architect shall prepare, based upon the approved Schematic Design documents, Design Development documents required to fix, describe and illustrate the full size, character and scope of the Project. 2. The Architect shall submit to the City an updated and itemized Construction Cost Estimate including an updated Project schedule, based on the completed Design Development documents, in the same format as the Estimate prepared for the Schematic Design Phase. The updated Construction Cost Estimate shall be in sufficient detail to give reasonable assurance that construction costs will not exceed the MACC. 3. The Architect shall review and respond to the City's review comments and shall secure City's written approval of the Design Development documents. Arai Jackson Ellison Murakami, LLP Page 4 of 15 3116/06 C. Construction Documents Phase 1. Upon written authorization to proceed from the City, the Architect shall prepare, based upon the approved Design Development documents, Construction Documents consisting of Drawings, Specifications and other documents setting forth in detail the scope of the Project. Such documents shall describe materials, standards of workmanship, finishes, equipment and the conditions affecting the work required to be performed in all divisions of the construction work. 2. In preparing the Construction Documents, the Architect shall, in consultation with the City, prepare the necessary bidding information, bidding forms, which shall include the City's General Conditions ofthe Contract, Supplemental Conditions, instructions to bidders and prevailing wage rates and ensure that the subsequent divisions of the Construction Documents are consistent therewith. 3. The Architect shall prepare a detailed Construction Cost Estimate, including an updated Project Schedule, based on the completed Construction Documents. The final detailed Construction Cost Estimate shall include an itemization of alternates proposed and the estimated construction cost to be added or deducted from each alternate selected. a. The Architect shall propose and prepare bid alternates to provide reasonable assurance that the City will be able to award a construction contract that does not exceed the MACe. 4. The Architect shall submit to the City four (4) sets of the completed construction drawings and specifications. 5. The Architect shall secure the City's written approval of the drawings and specifications, the final cost estimate, and the alternates. D. Bidding Phase 1. The Architect shall assist the City in issuing the Bid Documents (paid for by the City) to bidders and plan centers. The Architect shall attend and participate in the prebid conference and generally assist the City in managing the bid process. 2. In the event the lowest responsive bid submitted by a responsible bidder satisfactory to the City exceeds the MACC, then the Architect will, at it's sole cost and expense, revise the drawings and specifications as may be required by the City to reduce or modify the quality or quantity, or both, of the work so that the total construction cost of the Project will not exceed the MACC. Arai Jackson Ellison Murakami, LLP Page 5 of 15 3116/06 E. Construction Phase 1. The Architect shall participate with the City in the preconstruction conference with the Contractor. 2. During the progress of construction, the Architect shall perform services including: . Visit the site a minimum of once weekly during construction. Architect shall be familiar with the progress and quality of the work completed and able to determine if the work is being performed in a manner that will be in general conformance with the contract documents when completed. . . Consult with the City during the Construction Phase. Instructions to the Contractor shall be communicated by the Architect. The Architect shall have authority to act on behalf of the City only to the extent provided in the Contract Documents unless otherwise modified in writing by the City. · Interpretations of the requirements of the Contract Documents shall be made by the City with consultation and written recommendation from the Architect. . Provide to City copies of all written communications that the Architect provides to Contractor, at the same time such communication is provided to Contractor. . Verify general conformance with the contract documents, review, approve or otherwise take appropriate action upon Contractor's submittals, including field questions, shop drawings and submittals of materials, equipment, tests and inspections. The Architect shall take prompt action so as to cause no delay in the work. · Prepare necessary documents for changes in the work including revision drawings, cost estimates and reasons for change, and secure, analyze in detail and recommend disposition of proposals from Contractor. If requested, the Architect shall attend City meetings convened for purpose of reviewing proposed changes in the work. · Determine and certify the amount owing to Contractor, based on the Architect's observations and evaluation of Contractor's Application for Payment. The Architect's certification for payment shall constitute a representation that the work has progressed to the point indicated and that, to the best oftheArchitect's knowledge, information and belief, the quantity and quality of the work is in general conformance with the Contract Documents and that the Contractor is entitled to payment in the amount requested. . Review Contractor's progress schedules at least once per month for conformance with the Construction Documents, and promptly notify the City and Contractor of deviations and noncompliance. Arai Jackson Ellison Murakami, LLP Page 6 of 15 3/16/06 . Attend on-site Project progress meetings once per week. The Architect shall require its sub consultants attend progress meetings as needed and/or requested by the City. The Architect shall keep project meeting minutes, and transmit copies to the City and Contractor as soon as possible but in no event later than one day prior to the next weekly meeting. . The Architect shall select finish materials and colors and prepare color schedules for items included in the construction contract for the City's approval. 3. The Architect shall not be responsible for construction means, methods, techniques, sequences or procedures, or for safety precautions, and programs in connection with the work, and shall not be responsible for Contractor's failure to carry out the work in accordance with the Contract Documents. 4. The Architect shall at all times endeavor to discover and guard City against defects and deficiencies in the work of Contractor, but it is understood that the Architect does not guarantee the performance of the Contractor. The Architect shall promptly advise the City of work which does not conform to the Contract Documents. 5. The Architect shall have authority to reject work which does not conform to the Contract Documents. The Architect shall recommend to the City that the Contractor be directed to stop work when such stoppage may, in the Architect's reasonable opinion, be necessary to ensure the proper execution of the work. F. Construction Completion Phase 1. The Architect shall conduct pre-final inspection and prepare check lists of corrective items, make final inspections by all disciplines, including at least one re-inspection, recommend the date or dates of final completion and recommend acceptance of the Project to City. 2. The Architect shall obtain, review, approve and deliver to the City, written guarantees, manuals and instructions from Contractor as required by the Construction Documents upon completion of construction and prior to recommending acceptance of the Project to the City. Arai Jackson Ellison Murakami, LLP Page 7 of 15 3/16/06 3. The Architect shall modify the original Construction Drawings to conform to the project record drawings provided by Contractor which incorporates all changes in the work, including utilities, made during construction and addenda during bidding. The modified original Construction Drawings and related electronic media shall be completed and submitted to the City within two (2) months of the City's acceptance of the Project or as otherwise mutually agreed. 4. Upon the City's request during the warranty period set forth in the Construction Contract, the Architect shall assist City in identifying defects in the Project, determine corrective measures, provide inspection of the Project and assist the City in implementing corrective measures. G. Additional Services and Reimbursable Expenses '1. The City shall pay for the following Additional Services performed, furnished, or incurred by the Architect. However, the City has no obligation to pay Architect for Additional Services performed by Architect prior to receipt of the City's authorization for such service. The City reserves the right to employ other means to accomplish said services. a. Revising drawings or specifications previously approved by the City when such revisions are due to changes in project scope, program changes, changes required by the enactment or revisions to codes, laws, or regulations subsequent to the preparation of such documents, or changes directed by the City that are not normally made as a part of the Schematic or Design Development phases b. Providing consulting services for City-supplied equipment, new or used, to be incorporated into the Construction Contract. c. Providing consulting services in connection with selecting and/or procuring furniture, fixtures, and equipment (FF&E) outside of the Construction Contract. d. Providing consultation or contract administration for the replacement of any work damaged by fire, accidental or natural causes during construction, provided that such damage was not caused by the fault or negligence of the Architect; providing professional services or arranging for the work to proceed should the contractor default in the performance of the construction contract or become delinquent or insolvent. Arai Jackson Ellison Murakami, LLP Page 8 of 15 3/16/06 e. Providing brochures, detailed architectural models, or additional graphic presentations beyond the two (2) graphic presentations agreed to. f. Providing services during the construction phase in connection with unforeseen conditions or changes requested by the City. g. Providing services during construction in connection with processing more than seventy-five (75) Contractor-generated Requests for Information (RFI's), excluding any RFI's reasonably contributed to an error or omission of the Architect or its sub-consultants. h. In the event the construction period up to substantial completion exceeds the time stipulated in the construction contract including change order extensions by more than 10%, the Architect shall continue administration of the construction contract and be entitled to Additional Services compensation for the construction time extension occurring through no fault or neglect of the Architect. 1. Providing services after issuance to the City of the Contractor's final Certificate for Payment. 2. The City shall pay for the following reimbursable expenses incurred by the Architect and/or their sub-consultants. The City will pay the Architect an additional 7.5% of authorized reimbursable expenses as a handling fee. a. Providing additional copies of drawings, specifications, studies, reports, Contract Documents, correspondence, and/or papers received or issued by the Architect as requested by the City. b. Providing printing and distribution of documents to the City at the completion of each phase of service, including the construction documents for bidding. c. Out-of-pocket reprographic expenses when substantiated by third- party invoices. No reimbursement shall be made for postage, handling, telephone expenses, faxes, or copies of documents used by the Architect to perform normal services and not provided to the City. d. All round-trip ferry fares. 3. Fees for authorized Additional Services shall be mutually agreed to by the City and the Architect prior to performing such services. Arai Jackson Ellison Murakami, LLP Page 9 of 15 3/16/06 H Basis of Compensation 1. Maximum Allowable Construction Cost (MACC) Defined: The MACC for this project is $955,750 and is the total sum allocated by the City for construction of the project, not including Washington State Sales Tax, Architect compensation, or other items in the City's project budget such as contingencies, administrative costs, furniture or equipment purchased outside the construction contract. 2. It is understood that the Architect's fixed fee has been established, in part, by a percentage of the City's MACC as set forth in Schedule A of Attachment A. If at any time the City elects to increase the MACC by more than 10%, the Architects fee shall be adjusted proportionately to the adjustment in the MACC. I Standard Terms and Conditions 1. Time and Delay. Time is of the essence in this Agreement. The Architect agrees to punctually and diligently perform all parts of it's Services as scheduled in Schedule B of Attachment A, which shall be subject to change by the City as may be deemed necessary to the overall progress of the Project. 2. Monthly Invoices: Final Payment. a. Payments shall be made no more often than once each calendar month within thirty (30) days after the City's receipt of a monthly invoice for fees and costs incurred during the preceding month; provided that: (i) all services covered by the invoice have been fully and timely performed; (ii) the Architect has furnished the City with copies of supporting documentation for all costs covered by the invoice; and (iii) the Architect is not in default under this Agreement. b. Each payment made by the City to the Architect shall be deemed made to the Architect in trust for the Architect's sub-contractors and consultants to the extent such parties have not been paid for the services, supplies, equipment or materials provided by such parties. c. Should there be any claim, obligation or lien asserted before or after final payment is made that arises from the negligent performance of the Architect's work, the Architect shall reimburse the City for any costs and expenses, including attorney fees, costs and expenses, incurred by the City in satisfying, discharging or defending against any such claim, obligation or lien, including any action brought or judgment recovered. City shall have the right to withhold from any payment, or otherwise be reimbursed for, an amount sufficient to protect the City from any such claims. Arai Jackson Ellison Murakami, LLP Page 10 of 15 3/16/06 3. Compliance with Laws; Governmental Agency Communications. The Architect shall comply with all Federal, State and Local laws, rules, regulations and ordinances applicable to the services and the Architect's performance thereof, which are in effect at the time the services are provided and the requirements for environmental documents prepared under the State Environmental Policy Act (SEPA). 4. Performance Standard. The Architect shall perform the services in a professional, efficient and economical manner consistent with the City's needs as set forth in the scope of work attached hereto, and consistent with the level of care, skill, practice and judgment exercised by other professionals performing services of a similar nature under similar circumstances. The Architect represents and warrants to the City that all persons who will be performing the services possess the requisite skill, training and experience and hold all required licenses and permits to render the services contemplated by this Agreement. 5. Safety. a. The Architect shall comply with all applicable Federal, State and/or Local safety related laws and regulations, and shall comply with any such laws and regulations, including but not limited to any OSHA, WISHA/Oregon Department of Labor Health and Safety RuleslRegulations. The Architect shall fully comply with the Hazard Communication Standard for the Construction Industry, and any Federal, State or Local Right to Know Legislation and shall transmit information to all parties concerning chemical hazards requirements. 6. Amendments/Changes. The City may, without invalidating this Agreement, from time to time request changes in the scope of the services. If such changes involve additional time and expense by the Architect, the Architect shall, within five (5) days. of receiving notice of the requested change, submit its estimate to the City of the costs and additional time, if any, necessary to perform such changes. The Architect shall commence any such change order work only upon the written receipt by the Architect of the approval by the City to do so. 7. No Assignments or Delegation of Services. a. This Agreement may not be assigned by operation of law or otherwise, without the prior written consent of the City, which may be withheld at its sole discretion. b. The Architect shall assign the persons designated in Section E on the first page of this Agreement as itsukey personnel to perform the services on behalf of the Architect. Such key personnel shall be replaced only with the prior consent of the City, which may be Arai Jackson Ellison Murakami, LLP Page II of 15 3116/06 withheld in its sole discretion. None of the services may be delegated or sub-contracted to an independent contractor without the prior written consent of the City, which may be withheld at its sole discretion. The Architect shall remain fully responsible for the manner and quality of all services performed, including the performance of all consultants and sub-consultants retained by the Architect. 8. Indemnity. To the fullest extent permitted by law, and to the extent the Architect is negligent, the Architect shall indemnify, defend and hold harmless, the City, its officers, agents, employees and representatives from and against any and all claims, damages, losses and expenses, including, but not limited to, reasonable attorney fees, which arise out of or result from any negligent act or omission of the Architect, any consultants engaged by the Architect and for anyone directly or indirectly employed by them. If the claim results from the concurrent negligence of the City and the Architect, the Architect's indemnification obligation shall be limited to the extent of it's negligence; and (b) the Architect expressly waives any immunity that may be granted it under the Washington State Industrial Insurance Act, RCW Title 51, to the extent necessary to provide the City with such full indemnity. The provisions of this Section shall survive t.ermination of this Agreement for any reason. 9. Insurance. Prior to the commencement of the Services, the Architect shall, at its own expense, obtain the following insurance coverage, which coverage shall remain in force during the term of this Agreement: a. Commercial General Liability insurance, including blanket contractual liability coverage, with limits of at least: $1,000,000 General Aggregate (Other Than Products-Completed Operations) . $1,000,000 Products- Completed Operations Aggregate Limit $1,000,000 Personal and Advertising Injury Limit $1,000,000 Per Occurrence Limit $ 100,000 Fire Damage Limit (Any One Fire) b. Professional Liability insurance, including errors and omissions, with limits of liability equal to at least $1,000,000 each occurrence; c. Automobile Liability insurance with limits of liability of not less that $1,000,000 per occurrence combined single limit for bodily injury property damage; Arai Jackson Ellison Murakami, LLP Page 12 of 15 3/16/06 d. Employer's Liability or Stop Gap Liability insurance with limits of not less than $1,000,000 each accident, $1,000,000 each employee-disease and $1,000,000 policy limit-disease; and e. Insurance in accordance with all applicable laws relating to workers' compensation with respect to all of the Architect's employees, owners and officers, regardless of whether such coverage or insurance is mandatory or merely elective under the law. f. Each policy of insurance shall be in a form satisfactory to the City with an insurer having an A.M. Best rating of B+ VI or better, and provide thirty (30) days' advance notice to the City of non-renewal or material change. Such policies shall not have deductibIes that exceed $25,000 per occurrence. Prior to the commencement of the services, the Architect shall provide the City with written evidence of the required coverage in the form of a certificate of insurance with additional insured endorsements naming the City of Bremerton as additional insured attached or, upon the City's request, a copy of the policy. The insurance certificate requirements for the coverage required for workers' compensation will be satisfied by a letter from the appropriate state agency confirming participation in accordance with statutory requirements. 10. Architect's Default. If the Architect fails to prosecute the services promptly or properly or breaches or fails to perform any obligation under this Agreement, the City may give the Architect seven (7) days' written notice of such matter. If such matter has not been corrected within such seven-day period, the City may, without prejudice to any other right or remedy it may have, terminate this Agreement and correct any defective services and charge the Architect for all costs, expenses, and impacts to the Project arising from such defects, and deduct the same from sums otherwise due the Architect. 11. Documents and Data. a. The Architect agrees that all documents, drawings, reports, electronic files, AutoCAD 2000 or compatible or similar electronic information, together with other information prepared or obtained by the Architect in connection with the services including work in progress (cumulatively "materials"), are the sole property of the City for use exclusively by the City or its designated agents and employees and shall be submitted to the City within three (3) working days after a written request from the City and, in any event, upon completion of the services under this Agreement, prior to and as a condition of the final payment to the Architect. City shall indemnify Architect from any claims or damages arising from the City's subsequent use of the electronic version of said materials. Arai Jackson Ellison Murakami, LLP Pagel3ofl5 3116/06 12. Confidentiality. The Architect agrees that all documents, drawings, reports and other data and information prepared or obtained by the Architect in connection with the services are confidential and shall not be disclosed or made available to any individual or entity other than the City, its designated agents or employees and any person who must know the information in order for the Architect to complete the services except to the extent required to be disclosed pursuant to the Public Records Act, chapter 42.17 RCW. 13. Royalties. Patents. Copyrights and Trade Secrets. a. The Architect shall notinfringe on United States patent, copyright, trade secret or other proprietary right for any material, product, or part of any material or product (including, for example, software, hardware, service, design or equipmentO used or furnished in connection with this Agreement, and shall defend and indemnify the City from any suits or claims for infringement of any such rights and shall hold the City harmless from any loss on account thereof. 14. Notices. All notices provided for herein may be transmitted by facsimile, delivered or mailed. If mailed, such notice shall be considered delivered three (3) days after being deposited in such mail. The addresses to be used in connection with such correspondence and notices are as set forth on the first page of this Agreement, or such other address as a party shall from time to time direct. Notices or correspondence to the City shall be sent to such address marked for the attention bfthe City's Representative designated in Section F on the first page of this Agreement, or such other representative as the City may hereafter designate from time to time. 15. Suspension of Services; Termination. The City may, upon written notice, direct the Architect to suspend all or a portion of the Services. In the event of such suspension, the Architect shall be entitled to payment of: (a) all fees properly earned up to the effective date of suspension; and (b) all reimbursable expenses actually and properly incurred up to such date, but excluding any and all unearned overhead and profit. If the services are suspended for a continuous period of more than sixty (60) days, and such suspension is not due to the fault of the Architect, then the Architect shall also be entitled to payment of unavoidable out-of-pocket expenses, excluding any and all unearned overhead and profit, actually suffered as a result of such suspension. The City also reserves the right to terminate this Agreement for the convenience of the City at any time upon three (3) days written notice to the Architect. If the City so terminates this Agreement, the Architect shall be entitled to payment of: (a) all fees properly earned up to the effective date of termination, and (b) all direct reimbursable expenses actually and properly incurred up to such date, but excluding any and all overhead and profit accruing after the date of termination. Arai Jackson Ellison Murakami, LLP Page 140f15 3/16/06 16. Relationship of Parties. The Architect is an independent contractor and not an agent or employee of the City. Nothing contained in this Agreement shall be deemed to create a relationship of employer- employee, master-servant, partnership, joint venture or any other relationship between the City and the Architect other than that of independent contractor. Neither party shall have any authority to supervise the employees, representatives or sub-contractors of the other party, nor to make any statements, representations or commitments of any kind or take any actions which will be binding upon the other party except as specifically provided in this agreement. 17. Entire Agreement. This Agreement constitutes the final and complete agreement between the parties hereto with respect to the subject matter of this Agreement, superceding all prior agreements or discussions with respect thereto. No additions, deletions or modifications hereof shall become part of this Agreement unless each party hereto specifically recognizes and consents to their inclusion by a signed instrument. 18. Disputes a. This Agreement shall be governed by the laws of the State of Washington. b. The Architect consents to consolidation and/or joinder, in a single proceeding, of all claims and disputes by or between the City, sub- contractors, the Architect, the City's other consultants, or any other person or entity involved with the Project, with a claim or dispute relating in any manner to the Architect's services provided by it under this Agreement. c. In any dispute involving the City and the Architect or otherwise arising under or relating to this Agreement, each party shall be responsible for their own attorney's fees and costs, together with any and all expert fees. Arai Jackson Ellison Murakami, LLP Page] 5 of 15 3/16/06 Attachment A Letter from Steve Arai, Arai Jackson Ellison Murakami, LLP to Gary Sexton, City of Bremerton Director of Economic Development titled: "City of Bremerton Courthouse Architectural and Engineering Services Proposal" dated March 16, 2006 Arai Jackson Ellison Murakami, LLP - Attachment A Page I of 5 3/16/06 SD-l SD-2 SD-3 SD-4 Attachment B List of Deliverables 4 copies SCHEMATIC DESIGN 4 sets 4 copies 4 copies Design Report Preliminary Architectural Design Concept Code Analysis Systems Narratives: Structural Landscape Mechanical Electrical (Power and Lighting) Data/Communications Electronic, AudioNisual Security Design Drawings Architectural Site Plan Architectural Floor Plans Building Section Key Building Elevations Cost Estimate Updated Schedule Arai Jackson Ellison Murakami, LLP - Attachment B Page I of 4 3116/06 DD-I DD-2 DD-3 DD-4 DESIGN DEVELOPMENT 4 copies 4 sets 4 copies 4 copies Preliminary Technical Specifications Design Development Drawings Landscape Planting Plan Key Details Architectural Site Plan First Floor Plan First Floor Ceiling Plan Roof Plan Building Sections Wall Sections Enlarged Floor Plans Door Schedule Structural Structural Notes Foundation Plan First Floor Plal1 Roof Framing Typical Details Mechanical Symbols & Abbreviations First Floor Plumbing and Piping Plan First Floor HVAC Plan Electrical Symbols & Abbreviations Electrical Site Plan First Floor Lighting and Power Plan Power One-Line Diagrams Cost Estimate Updated Schedule Arai Jackson Ellison Murakami, LLP - Attachment B Page 2 of 4 3/16/06 CD-l CD-2 CONTRACT DOCUMENTS 4 sets 4 sets Final Specifications Final Drawings Landscape Architectural Structural Mechanical Arai Jackson Ellison Murakami, LLP - Attachment B Page 3 of 4 3/16/06 Planting Plan Irrigation Plan Details Cover Sheet Code Analysis Site Plan Site Details First Floor Plan First Floor Ceiling Plan Roof Plan Roof Details Building Sections Building Elevations Enlarged Plan & Sections Enlarged Plan Wall Sections, Wall Types Room Finish Schedule Door Schedule - Door Types Interior Elevations Details Signage Plan Structural Notes Foundation Plan First Floor Framing Plan Roof Framing Plan Lateral Frame Elevations Foundation Details Framing Details Court Room Toilet Rooms Symbols, Abbreviations & Schedules First Floor Plumbing and Piping Plan First Floor HVAC Plan Enlarged Mechanical Room Plans HVAC Details Plumbing Details Electrical Symbols & Abbreviations Energy Calculations Electrical Site Plan First Floor Lighting Plan First Floor Power Plan Electrical Roof Plan Partial Plans, Details One-Line Diagram and Elevation Lighting Fixture Schedule Details CD-3 4 sets Final Cost Estimate BIDDING BID-l Addenda I End of Attachment B Arai Jackson Ellison Murakami, LLP - Attachment B Page 4 of 4 3/16/06 aral jac:uon eUf10n ml1Jakamf llJ? ~~l:~j r~c ~1,:,.l5_e I IJ !l LilH'.i t1!.':,S:Hn.'~ il-. f ~nml~!S Fee Proposal Summary for Basic Services and AlE Extra Services March 16, 2006 Schedule A MACC = $ 955,750. Basic Service Basic Service Fee Fee = $ 87,500. AlE Extra Service Descriotion AlE Extra Service Fee Landscape Architecture $ 4,780.* Cost Estimating Consultant = $ 5,100. Interior Design Consultant = $ 5,235. Record Drawings = $ 5,385. Total Contracted NE Extra Service = $ 20,500. AlE Extra Services Held In Reserve AlE Extra Service Fee Held In Reserve Security, AudioNisual, Data/Communications Consultant = $ 9,500. * Allowance 2300 seventh avenue seattle wa 98121 v 206 3238800 f 206 3238518 www.arauackson.com PARTNERS: steven arai . cliff jackson . bruce ellison . richard murakami . frank silkwood PRINCIPALS: mark spitzer. ben dayot ASSOCIATES: connie cadag . gary oppenheimer. ben pongprot . greg ransom arat jac:bGn e!1f$Gn murakami LLP ~,':h~ 1,:'( f!.i~~ IlJm~u,t-t In:'~II'Jl''.:ttt! r.::~u~m:; Schematic Design Design Development Contract Documents Permit Bidding Contracts Construction Closeout Schedule of Performance for Basic Services and AlE Extra Services March 16, 2006 Schedule B Start date: March 16, 2006 April 8, 2006 May 6,2006 May 26, 2006 June 12, 2006 July 6, 2006 August 1, 2006 February 1, 2007 Como/eted bv: April 7, 2006 May 5, 2006 June 9, 2006 June 16, 2006 July 5, 2006 July 31, 2006 January 31, 2007 February 21 , 2007 2300 seventh avenue seattle wa 98121 v 2063238800 r 206 3238518 www.arauackson.com PARTNERS: steven arai . cliff jackson . bruce ellison . richard murakami . frank silkwood PRINCIPALS: mark spitzer. ben dayot ASSOCIATES: conniecadag . gary oppenheimer. pen pongprot . greg ransom .... o aral pcbom ellisGo murakami I,IP ~1':"'nt(.''J:(l[ !il'~M ['f::-5':i"':lt'\f~~Df~ Site Acquisition (PSE Site @ 10th & Park) $ 0 Construction MACC (See attached Preliminary Cost Estimate) $ 955,750 Sales Tax (@ 8.6% of MACC) $ 82,195 NE Fee (Total Basic & Extra Services) $ 117,500 NE Basic Fee (See Schedule A) $ 87,500 NE Extra Services (See Schedule A) = $ 20,500 NE Extra Services Held in Reserve (See Schedule A) $ 9,500 Expenses (Reimbursement, printing, etc.) $ 3,060 Special Inspections & Testing $ 5,000 Environmental $ 2,000 Geotechnical Study $ 2,500 Site Survey $ 5,200 Permits (@ 2% of Construction) $ 19,115 Security $ 3,060 Voice & Data $ 3,060 Sigl'lage $ 1,300 Equipment & Furnishings $ 48,900 Contingency - 10% of MACC $ 95,575 Total Project Costs $ 1,344,215 Cost & Fee - Court OnlyBPCII]roj.Jee_06.03.16.xls Page 1 of2 Print Date: 3/15/06 DATE: 16-Mar-06 .... o aral iackSGft ellbaR murakamt LIP v".c:~m~ r.;:~sr'{~]I',~:"!]~ n:~h:'t;: it\:i'J,~'iH;h"~ Bremerton Courthouse City of Bremer10n 239 Fourth Avenue Bremerton, Washington BY: GT JOB NO.: 2004198 CHECKED BY: BE Courthouse Costs Per Previous Budget: 6,200 sJ. @ $140.00 IsJ. 17 550 sJ. $5.00 IsJ. Total Estimated MACC wlo Soft Costs * *~ Estimate does include 4% Contractor overhead, 4% profit, 36% labor tax and 5% general conditions. No Non-Construction Soft Costs (Design fees. permits, taxes, testing, escalation, furnishings, loose equipment, etc.) are included in this preliminary construction estimate. No contingency is included in this preliminary construction estimate. No escalation is included in this preliminary construction estimate. Cost & Fee ~ Court OnlyBPCII_Proj._Fee_06.03.16.xts Page 2 012 Print Date: 3/15/06 DATE SUBMITTED: March 20, 2006 BILL# tk- O~')- AGENDA BILL CITY OF BREMERTON CITY COUNCIL 4Gt ........................................................................................ SUBJECT: Resolution No. ?-- q tOG{ authorizing retroactive application of salary adjustments for certain management and professional employee positions Committee Meeting Date: March 22, 2006 COUNCIL MEETING Date: March 29, 2006 Department: City Council Presenter: Cecil McConnell Phone: 473-5280 SUMMARY: During the 2006 budget review process, salary adjustments were proposed for certain management and professional employee positions. City Council requested a more comprehensive review of the positions and salaries. That review is expected to conclude later this year. The proposed resolution provides for retroactive application of salary adjustments authorized by City Council as a result of the review. ATTACHMENTS: Proposed Resolution No c )..q~~ FISCAL IMPACTS (Include Budgeted Amount): Final financial effect will be determined upon conclusion of the review process. Sufficient funds are included in the 2006 budget for the previous salary review process recommendation, however, the conclusions of the current review process may be different. APPROVALS: DEPARTMENT DIRECTOR: -.? ~ CITY ATTORNEY: ~ S:~;: FINANCE DIRECTOR: MAYOR: .... ~ FISCAL/BUDGET: OPERATIONS: COUNCIL PRESIDENT: RECOMMENDED MOTION: I CONSENT AGENDA ~ Move to pass Resolution No. J. q g q authorizing retroactive application of salary adjustments for certain management and professional employee positions. COUNCIL ACTION: 0 Approve 0 Deny 0 Table o Continue 0 No Action RESOLUTION NO. ~~0q A RESOLUTION of the City Council of the City of Bremerton, Washington, authorizing the retroactive application of salary adjustments for certain management and professional employee positions following conclusion of the current pay plan study and approval of a management and professional employee pay plan expected later this year. WHEREAS, during the 2006 budget review process, adjustments were proposed to the salaries for certain management and professional employee positions based upon the review of the salaries for management and professional employees; and WHEREAS, upon review of the proposed salary adjustments, the City Council requested a more comprehensive review of the positions and salaries; and WHEREAS, the review of management and professional employee positions and salaries is expected to be concluded later this year; and WHEREAS, because this review is expected to take a few months to complete, City Council believes it is appropriate to authorize any adjustments that may be approved to be effective on a date earlier than the anticipated completion date of the current study; NOW THEREFORE, THE CITY COUNCIL OF THE CITY OF BREMERTON, WASHINGTON, DOES HEREBY RESOLVE AS FOLLOWS: SECTION 1. Salary adjustments authorized by the City Council as a result of the current pay plan study of management and professional employee positions shall be effective retroactive to April 16, 2006. SECTION 2. Severa b ilitv. If anyone or more sections, subsections, or sentences of this Resolution are held to be unconstitutional or invalid, such decision shall not affect the validity of the remaining portion of this Resolution and the same shall remain in full force and effect. ' SECTION 3. Effective Date. This Resolution shall take effect and be in force immediately upon its passage. day of PASSED by the City Council of the City of Bremerton, Washington this_ ,2006. CECIL McCONNELL, Council President 1 Retroactive Salary Adjustment APPROVED AS TO FORM: ROGER A. LUBOVICH, City Attorney R:\Legal\Legal\Resolutions\City Council\Retroactive Salary Adjustment.doc ATTEST: PAULA JOHNSTON, City Clerk 2 Retroactive Salary Adjustment DATE SUBMITTED: March 20,2006 BILL # 0"- Of03 AGENDA BILL CITY OF BREMERTON CITY COUNCIL I.fH ..............................................................m......................... SUBJECT: Resolution No. ~q qo authorizing a 1 % cost of living adjustment for the Mayor and all management and professional employee classifications Committee Meeting Date: March 22, 2006 COUNCIL MEETING Date: March 29, 2006 Department: City ~ouncil Presenter: Carol Arends Phone: 473-5280 SUMMARY: Due to budget constraints, the Mayor and management and professional employees did not receive a cost of living adjustment in 2004. At the time, City Council expressed its desire to provide the adjustment at a later date if funds became available. Funds are now available to provide the cost of living adjustment to the Mayor and management and professional employees. A TT ACHMENTS: Proposed Resolution tJ o. 2'l q 0 FISCAL IMPACTS (Include Budgeted Amount): This action requires a budget adjustment of $33,108 as this was not included in the 2006 budget as adopted. There are adequate funds available in ending fund balances to cover this adjustment. APPRO V ALS: DEPARTMENT DIRECTOR: CITY ATTORNEY: FINANCE DIRECTOR: MA YOR: He.ffct 3/ ;J-;}-/ 0 (p l{~~ /~~ RECOMMENDED MOTION: FISCAL/BUDGET: OPERATIONS: COUNCIL PRESIDENT: I CONSENT AGENDA ~ Move to pass Resolution No. d-.C1 q 0 authorizing a cost ofliving adjustment in the amount of 1 % for the Mayor and all management and professional employee classifications. COUNCIL ACTION: D Approve D Deny D Table D Continue D No Action RESOLUTION NO. ~ 990 A RESOLUTION of the City Council of the City of Bremerton, Washington, authorizing a cost of living adjustment in the amount of one percent (1 %) for the Mayor and all management and professional employee classifications. WHEREAS, due to budget constraints, the Mayor and the management and professional employees of the City of Bremerton did not receive a cost of living adjustment for the year 2004; and WHEREAS, had the Mayor and the management and professional employees received a cost ofliving adjustment, the amount of adjustment would have been one percent (1 %); and WHEREAS, other regular employees of the City received a cost of living adjustment based on their labor contracts; and WHEREAS, during deliberations of this issue, the City Council expressed their desire to provide this cost of living adjustment at a later date if funding became available; and WHEREAS, the City Council has determined that funding is available to provide such an adjustment and now believes it is appropriate to do so; NOW THEREFORE, THE CITY COUNCIL OF THE CITY OF BREMERTON, WASHINGTON, DOES HEREBY RESOLVE AS FOLLOWS: SECTION 1. Effective April 16, 2006, the salary schedules for the Mayor and all management and professional employee classifications shall receive a cost ofliving adjustment in the amount of one percent (1 %). SEl';,TION 2. The budget is hereby amended to provide for this additional personnel expense in 2006. SECTION 3. Severability. If anyone or more sections, subsections, or sentences of this Resolution are held to be unconstitutional or invalid, such decision shall not affect the validity of the remaining portion of this Resolution and the same shall remain in full force and effect. SECTION 4. Effective Date. This Resolution shall take effect and be in force immediately upon its passage. 1 1% Salary Adjustment day of PASSED by the City Council of the City of Bremerton, Washington this ,2006. CECIL McCONNELL, Council President APPROVED AS TO FORM: ATTEST: ROGER A. LUBOVICH, City Attorney P AULA JOHNSTON, City Clerk R:\Legal\Legal\Resolutions\City Council\! % salary adjustment.doc 2 1 % Salary Adjustment DATE SUBMITTED: 3-29-06 .BILL # 06-066 AGENDA BILL CITY OF BREMERTON CITY COUNCIL . ) 4I .g.smmm.mmmsBmamma.uBDs.....a...a....a..a..mBs.mma....mamgBDUDaD.BmmBma...C8ma.a.amBDUDI SUBJECT: Resolution No. 2992 Authorizing the Re-development Project Administrator of Economic Development to apply for Grant Funding from the Community Economic Revitalization Board - Job Development Fund Program Committee Meeting Date: 3-29-06 Pre Council COUNCIL MEETING Date: 3-29-06 Department: Econ Development Presenter: Gary Sexton Phone: 473-5282 SUMMARY: In order to apply for grant funding from the Community Economic Revitalization Board - Job Development Fund Program, City Council must authorize the Re-development Project Administrator to submit the application. ATTACHMENTS: FISCAL IMPACTS (Include Budgeted Amount): Potential loss of six million dollars for downtown pedestrian improvements that may be awarded through this grant process. APPROVALS: DEP ARTMENT DIRECTOR: CITY ATTORNEY: FINANCE DIRECTOR: MAYOR: .~ RECOMMENDED MOTION: Move to pass Resolution No. 2992 authorizing the Re-development Project Administrator of Economic Development to apply for Grant Funding from the Community Economic Revitalization Board - Job Development Fund Program. -- FISCAL/BUDGET: OPERATIONS: COUNCIL PRESIDENT: I CONSENT AGENDA ~ COUNCIL ACTION: 0 Approve 0 Deny 0 Table o Continue 0 No Action RESOLUTION NO. 2992 A RESOLUTION of the City Council of the City of Bremerton, Washington, authorizing the Re-development Project Administrator of the Department of EconomiQ Development to apply for grant funding from the Community Economic Revitalization Board - Job Development Fund Program. WHEREAS, the City Council wishes to continue to pursue grant funding for the Bremerton Downtown Pedestrian Improvements; NOW THEREFORE, THE CITY COUNCIL OF THE CITY OF BREMERTON, WASHINGTON, DOES HEREBY RESOLVE AS FOLLOWS: SECTION 1. The Re-development Project Administrator of the Department of Economic Development is hereby directed and authorized to file an application for funding from the Community Economic Revitalization Board - Job Development Fund Program for the Bremerton Downtown Pedestrian Improvements. SECTION 2. Severability. If anyone or more sections, subsections, or sentences of this Resolution are held to be unconstitutional or invalid, such decision shall not affect the validity ofthe remaining portion ofthis Resolution and the same shall remain in full force and effect. SECTION 3. Effective Date. This Resolution shall take effect and be in force immediately upon its passage. day of PASSED by the City Council of the City of Bremerton, Washington this - ,20_ CECIL McCONNELL, Council President APPROVED AS TO FORM: ATTEST: ROGER A. LUBOVICH, City Attorney P AULA JOHNSTON, City Clerk R:\LEGAL\Resolutions\Resolution form.doc 1 DATE SUBMITTED: March 8, 2006 AGENDA BILL CITY OF BREMERTON CITY COUNCIL BILL#~4.{ 5A ...............................................................................aa....... SUBJECT: Purchase of Puget Sound Energy 17,550 sq. ft. parking lot at 10th and Park for a new Court facility. Committee Meeting Date: March 22, 2006 COUNCIL MEETING Date: March 29, 2006 Department: Economic Developmnt. Presenter: Gary Sexton Phone: 360-473-5282 SUMMARY: Staff is recommending the approval of the purchase and sale agreement for the purchase from Puget Sound Energy, of the 17,550 sq. ft. of property at the south west corner of 10th and Park for the construction of a new Court facility. Purchase price of $249,000. A TT ACHMENTS: Real Estate Purchase and Sale Agreement. FISCAL IMPACTS (Include Budgeted Amount): The original scope of the court facility relocation project envisioned remodeling of an existing City facility. The purchase of this land reflects the current direction of acquiring property and building a new facility thereon. With this change in the scope of the project - additional funding of $500,000 will be needed for the Public Safety Bond Fund to provide for the land purchase and additional costs related to new construction. A transfer of $500,000 from the General Fund and additional budget expenditure approval is required to proceed with the land acquisition and construction of the new Municipal Court facility. The remaining funding requirements are provided for by Public Safety Bond proceeds. APPROVALS: DEPARTMENT DIRECTOR: CITY ATTORNEY: FINANCE DIRECTOR: MA YOR: FISCAL/BUDGET: OPERA TrONS: COUNCIL PRESIDENT: I CONSENT AGENDA D I RECOMMENDED MOTION: Move to approve the Puget Sound Energy/City of Bremerton Real Estate Purchase and Sale Agreement and authorize the Mayor to execute these documents in substantially the same form as presented and to approve a 2006 budget amendment and transfer of $500,000 from the General Fund to the Public Safety Bond Fund to cover the purchase of this land and other additional costs. COUNCIL ACTION: 0 Approve 0 Deny 0 Table o Continue 0 No Action REAL ESTATE PURCHASE AND SALE AGREEMENT WITH EARNEST MONEY PROVISION This contract controls the terms of the sale of real property. (Please read carefully before sh!Dine:.) This Agreement is entered between the CITY OF BREMERTON, a Washington municipal corporation ("Buyer"), and Puget Sound Energy, a ("Seller"), for the sale and purchase of real property as follows: 1. PROPERTY. The property, including all improvements and appurtenances situated thereon, which Buyer agrees to buy and Seller agrees to sell, is commonly known to be located at 10th Street and Park Avenue, Bremerton, W ashington (the "Property"), and which Property is legally described in Exhibit A, attached hereto and incorporated herein by this reference. A map indicating the location of the Property is also attached as Exhibit B, incorporated herein by this reference. 2. EARNEST MONEY. Received from Buyer, Five Thousand and No/I 00 Dollars ($5,000.00) in the form of a Promissory Note, as earnest money and part payment on the purchase price for the Property. 3. PURCHASE PRICE. The total purchase price for the Property is Two Hundred Forty Nine Thousand and No/IOO Dollars ($249,000.00), including earnest money, payable on closing. 4. CONTINGENCIES. This agreement is contingent upon: (a) Acceptance of its terms by the Bremerton City Council. (b) Buyers review and approval of the title report on the property prior to Closing. (c) A Feasibility Study as follows: (1) Buyer shall have sixty (60) days from the date of mutual acceptance of this Agreement to determine, in Buyer's sole and absolute discretion, if the Real Property is feasible for investment and/or development by Buyer. (2) Buyer's feasibility study may include (but is not limited to) a Phase I and/or Phase II environmental assessment, utilities availability and capacity, access availability, zoning, preliminary architectural and engineering studies, marketing feasibility. (3) A Phase I environmental assessment generally will consist of a review of title of ownership and land use, review of geologic and hydrologic maps of the area, review of federal and state databases for known hazardous waste generators or contaminated sites and a site REAL EST A TE PURCHASE AND SALE AGREEMENT Page 1 of 5 PSE VlSlt. If the Phase I review reveals the potential of a contaminated site, a Phase II environmental assessment may be conducted which generally will consist of on-site sampling, including the digging or boring of test holes for soil samples. By executing this agreement, Seller hereby authorizes Buyer a right of entfy on to the property for the purpose of conducting this feasibility study including a Phase 1, and if necessary, a Phase II environmental assessment. Seller will be notified if a Phase II environmental assessment is to be conducted. (4) The cost of the environmental remediation work shall be deducted from the property purchase price at closing. (d) Upon receipt of the environmental assessment and the estimated cost of remediation work, each party shall have fifteen (15) days within which to terminate this agreement. If either party exercises this termination right, earnest money paid to Seller shall be returned to Buyer. Should any of these contingencies not be met prior to closing, then this Agreement shall terminate except neither Buyer nor Seller shall have any further rights, duties or obligations hereunder, except that the Earnest Money held in escrow shall be immediately returned to Buyer. 5. CONVEYANCE AND CONDITION OF TITLE. The title to the real property shall be conveyed by Seller to Buyer at closing by Statutory Warranty Deed, free and clear of all liens, encumbrances or defects except those described in Paragraph 6 below. 6. TITLE INSURANCE. At Closing, Seller shall cause Transnation Title Insurance Company, whose address and telephone number is 9619 Levin Road NW, Silverdale, W A 98383; 360-692-4556, to issue a standard form owner's policy of title insurance to Buyer in an amount equal to the total purchase price of the Property. The cost ofthis policy shall be paid from Seller's funds at Closing. For purposes of this Agreement, the following shall not be deemed encumbrances or defects: rights reserved and federal patents or state deeds; building or use restrictions consistent with current zoning, and utility and road easements of record. Iftitle cannot be made so insurable prior to the Closing date called for herein, unless, Buyer elects to waive such defects or encumbrances, this agreement shall terminate. 7. CLOSING COSTS AND PRO-RATIONS. The cost of escrow shall be shared equally between Buyer and Seller, except those fees which are expressly limited by Federal Regulation. Seller ~hall pay for excise tax and revenue stamps. Taxes for the current year, rents, interest, Association, Condominium and/or Homeowner's fees, water and other utility charges, if any, shall be pro-rated as of date of closing unless otherwise agreed. 8. CLOSING OF THE SALE. With the understanding that time is of the essence for this agreement, this sale shall be closed by May 31, 2006 which shall also be the termination date of this agreement unless said closing date is extended in writing by mutual agreement of the parties. When notified, the Buyer and Seller will deposit, without delay, in escrow with Transnation Title Insurance Company, all instruments and monies required to complete the transaction in accordance REAL ESTATE PURCHASE AND SALE AGREEMENT Page 2 of5 PSE with this agreement. Closing, for the purpose of this agreement, is defined as the date that all documents are executed and the sale proceeds are available for disbursement to the Seller. 9. CASUAL TY LOSS. If prior to closing, improvements on said premises shall be destroyed or materially damaged by fire or other casualty, this agreement, at option of the Buyer, shall become null and void. 10. POSSESSION. Buyer shall be entitled to possession on closing. 11. SELLER'S REPRESENTATIONS. Seller represents: (a) that he/she will maintain the property in present or better condition until time of agreed possession, (b) that he/she has no knowledge or notice from any governmental agency of any violation of laws relating to the subject property, (c) that the property is not encumbered by any leases. 12. SELLER'S ENVIRONMENTAL REPRESENT A TIONS. Seller represents that to the best of his/her knowledge that he/she is not aware of existence of, or has caused or allowed to be caused, any environment condition (including, without limitation, a spill, discharge or contamination) that existed as of and/or prior to the closing date or any act of omission occurring prior to the closing date, the result of which may require remedial action pursuant to any federal, state or local law or may be the basis for the assertion of any third party claims, including claims of governmental entities. This provision shall survive the closing and be in addition to Seller's obligation for breach of a representation or warranty as may be set forth herein. 13. DEFAULT AND ATTORNEY'S FEES. (a) Buyer's Default. If Buyer defaults hereunder, Seller's sole remedy shall be limited to damages against Buyer in the liquidated amount of the earnest money previously paid the Buyer. Buyer and Seller intend that said amount constitutes liquidated damages so as to avoid other costs and expenses to either party in connection with potential litigation on account of Buyers' default. Buyer and Seller believe said amount to be a fair estimate of actual damages. (b) , Seller's Default. If Seller defaults hereunder, Buyer shall have all the rights and remedies available at law or in equity. (c) Attorney's Fees and Costs. In the event of litigation to enforce any ofthe terms or provisions herein, each party shall pay all its own costs and attorney's fees. 14. NOTICE TO SELLER. This form contains provisions for an agreement for the purchase and sale of real estate. Buyer makes no warranty or representation of any kind that this form, or any of its provisions, is intended to meet the factual and legal requirements of a particular transaction, or that it accurately reflects that laws of the State of Washington at the time you enter the REAL EST A TE PURCHASE AND SALE AGREEMENT Page 3 of 5 PSE agreement. This agreement has significant legal and financial consequences. By signing this agreement, Seller acknowledges that Seller has or has had the opportunity to consult with an attorney regarding Sellers rights and obligations in this agreement. 15. BROKERS FEES/COMMISSIONS. Seller agrees to indemnify, defend and hold harmless Buyer with respect to any claim by any person or entity claiming through Seller to be entitled to a commission with respect to the transaction contemplated by this agreement. 16. NON-MERGER. The terms, conditions, and provisions ofthis Agreement shall not be deemed merged into the deed, and shall survive the Closing and continue in full force and effect. 17. NOTICES. All notices required or permitted to be given hereunder shall be in writing and shall be sent U.S. certified mail, return receipt requested, or by facsimile transmission addressed as set forth below: (a) All notices to be given to Buyer shall be addressed as follows: City Clerk City of Bremerton 345 6th Street, Suite 600 Bremerton, Washington 98337-1873 (b) All notices to be given to Seller shall be addressed as follows: Either party hereto may, by written notice to the other, designate such other address for the giving of notices as being necessary. All notices shall be deemed given on the day such notice is personally served, or on the date of the facsimile transmission, or on the third day following the day such notice is mailed in accordance with this paragraph. 18. ENTIRE AGREEMENT. This agreement, including all incorporated exhibits, constitutes the full understanding between seller and buyer. There have been no verbal or other agreements that mo~lify this agreement. 19. BINDING EFFECT AND SURVIVAL. This Agreement shall be binding upon parties hereto and their respective heirs, successors and assigns; and the terms, conditions and provisions of this Agreement shall survive the closing of this transaction. 20. DATE OF MUTUAL ACCEPTANCE. For the purposes of this Agreement, the date of mutual acceptance of this Agreement shall be the last date on which the parties to this REAL ESTATE PURCHASE AND SALE AGREEMENT Page 4 of 5 PSE Agreement have executed this Agreement as indicated below. 21. EXPIRATION OF OFFER. Seller shall have only until 5:00 p.m. on March 17, 2006, to accept the purchase and sale agreement as written, by delivering a signed copy thereof to the Buyer or the Buyer's agent. If Seller does not so deliver a signed copy within said period, this agreement shall lapse and all right of the parties hereunder shall terminate. IN WITNESS WHEREOF, the parties hereto have executed this Agreement on the date set forth below. BUYER: SELLER: THE CITY OF BREMERTON PUGET SOUND ENERGY By: Cary Bozeman, Mayor By: Its: Dated: Dated: By: Its: Dated: APPROVED AS TO FORM: By: Roger A. Lubovich, City Attorney R:\LegaI\Legal\Files\Current Active Files\PSE Property Purchase\REPSA.doc , REAL ESTATE PURCHASE AND SALE AGREEMENT Page 5 of5 PSE DATE SUBMITTED: March 13,2006 BILL # O~- O<o~ AGENDA BILL CITY OF BREMERTON CITY COUNCIL ~B ........................................................................................ SUBJECT: Ordinance No. Aq (g(P amending certain chapters of Title 2 BMC relating to Administration and Personnel Committee Meeting Date: March 22, 2006 COUNCIL MEETING Date: March 29,2006 Department: City Attorney's Office Presenter: Roger A. Lubovich Phone: 473-2345 SUMMARY: Staff is proposing amendments to Title 2 BMC relating to the reorganization of certain offices in order to obtain more efficiency in the provision of administrative services of city government. The recommended change includes moving Human Resources and the Risk Management functions into the Financial Services Department; moving Information T€chnology tt) th@ Publi€ W\H:h 8r TTtiliti~~ Dep:;yim~.mt; changing the "Director of Human Resources" position to "Manager of Human Resources" and authorization to move departmental budgets to align with the organizational change. ATTACHMENTS: Proposed Ordinance NO. +qc," FISCAL IMPACTS (Include Budgeted Amount): No changes to budget expenditures are requested. Council approval to amend the budget to authorize a change in title for one position and to move budgets to align with the organizational change is required. APPROV ALS: DEPARTMENT DIRECTOR: CITY ATTORNEY: FINANCE DIRECTOR: MA YOR: ?> FISCAL/BUDGET: OPERATIONS: COUNCIL PRESIDENT: RECOMMENDED MOTION: Move to: 1. pass Ordinance No. 4q (p Cd amending Title 2 BMC relating to reorganization of certain offices; and 2. approve amendment of the adopted 2006 budget to move budgets in accordance with the organizational changes in Ordinance No. ~ and changing the position of Director of Human Resources to Manager of Human Resources per the attached revised Management Salary Plan 2006. I CONSENT AGENDA 0 I COUNCIL ACTION: 0 Approve 0 Deny 0 Table o Continue 0 No Action ;."m....._c.:.,~.~~~.'"""~~~~.~7:,: i; ,;j H ;;1 I' 4oy... ' il..,. ..... '!I.. IL !ll I:', _ ~ _ ." _ ._ . :'__. . _ _ -=~ :!i !:ro,,:'; ""~".~j Memorandum To: City Council Mayor Cary Bozeman From: Laura Lyon, Director of Financ' Roger Lubovich, City Attorn Re: Organizational Changes Date: March 14, 2006 The City Attorney's office recently requested the Mayor to consider an organizational change - incorporating Risk Management functions into the Financial Services Department and consideration of consolidating the Human Resources Department with Financial Services as well. The request was made based on an expectation that better work coordination and use of staff resources would provide efficiency and work product improvements for the City. The Mayor supports the requested change and asked the City Attorney and Director of Financial Services to work together towards that objective. The recommendation before the City Council for approval is to combine Risk Management and Human Resources into the Financial Services Department. It is recommended that the incumbent Director of Human Resources (Carol Conley) have a position change to Manager of Human Resources with the approved salary held at the current rate of pay. The directors of the Legal Department, a~d Financial Services have worked together to form this recommendation and are in agreement that this should provide better. coordination, communication, and improved work efficiencies for these areas that consistently work together and have common interests and concerns. Implementation of this organizational change requires council approval by adoption of an ordinance that updates the BMC regarding departmental responsibilities. In addition, council action must include approval of the position change (Director of Human Resources to Manager of Human Resources) and authorize the move of adopted budgets for these departments to the new departments in accordance with this organizational change. ORDINANCE NO. 4 q Co (0 AN ORDINANCE of the City Council of the City of Bremerton, Washington, repealing Chapter 2.22 of the Bremerton Municipal Code entitled "Human Resources Department" and amending certain sections of Chapter 2.05 entitled "Departments", Chapter 2.06 entitled "City Attorney", Chapter 2.09 entitled "Department of Financial Services", and Chapter 2.92 entitled "Office of Risk Management and Safety", all relating to a reorganization of certain offices for more efficient delivery of administrative services of city government. WHEREAS, the City Council desires to amend chapters ofthe Bremerton Municipal Code relating to city departments in order to obtain more efficiency in the provision of certain administrative services of city government; NOW THEREFORE, THE CITY COUNCIL OF THE CITY OF BREMERTON, WASHINGTON, DOES HEREBY ORDAIN AS FOLLOWS: SECTION 1. Chapter 2.22 of the Bremerton Municipal Code entitled "Human Resources Department" is hereby repealed in its entirety. SECTION 2. Section 2.05.010 of the Bremerton Municipal Code entitled "Departments" is hereby amended to read as follows: 2.05.010 DEPARTMENTS. Departments of the City of Bremerton are created pursuant to the chapters and their provisions as follows: Chapter 2.06 Office ofthe City Attorney Chapter 2.07 Economic DevelopmentDepartment Chapter 2.09 Department of Financial Services Chapter 2.10 Department of Public Works and Utilities Chapter 2.15 Department of Community Development Chapter 2.1(5 Fire Department Chapter 2.17 Parks and Recreation Department Chapter 2.19 Police Department Chapter 2.22 Human Resources Department SECTION 3. Section 2.06.010 of the Bremerton Municipal Code entitled "Department Created" relating to the Office ofthe City Attorney is hereby amended to read as follows: 2.06.010 DEPARTMENT CREATED. There is hereby created the Office of the City Attorney which shall serve as the Legal Department for the city pursuant to the laws of the State of Washington and the Charter of the 1 City Departments City of Bremerton for the purpose of representing the city in all legal matters involving the city. The office shall be managed by the City Attorney who shall serve as its director, and who shall be responsible for hiring and supervising employees of the office. The City Attorney shall oversee the civil and prosecution divisions of the office and the Office of Risk Management and Safety established pursuant to Chapter 2.92 BMC. SECTION 4. Section 2.06.030 ofthe Bremerton Municipal Code entitled "Duties" relating to the Office ofthe City Attorney is hereby amended to read as follows: 2.06.030 DUTIES. To accomplish the directives of the City Charter and requirements of state law, the function of the Office of the City Attorney shall include, but not be limited to: (a} Advise the Mayor, boards, commissions, department heads, Council and its committees, and other City officials and officers, including the rendering of formal legal opinions when so requested or when it appears to the attorney advisable to do so. (b} Attend all regular and special meetings of the Council, unless excused by the President of the Council. (c} Prepare, draft, approve as to form, or supervise the preparation of ordinances, resolutions, leases deeds, contracts and/or agreements, and such other and similar instruments as may be required by the business of the City. (d} Represent the City in criminal prosecutions in Municipal Court and appellate courts. &.- Manage the Office of Risk Management and Safety. (f~.,. Represent the City in all litigation and administrative proceedings in which the City is involved either as a plaintiff or defendant, or recommend the appointment of special counsel therein. (gt) Attend meetings of the Civil Service Commission, pension boards, and other commissions, boards, or committees required by law, or as directed by the Council, or requested by the chair of such board or commission. (fig} Facilitate bond issues; provided, this shall not mean the rendering of an opinion on the validity ofthe bonds in any case where special bond counsel has been retained by the City or by any prospective bond buyer. (in} On request of the Mayor or Council participate in intergovernmental relations affecting the City. liD..,. Keep litigation files and records, and copies of all other official written communications, and deliver same to successors of the Office of the City Attorney. (kj} Direct or participate in proceedings for the vacation of streets, condemnation of land, land acquisition, sale of surplus properties, and related legal transactions. (lk} Prepare and administer the budget for the Office of the City Attorney. (ml} Serve as advisor and/or participant in labor negotiations and approve labor contracts as to form. (Hll!l.,. Coordinate and assist in obtaining information and legal opinion from Municipal Research as requested by the Mayor, Council President, or Chair of the Audit Committee. (elli.,. Prepare and/or approve ballot measures and levies. iP2l.,. Interpret substance, form, and applicability of the City Charter and ensure consistency of all ordinances, resolutions, and administrative rules therewith. 2 City Departments SECTION 5. Chapter 2.09 ofthe Bremerton Municipal Code entitled "Department of Financial Services" is hereby amended to read as follows: Chapter 2.09 DEPARTMENT OF FINANCIAL SERVICES 2.09.010 DEPARTMENT CREATED. There is hereby created the Department of Financial Services. The Department of Financial Services shall consist of the following divisions, as well as any other divisions established by the City Council: 1. Finance; 2. Information Technology; 3. Office of the City Clerk; 4. Human Resources; 5. Office of Risk Management and Safety; and 42.. Bremerton Kitsap Access Television (BKA T). The duties enumerated in each division as set forth in this chapter may be reassigned within the Department of Financial Services at the discretion of the Director of Financial Services for the purpose of achieving work efficiencies. 2.09.020 DIRECTOR OF FINANCIAL SERVICES AND DIVISION MANAGERS - POSITIONS CREATED AND APPOINTMENT. (a) Department Director - Appointment. There is hereby created the position of Director of Financial Services who shall be in charge of the Department of Financial Services and all divisions established thereunder. The Director of Financial Services shall have complete charge of all of the work of the Department and shall be responsible for hiring and supervising employees of the Department. The Director of Financial Services shall be appointed by the Mayor, subject to confirmation by the City Council, on the basis of professional experience, education and demonstrated knowledge of accepted practices relating to the duties of the department. All appointees to the position of Director of Financial Services are terminable at will by the Mayor as set forth in Chapter 2.05 BMC. (b) Division Managers - Appointment. There are hereby created the positions of Finance Officer, Information Technology Manager, Human Resources Manager, City Clerk, Risk Manager, and,Public Access Manager as managers for their respective divisions. The managers (hereinafter "managers" or "division managers") shall manage the operations of their respective divisions and shall report directly to the Director of Financial Services. The division managers shall be appointed by and shall serve at the pleasure of the Director of Financial Services, subject to the approval of the Mayor, on the basis of professional experience, education and demonstrated knowledge of accepted practices relating to the duties of the division. All appointees to the division manager positions shall serve as "at will" employees subject to termination by the Director of Financial Services without cause at any time with no notice or hearing unless otherwise provided pursuant to applicable civil service rule or regulation, the City Charter, ordinance, or terms and conditions as approved by the City Council. 3 City Departments 2.09.030 FINANCE DIVISION CREATED - DUTIES. There is hereby created the Finance Division for the purpose of performing all finance and accounting functions of the City of Bremerton. The division shall be managed by the Finance Officer who shall serve as the City Treasurer. It shall be the duty of the Finance Officer to: (a) Be responsible for assisting in the management of the City's investment and debt portfolios. (b) Assist City administration in budget preparation and monitoring. (c) Maintain the accounting system in accordance with generally accepted accounting principles (GAAP). (d) Maintain the payroll system. (e) Exercise control of accounts payable and purchasing. (f) Maintain an inventory of capital assets. (g) Collect and account for all City funds. The Finance Officer shall perform such other duties as the Mayor and Director of Financial Services may direct or as may be required by law. 2.09.040 INFORMATION TECHNOLOGY DIVISION CREATED - DUTIES. There is hereby created the Information Technology Division for the purpose of performing all information technology operations of the City. The division shall be managed by the Information Technology Manager. It shall be the duty of the Information Technology Manager to: (a) Direct the activities of the Information Technology division with the responsibility to provide technological leadership in systems planning, implementation and support programs. (b) Direct the development and maintenance of long-range information processing plans and budgets. (c) Act as a contact person with user departments responding to and analyzing their mqumes. The Information Technology Manager shall perform such other duties as the Mayor or the Director of Financial Services may direct or as may be required by law. 2.09.050 OFFICE OF THE CITY CLERK CREATED - DUTIES. There is hereby created the Office of the City Clerk for the purpose of performing all records manageme\lt functions of the City. The division shall be managed by the City Clerk. It shall be the duty ofthe City Clerk to act as the official records keeper of the City and in such capacity shall perform those duties as required by the laws of the State, City Charter or City Code. The City Clerk shall perform such other duties as the Mayor or the Director of Financial Services may direct or as may be required by law. 2.09.060 OFFICE OF HUMAN RESOURCES CREATED - DUTIES. There is hereby created the Office of Human Resources. The division shall be managed by the Human Resources Manager. It shall be the duty of the Human Resources Manager to: (a) Assist City departments with recruitment, testing and hiring as applicable 4 City Departments (b) Advise City departments on professional personnel management practices including performance evaluations and employee relations. (c) (d) (e) (f) (g) (h) (i) Program. Support City labor negotiator and negotiations advisory team. Conduct employee training and counseling. Administer employee benefit programs. Maintain personnel records. Perform salary surveys. Serve as liaison between the administration and Civil Service Commission. Coordinate temporary placements in support of the City Workers Compensation The Human Resources Manager shall perform such other duties as the Mayor or the Director of Financial Services may direct or as may be required by law. 2.09.070 OFFICE OF RISK MANAGEMENT AND SAFETY. The division shall be managed by the Risk Manager. It shall be the duty of the Risk Manager to carry out the provisions of Chapter 2.92 BMC. The Risk Manager shall perform such other duties as the Mayor and the Director of Financial Service may direct or as may be required by law. 2.09.()6()080 BREMERTON KITSAP ACCESS TELEVISION (BKAT) DIVISION CREA TED - DUTIES. There is hereby created the Bremerton Kitsap Access Television (BKA T) Division for the purpose of performing all public access television functions of the City. The division shall be managed by the Public Access Manager. It shall be the duty of the Public Access Manager to manage the production, programming and operation of the local access television station. The Public Access Manager shall perform such other duties as the Mayor or the Director of Financial Services may direct or as may be required by law. SECTION 6. Chapter 2.92 of the Bremerton Municipal Code entitled "Office of Risk Management and Safety" is hereby amended to read as follows: _ Chapter 2.92 OFFICE OF RISK MANAGEMENT AND SAFETY 2.92.010 CREATED. There is created the Office of Risk Management and Safety within the Office of the City l\ttomey Department of Financial Services. The supervisor of said office shall be the Risk Manager, who shall report directly to the City AttomeyDirector of Financial Services. 2.92.020 FUNCTIONS. The Office of Risk Management and Safety shall be responsible for: (~+) Loss reduction or prevention where such reduction or prevention is cost effective; 5 City Departments (122) Transfer of risks to other parties where feasible through the purchase of insurance, and/or risk retention through a system of self-insurance and/or participation in programs providing pooled coverage, in whatever combination is most responsible and cost effective; (.QJ.) Coordination and handling of all claims, including workers' compensation claims; and (44) The maintenance of an effective employee safety program within the City. (~~) Writing interdepartmental rules as he or she deems appropriate for the implementation and administration of this chapter. 2.92.030 RESPONSIBILITY - SAFETY, LOSS REDUCTION, PREVENTION. (~-l-) The Risk Manager shall be responsible for risk identification, analysis and control. Under the direction of the Risk Manager, the Safety Officer shall develop and administer the City's Safety Program and ensure compliance with the program by making periodic inspections of City facilities, work sites, and office spaces in regards to employee safety. The Risk Manager and the Safety Officer have full authority to immediately stop any ongoing work when prescribed safety precautions are not being adhered to, or if there are serious concerns for safety until the matter is satisfactorily resolved. (122-) The Safety Officer is not required to be assigned to the Office of the City .\ttomeyDepartment of Financial Services. He or she may be assigned to any other department within the City,. The duties of Safety Officer may also be assigned to one or more persons, but when functioning in that capacity, the Safety Officer will serve under the direction of the Risk Manager. (.QJ.) The Safety Officer, through the Risk Manager, may make written recommendations regarding employee safety to the appropriate Department Head. Should the Department Head disagree with the Safety Officer, a written response shall be made to the Gity "^~ttorneyDirector of Financial Services stating the reasons for the disagreement. The Mayor shall make the final decision regarding implementation of any disputed recommendation. (44) The Safety Officer is responsible for ensuring proper safety training is provided to all City employees and for ensuring that required certifications for employees are kept current. He or she shall also become actively involved in the on-going training programs provided by Human Resources and other departments and ensure that a portion of that training is on Safety Awareness and Loss Prevention. (~~) The~Risk Manager and Safety Officer are permanent members of the City's Safety and Health Committee and shall monitor the Committee to ensure compliance with all applicable WISHA directives, provide input, and offer advice and assistance in helping the Committee to achieve its stated goals. The Safety Officer shall maintain the file of minutes of each Committee meeting. (fe) The City Attorney shall advise and recommend to all City Departments, appropriate contractual clauses providing for indemnity, hold harmless and insurance provisions. The Risk Manager shall review all proposed City contracts, permits and leases to ensure that all contractual provisions relating to indemnity and hold harmless provisions adequately protect the City. 6 City Departments 2.92.040 INSURANCE/SELF-INSURANCE/POOLED COVERAGE PROGRAMS. The Risk Manager is responsible for the design, negotiation, procurement and administration of all insured, self-insured and/or pooled coverage programs: (!!+) The Risk Manager shall determine and recommend the appropriate retention levels and amount of reserves to be established; (!2~) The Risk Manager shall negotiate with insurance brokers for any type of insurance and may recommend that the City engage the services of such brokers; (~';) The Risk Manager shall purchase, with the approval of the City 1^~ttomoyDirector of Financial Services and City Council, all insurance policies, funded self-insurance programs, pooled coverage and related services, and shall administer the same; (Q4) The Risk Manager shall make an annual report to the City Council regarding insurance coverage and the level of retained risk, and such other reports as may be required by Council. 2.92.050 CLAIMS MANAGEMENT - SELF-INSURED WORKERS' COMPENSATION CLAIMS. The Risk Manager, or designee, shall be responsible for the direction and monitoring of all workers' compensation claims to a fair and equitable conclusion. (~+) Every employee shall immediately complete the appropriate report form when work-related injury or illness occurs and promptly forward same to the designated supervisor, who is responsible for immediately forwarding to the Risk Manager with any pertinent comments. The Risk Manager shall complete the employer section. (!2~) The Risk Manager shall coordinate activity on the claim with the claim's administrator, who shall be a certified workers' compensation claims administrator as required by law, including time-loss, medical verification, and instruction involving progress of the claim. (f.';) The Risk Manager shall coordinate with the City Attorney and the Human Resources Director for retaining such outside expertise as necessary for the resolution of claims. These may include, but are not limited to, doctors, rehabilitation specialists, and investigators. The City Attorney's Office may elect to represent the City in all hearings and/or trials involving workers' compensation claims, or shall appoint outside counsel when appropriate. (Q4) The Human Resources Director shall develop appropriate return-to-work opportunities for injured employees and, when feasible, will coordinate the implementation of specific return-to-work plans with the department heads involved. , 2.92.055 CLAIMS MANAGEMENT COMMITTEE. CLAIMS MANAGEMENT COMMITTEE. To assist the Mayor, a Claims Management Committee comprised of the Mayor or designee, City Attorney, Risk Manager, appropriate department head(s), and the City's contracted claims adjuster may convene as needed as determined by the City Attorney. This committee will review large, litigated, or controversial liability and workers' compensation claims against the City. The committee's review shall include: (a) (b) (c) (d) The possibilities for early settlement. Identification of defense and settlement strategies. Identification of defense counsel. Estimation of reserve level necessary for claims resolution. 7 City Departments ( e) Discussion and clarification of loss control responsibilities and policies. 2.92.060 CLAIMS MANAGEMENT - NONLITIGATION CLAIMS. The Risk Manager or designee shall be responsible for the successful conclusion of all nonlitigation claims by or against the City. (~+) The City Clerk is hereby designated to receive all claims. He/she shall forward to the Risk Manager all nonlitigation claims naming the City and/or its officers or employees, which claim(s) allege that said officers or employees, acting within the scope of their duties, caused the claimant damages. (h~) All city departments, divisions and other city agencies shall report immediately to the Risk Manager the occurrence of any accident or incident which may give rise to a claim by or against the city to ensure prompt investigation of the incident. (~J.) The Risk Manager shall initiate and/or coordinate the investigation of all nonlitigation claims. The Risk Manager may employ, subject to the City }~ttom8y'sDirector of Financial Services' approval, the services of claims specialists. All investigation of nonlitigation claims and potential claims shall be conducted as the agent ofthe City Attorney, and protected by the attorney-client privilege and attorney work product rule. (~4) The Risk Manager shall have the authority to deny or negotiate the settlement of any claim to an amount not to exceed $14,999 subject to the approval of the City Attorney Director of Financial Services. (f~) For all nonlitigation claims of $15,000 or more, the Risk Manager shall provide the Director of Financial Services City }~ttorney with a recommendation that the nonlitigation claim be accepted or denied and the reasons therefor. Upon request of the Director of Financial ServicesCity "^~ttornoy, the Risk Manager shall coordinate additional investigation of the claim. The Mayor shall have the authority to accept or deny the claim provided, however, that claim payments in excess of $49,999 shall be subject to approval by the City Council. (ge) The Risk Manager shall maintain complete histories of all nonlitigation claims reported to the office of Risk Management and Safety, and investigation thereof sufficient to document at least a five-year claims history. 2.92.070 CLAIMS MANAGEMENT - LITIGATION CLAIMS. (M-) Service of process on the Mayor, Mayor's designee or City Clerk shall constitute service on the city. No other city official or employee may accept service of a summons and/or complaint unless slich official or employee is specifically named in the lawsuit. (h~) The Mayor, Mayor's designee or City Clerk or defendant employee upon accepting service of the summons and/or complaint, shall deliver copies to the Risk Manager and City Attorney. (fJ.) The Risk Manager shall transmit copies of the lawsuit to the affected department and/or individual and, where appropriate, to the insurance company, pool or representative. The Risk Manager shall advise the City Attorney of the insured status of the lawsuit. (~4) The Risk Manager shall initiate and/or coordinate the investigation of all lawsuits which may be insured against involving the city and/or its officials/employees. The Risk Manager may employ, subject to City Attorney's approval, the services of claims specialists. All investigation of law suits shall be conducted as the agent of the City Attorney, and protected by the attorney-client privilege and attorney work product rule. 8 City Departments (f~) Upon completion of the investigation, or at any time requested by the City Attorney, the Risk Manager shall forward the investigative file to the City Attorney. Upon request of the City Attorney, the Risk Manager shall coordinate additional investigation of the lawsuit. (ge.) The City Attorney shall have the authority to authorize settlements up to $14,999. (n-+.) For all litigated claims of $15,000 or more, the City Attorney shall provide the Mayor with a recommendation that the litigated claim by accepted or denied and the reasons therefor. The Mayor shall have the authority to accept or deny the claim, provided however that settlement payments in excess of $49,999 shall be subject to approval by the City Council. (i&) The City Attorney shall maintain complete histories of all lawsuits sufficient to document at least a five-year history of same. 2.92.075 CLAIMS NEGOTIATION, D~SCUSSION, AND REPORTING. (~-l-) Except as specifically directed by the Risk Manager, Mayor or City Attorney, no city department, division, or other city agency, and no city official or employee, acting individually or collectively, may engage in the following acts: (la) Negotiate or otherwise effect the settlement of a claim or lawsuit involving the city; (Ie) Discuss with persons other than the Risk Manager, Director of Financial Services. Mayor, City Attorney, or persons authorized by the Risk Manager, Mayor or City Attorney, incidents which could reasonably lead to a claim or lawsuit against the city; provided, however, that the employee may discuss the incident with his/her supervisor. (.12.2) Prior to any formal settlement offer, the Risk Manager shall be advised, in writing, of all proposed settlements of claims and lawsuits against the City. The Risk Manager shall seek approval of its insurers, in conformance with the provisions of any insurance policies applicable to the claim or lawsuit. In the event the insurer does not provide necessary settlement approval, no settlement shall be made without the Mayor's written approval and acknowledgment that the City's insurers have withheld approval. (f.;;) The Risk Manager shall annually report to the council the total number and amount of all claims filed against the city and the number and amounts of all claims or lawsuits paid by the city during the preceding calendar year. 2.92.080 RECOVERY OF LOSSES. (~-l-) Act\On for Recovery. The Risk Manager and City Attorney shall be responsible for bringing all actions, including claims and lawsuits, for recovery oflosses to the City arising out of the acts of others. Such losses may include property damage or losses which impact on the City as a result of personal injuries to city officers or employees. In addition, the City Attorney may join the City as a party with any third party; in a lawsuit involving recovery ofloss to the City. (.12.2-) Allocation of Recoveries. Any moneys recovered (excluding costs of recovery) by the Risk Manager or City Attorney on account of losses to the City shall be paid to the budget unit or department which has expended funds and/or materials as a result ofthe loss. Any moneys in excess of those so expended shall be transferred to the risk management fund. 9 City Departments SECTION 7. Severability. If anyone or more sections, subsections, or sentences ofthis ordinance are held to be unconstitutional or invalid, such decision shall not affect the validity of the remaining portion of this ordinance and the same shall remain in full force and effect. SECTION 8. Effective Date. This ordinance shall take effect and be in force ten (10) days from and after its passage, approval and publication as provided by law. PASSED by the City Council the day of ,2006 CECIL McCONNELL, Council President Approved this day of ,2006 CARY BOZEMAN, Mayor ATTEST: APPROVED AS TO FORM: PAULA JOHNSTON, City Clerk ROGER A. LUBOVICH, City Attorney PUBLISHED the EFFECTIVE the ORDINANCE NO, day of day of ,2006 ,2006 R: \Legal\Legal\Ordinances\legal \Departments 2006.doc 10 City Departments CITY OF BREMERTON MANAGEMENT SALARY PLAN - 2006 Includes 2.311% Cost of Living Adjustment PAY SALARY BAND TITLE BASE RATE 1 RATE 2 RATE 3 RATE 4 RATES RATE 6 RATE 7 RATE 8 22 City Attorney APPROX MO 7,632.00 8,019.00 8,219.00 8,425.00 8,635.00 8,851.00 9,072.00 9,299.00 ~Oirector of Financial Services ACTUAL SEMI-MO. 3,816.17 4,009.37 4,109.60 4,212.34 4,317.65 4,425.59 4,536.23 4,649.64 Fire Chief ANNUAL 91,588.17 96,224.82 98,630.44 101,096.20 103,623.60 106,214.19 108,869.55 111,591.29 Police Chief Oir. Of Public Works & Utilities Redevelopment Projects Administrator 21 - APPROX MO 7,265.00 7,632.00 7,823.00 8,019.00 8,219.00 8,425.00 8,635.00 8,851.00 ACTUAL SEMI-MO. 3,632.29 3,816.17 3,911.58 4,009.37 4,109.60 4,212.34 4,317.65 4,425.59 ANNUAL 87,174.93 91,588.17 93,877,87 96,224.82 98,630.44 101,096.20 103,623,60 106,214.19 20 Oir of Community Development APPROX MO 6,915.00 7,265.00 7,446.00 7,632.00 7,823.00 8,019.00 8,219.00 8,425.00 Dir of Economic Development ACTUAL SEMI-MO. 3,457.26 3,632.29 3,723.10 3,816.17 3,911.58 4,009.37 4,109.60 4,212.34 ANNUAL 82,974.36 87,174.93 89,354,31 91,588.17 93,877 ,87 96,224.82 98,630,44 101,096.20 19 City Engineer APPROX MO 6,581.00 6,915.00 7,087.00 7,265.00 7,446.00 7,632.00 7,823.00 8,019.00 Gifc-ef Human Resources Manaqer ACTUAL SEMI-MO. 3,290.67 3,457.26 3,543.70 3,632.29 3,723.10 3,816.17 3,911.58 4,009.37 Dir. Of Parks & Recreation ANNUAL 78,976.19 82,974.36 85,048.72 87,174,93 89,354.31 91,588,17 93,877 .87 96,224,82 18 Assistant Fire Chief APPROX MO 6,264.00 6,581.00 6,746.00 6,915.00 7,087.00 7,265.00 7,446.00 7,632.00 ACTUAL SEMI-MO. 3,132.11 3,290.67 3,372.94 3,457.26 3,543.70 3,632.29 3,723.10 3,816.17 ANNUAL 75,170.67 78,976.19 80,950.59 82,974.36 85,048.72 87,174.93 89,354.31 91,588,17 17 Assistant City Attorney APPROX MO 5,962.00 6,264.00 6,421.00 6,581.00 6,746.00 6,915.00 7,087.00 7,265.00 City Auditor ACTUAL SEMI-MO. 2,981.19 3,132.11 3,210.41 3,290.67 3,372.94 3,457.26 3,543.70 3,632.29 ANNUAL 71,548.53 75,170.67 77 ,049.94 78,976.19 80,950.59 82,974.36 85,048.72 87,174.93 16 Finance Officer APPROX MO 5,675.00 5,962.00 6,111.00 6,264.00 6,421.00 6,581.00 6,746.00 6,915.00 Managing Engineer ACTUAL SEMI-MO. 2,837.54 2,981.19 3,055.72 3,132.11 3,210.41 3,290.67 3,372.94 3,457.26 Public Works Operations Manager ANNUAL 68,100.92 71,548.53 73,337,24 75,170,67 77,049.94 78,976,19 80,950.59 82,974.36 Risk Manager 15 Forestry Manager APPROX MO 5,402.00 5,675.00 5,817.00 5,962.00 6,111.00 6,264.00 6,421.00 6,581.00 Planning Manager ACTUAL SEMI-MO, 2,700.81 2,837.54 2,908.48 2,981.19 3,055.72 3,132.11 3,210.41 3,290.67 Utility Operations Manager ANNUAL 64,819.44 68,100.92 69,803.44 71,548,53 73,337.24 75,170.67 77,049,94 78,976.19 Project Manager Wastewater Manager Development Manager Information Systems Manager Water Resources Manager 14 Assistant Finance Officer APPROX MO 5,141.00 5,402.00 5,537.00 5,675.00 5,817.00 5,962.00 6,111.00 6,264.00 ACTUAL SEMI-MO. 2,570.67 2,700.81 2,768.33 2,837.54 2,908.48 2,981.19 3,055.72 3,132.11 ANNUAL 61,696.07 64,819.44 66,439,92 68,100.92 69,803.44 71,548.53 73,337.24 75,170.67 13 APPROX MO 4,894.00 5,141.00 5,270.00 5,402.00 5,537.00 5,675.00 5,817.00 5,962.00 ACTUAL SEMI-MO. 2,446.80 2,570.67 2,634.94 2,700.81 2,768.33 2,837.54 2,908.48 2,981.19 ANNUAL 58,723.21 61,696,07 63,238.47 64,819.44 66,439.92 68,100.92 69,803.44 71,548.53 12 Fleet Manager APPROX MO 4,658.00 4,894.00 5,016.00 5,141.00 5,270.00 5,402.00 5,537.00 5,675.00 Court Services Manager ACTUAL SEMI-MO. 2,328.90 2,446.80 2,507.97 2,570.67 2,634.94 2,700.81 2,768.33 2,837.54 City Clerk ANNUAL 55,893,60 58,723.21 60,191,29 61,696.07 63,238.47 64,819,44 66,439,92 68,100.92 Parks Maintenance Manager 11 Athletics/Recreation Manager APPROX MO 4,433.00 4,658.00 4,774.00 4,894.00 5,016.00 5,141.00 5,270.00 5,402.00 Public Wks. & Util. Financial Mgr. ACTUAL SEMI-MO. 2,216.68 2,328.90 2,387.12 2,446.80 2,507.97 2,570.67 2,634.94 2,70081 ANNUAL 53,200.33 55,893.60 57,290.94 58,723.21 60,191.29 61,696.07 63,238.47 64,819.44 10 APPROX MO 4,220.00 4,433.00 4,544.00 4,658.00 4,774.00 4,894.00 5,016.00 5,141.00 ACTUAL SEMI-MO, 2,109.87 2,216.68 2,272.10 2,328.90 2,387.12 2,446.80 2,507.97 2,570.67 ANNUAL 50,636.84 53,200,33 54,530.34 55,893,60 57,290.94 58,723.21 60,191.29 61,696.07 CITY OF BREMERTON MANAGEMENT SALARY PLAN - 2006 Includes 2.311% Cost of Living Adjustment PAY SALARY BAND TITLE BASE RATE 1 RATE 2 RATE 3 RATE 4 RATES RATE 6 RATE 7 RATE 8 9 Public Access Manager APPROX MO 4,016.00 4,220.00 4,325.00 4,433.00 4,544.00 4,658.00 4,774.00 4,894.00 ACTUAL SEMI-MO. 2,008.20 2,109.87 2,162.62 2,216.68 2,272.10 2,328.90 2,387.12 2,446.80 ANNUAL 48,196.87 50,636,84 51,902.76 53,200.33 54,530.34 55,893.60 57,290.94 58,723.21 8 APPROX MO 3,823.00 4,016.00 4,117.00 4,220.00 4,325.00 4,433.00 4,544.00 4,658.00 ACTUAL SEMI-MO. 1,911.44 2,008.20 2,058.41 2,109.87 2,162.62 2,216.68 2,272.10 2,328.90 ANNUAL 45,874.48 48,196.87 49,401.79 50,636.84 51,902.76 53,200.33 54,530.34 55,893.60 7 APPROX MO 3,639.00 3,823.00 3,918.00 4,016.00 4,117.00 4,220.00 4,325.00 4,433.00 - ACTUAL SEMI-MO. 1,819.33 1,911.44 2,008.20 2,058.41 1,959.22 2,109.87 2,162.62 2,216.68 ANNUAL 43,663.99 45,874.48 47,021.34 48,196.87 49,401.79 50,636.84 51,902.76 53,200.33 6 APPROX MO 3,463.00 3,639.00 3,730.00 3,823.00 3,918.00 4,016.00 4,117.00 4,220.00 ACTUAL SEMI-MO. 1,731.67 1,819.33 1,864.82 1,911.44 1,959.22 2,008.20 2,058.41 2,109.87 ANNUAL 41,560.01 43,663.99 44,755.59 45,874.48 47,021.34 48,196.87 49,401.79 50,636.84 5 APPROX MO 3,296.00 3,463.00 3,550.00 3,639.00 3,730.00 3,823.00 3,918.00 4,016.00 ACTUAL SEMI-MO. 1,648.23 1,731.67 1,774.96 1,819.33 1,864.82 1,911.44 1,959.22 2,008.20 ANNUAL 39,557.42 41,560.01 42,599.01 43,663.99 44,755.59 45,874.48 47,021.34 48,196.87 4 APPROX MO 3,138.00 3,296.00 3,379.00 3,463.00 3,550.00 3,639.00 3,730.00 3,823.00 ACTUAL SEMI-MO. 1,568.81 1,648.23 1,689.43 1,731.67 1,774.96 1,819.33 1,864.82 1,911.44 ANNUAL 37,651.32 39,557.42 40,546.35 41,560.01 42,599.01 43,663.99 44,755.59 45,874.48 3 APPROX MO 2,988.00 3,138.00 3,216.00 3,296.00 3,379.00 3,463.00 3,550.00 3,639.00 ACTUAL SEMI-MO. 1,494.10 1,568.81 1,608.03 1,648.23 1,689.43 1,731.67 1,774.96 1,819.33 ANNUAL 35,858.40 37,651.32 38,592.60 39,557.42 40,546.35 41,560.01 42,599.01 43,663.99