Hartford Linking Agreement
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DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
LINKING AGREEMENT
BETWEEN
THE CITY OF GLENDALE, ARIZONA
AND
HARTFORD LIFE AND ACCIDENT INSURANCE
THIS LINKING AGREEMENT (this "Agreement") is entered into as of this ___ day of,
___ 2021, between the City of Glendale, an Arizona municipal corporation (the "City"), and
Hartford Life and Accident Insurance, a(n) Connecticut corporation authorized to do business in
Arizona ("Contractor"), collectively, the "Parties."
RECITALS
A.
On June 25, 2020 under S.A.V.E. Cooperative Agreement, the City of Tempe entered into a
contract with Contractor to purchase the goods and services described in the City Provided Life,
AD&D, and Voluntary Supplemental Insurance Contract No. T20-109-01 ("Cooperative
Purchasing Agreement"), which is attached hereto as Exhibit A. The Cooperative Purchasing
Agreement permits its cooperative use by other governmental agencies including the City.
B.
Section 2-149 of the City's Procurement Code permits the Materials Manager to procure
goods and services by participating with other governmental units in cooperative purchasing
agreements when the best interests of the City would be served.
C.
Section 2-149 also provides that the Materials Manager may enter into such cooperative
agreements without meeting the formal or informal solicitation and bid requirements of
Glendale City Code Sections 2-145 and 2-146.
D.
The City desires to contract with Contractor for supplies or services identical, or nearly
identical, to the supplies or services Contractor is providing other units of government under
the Cooperative Purchasing Agreement. Contractor consents to the City's utilization of the
Cooperative Purchasing Agreement as the basis of this Agreement, and Contractor desires to
enter into this Agreement to provide the supplies and services set forth in this Agreement.
AGREEMENT
NOW, THEREFORE, in consideration of the foregoing recitals, which are incorporated by reference,
and the covenants and promises contained in this Linking Agreement, the parties agree as follows:
1.
Term of Agreement. The City is purchasing supplies and/or services from Contractor pursuant
to the Cooperative Purchasing Agreement. According to the Cooperative Purchasing
Agreement, purchases can be made by governmental entities from the date of award, which was
June 25, 2020, until the date the contract expires on June 24, 2022 unless the term of the
Cooperative Purchasing Agreement is extended by the mutual agreement of the original
contracting parties. The Cooperative Purchasing Agreement, however, may not be extended
beyond June 24, 2025 The initial period of this Agreement, therefore, is the period from the
Effective Date of this Agreement until June 24, 2022. The City may renew the term of this
Agreement for three (3) additional one (1) year renewals until the Cooperative Purchasing
Agreement expires on June 24, 2025. Glendale renewals are not automatic and
1/2/2020
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shall only occur if the City gives the Contractor notice of its intent to renew. The City may give
the Contractor notice of its intent to renew this Agreement 30 days prior to the anniversary of
the Effective Date to effectuate such renewal.
2.
Scope of Work; Terms. Conditions, and Specifications.
A.
Contractor shall provide City the supplies and/or services identified in the Scope of
Work attached as Exhibit B.
B.
Contractor agrees to comply with all the terms, conditions and specifications of the
Cooperative Purchasing Agreement. Such terms, conditions and specifications are
specifically incorporated into and are an enforceable part of this Agreement.
3.
Compensation.
A.
City shall pay Contractor compensation at the same rate and on the same schedule as
provided in the Cooperative Purchasing Agreement, which is attached hereto as Exhibit C.
The cost of insurance is dependent on each individual group’s experience. Therefore, the
quote provided to a group may not be valid for another group with differing experience and
population. Any group wishing to purchase coverage from The Hartford will need to provide
us with population information that will allow us to provide the group with appropriate rates.
B.
The total purchase price for the supplies and/or services purchased under this
Agreement shall not exceed seventy thousand dollars ($70,000) for the entire term of
the Agreement (initial term plus any renewals).
4.
Cancellation. This Agreement may be cancelled pursuant to A.R.S. § 38-511.
5.
Non-discrimination. Contractor must not discriminate against any employee or applicant for
employment on the basis of race, color, religion, sex, national origin, age, marital status, sexual
orientation, gender identity or expression, genetic characteristics, familial status, U.S. military veteran
status or any disability. Contractor will require any Sub-contractor to be bound to the same
requirements as stated within this section. Contractor, and on behalf of any subcontractors, warrants
compliance with this section.6. Insurance Certificate. A certificate of insurance applying to this
Agreement must be provided to the City prior to the Effective Date.
7.
E-verify. Contractor complies with A.R.S. § 23-214 and agrees to comply with the
requirements of A.R.S. § 41-4401.
8.
No Boycott of Israel. To the extent A.R.S § 35-393 through § 35-393.03 are applicable, the parties
hereby certify that they are not currently engaged in, and agree for the duration of the
Agreement to not engage in, a boycott of goods or services from Israel, as that term is defined in
A.R.S § 35-393.
9.
Attestation of PCI Compliance. When applicable, the Contractor will provide the City annually
with a Payment Card Industry Data Security Standard (PCI DSS) attestation of compliance
certificate signed by an officer of Contractor with oversight responsibility.
2
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10.
Notices. Any notices that must be provided under this Agreement shall be sent to the
Parties' respective authorized representatives at the address listed below:
City of Glendale
c/o Nancy Rodriguez
5850 W Glendale Ave #B56
Glendale, AZ 85301
And
Hartford Life and Accidental Insurance Company
One Hartford Plaza
Hartford, CT
06155
IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the date and year set
forth above.
"City"
"Contractor"
City of Glendale, an Arizona
Hartford Life and Accident Insurance Co.,
municipal corporation
a Connecticut corporation
By:
By:
Name: Mellissa Wrinn
Title: Assistant Vice President/Operations
Kevin R. Phelps
City Manager
ATTEST:
Julie K. Bower
(SEAL)
City Clerk
APPROVED AS TO FORM:
Michael D. Bailey
City Attorney
3
1/2/2020
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
LINKING AGREEMENT
BETWEEN
THE CITY OF GLENDALE, ARIZONA
AND
Hartford Life and Accident Insurance Company
EXHIBIT A
City Provided Life, AD&D, and Voluntary Supplemental Insurance Contract No. T20-109-01
4
1/2/2020
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
LINKING AGREEMENT
BETWEEN
THE CITY OF GLENDALE, ARIZONA
AND
Hartford Life and Accident Insurance Company
EXHIBIT B
Scope of Work
PROJECT
The Hartford will provide Commuter and Business Travel Insurance for City of Glendale
employees.
5
1/2/2020
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
LINKING AGREEMENT
BETWEEN
THE CITY OF GLENDALE, ARIZONA
AND
Hartford Life and Accident Insurance Company
EXHIBIT C
METHOD AND AMOUNT OF COMPENSATION
1. Contractor will invoice the City of Glendale $15,666 annually for Commuter and Business Travel
Insurance.
2. City of Glendale will Pay by Check or by EFT
NOT TO EXCEED AMOUNT
The total amount of compensation paid to Contractor for full completion of all work required by
the Project must not exceed $15,666 annually or $70,000 for the entire term of the Agreement.
DETAILED PROJECT COMPENSATION
Annual Premium: $16,490.00
3 Year Annual Installment Premium: $15,666.00 Per Year
3 Year Prepaid Premium: $44,523.00
6
1/2/2020
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EXHIBIT A
THE
HARTFORD
City of Tempe
Table of Contents
Section 1
Cover Letter
Section 2
City of Tempe 7.1.21 Life Renewal
Section 3
Proposal Questionnaire and Plan Design
Section 4
Exhibit A — Life and ADD Pricing Sheet
Exhibit A Pricing Section
Section 5
Forms
•
Vendor's Offer — 201-B Form - Signed
•
Antidiscrimination Policy Signed
•
Checklist for Submittal
•
Addendum #1- Signed
Section 6
Samples and Attachments
•
Deviations and Exceptions
•
City of Tempe WC Auto CGL with Al E&O 2020 Certificate
•
Affidavit of Compliance With Tempe City Code
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
THE
HARTFORD
Business Insurance
Employee Benefits
Auto
Home
May 12, 2020
Re: Request for Proposal for City of Tempe
Dear Kim Shelley:
Thank you for considering The Hartford' as the continued Life and AD&D carrier of choice for City of Tempe. It
has been a privilege to be your Life and AD&D provider and we appreciate the opportunity to continue to meet
your Life and AD&D needs. We are also happy to add any new coverage options you may need to complement
your existing suite at this time. As the second largest group life and disability insurer in the market, we are
committed to doing the right things, the right way for our customers.
It is our mission to provide an unparalleled standard of Group Benefits experience for you, at every touch point
to help you attract and retain valuable employees. We welcome the opportunity to continue to provide the best
solution to meet your Life and AD&D benefit needs.
We offer flexible and customized benefit plans to suit your business objectives and the compassionate care
your employees should expect from their benefits provider. Our knowledgeable claim professionals can assist
employees through every step of the claim process when they experience a disabling event or loss of a loved
one.
We realize you have a choice in carriers when providing these important benefits to your customers, and we
thank you for considering The Hartford. We look forward to hearing the results of your review.
Sincerely,
Tony Metzler
Kati Dewyer
Tony Metzler
Kati Dewyer
Regional Account Executive
Client Relationship Manager
1 The Hartford® is The Hartford Financial Services Group, Inc. and its subsidiaries including issuing companies Hartford Life Insurance
Company and Hartford Life and Accident Insurance Company. Home office is Hartford, CT.
This letter includes one or more products, which are issued on the following forms: Accident Form Series includes GBD-2000, GBD-2300, or
state equivalent. Accidental Death and Dismemberment Form Series induces GBD-1000 and GBD-1300, or state equivalent. Critical illness
Form Series includes GBD-2600, GBD-2700, or state equivalent Disability Form Series includes GBD-1000. GBD-1200, or state equivalent.
Life Form Series includes GBD-1000, GBD-1100 or state equivalent. Hospital Indemnity Form Series includes GBD-2800, GBD-2900, or
state equivalent. Blanket Accident Form Series includes BTA-1000, BTA-1300, BSR-1000, BSR-1200 or state equivalent.
Al! insurance benefits are subject to the terms and conditions of the policy. Policies underwritten by the issuing companies listed above
detail exclusions, limitations, reduction of benefits and terms under which the policies may be continued in force or discontinued. This
proposal explains the general purpose of the insurance described, but in no way changes or affects the policy as actually issued. In the
event of a discrepancy between this proposal and the policy, the terms of the policy apply. Complete details are in the Certificate of
Insurance issued to each insured individual and the Master Policy as issued tc the policyholder. Benefits are subject to state availability.
7094 NS 05118
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GROUP BENTS It S RENEWAL PACKAGE
CITY OF TEMPE
THE
HARTFORD
7/1/2020 Renewal Package
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
THE HARTFORD
TABLE OF CONTENTS
Page(s)
BASIC LIFE
1
BASIC AD ND
2
SUPPLEMENTAL LIFE
3
STAND ALONE AD&D
4
SUPPLEMENTAL DEPENDENT LIFE
5
GLOSSARY
6
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RENEWAL BILLING ASSUMPTIONS
7-8
DISCLOSURE
9
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Renewal Annual
Rate
Premium/Fees
Adjustment
Current
Annual
Premium/Fees
Current
Lives
Date
Renewal
Coverage
THE wai_
HARTFORD
OVERVIEW
Thank you for trusting us to help protect one of your company's greatest assets - your employees.
We have completed a review of your current coverage(s) with The Hartford and are pleased to
provide the following renewal information for your consideration. This package provides important
information about the performance of your employee benefits program.
CITY OF TEMPE has been a customer of The Hartford since July 1, 2013. CITY OF TEMPE has
the following programs inforce with The Hartford.
Life
7/1/2020
$135,329
$97,936
-27.6%
AD&D
7/1/2020
$25,730
$25,730
0.0%
Supp Life
7/1/2020
$156,302
$156,302
0.0%
SAADD
7/1/2020
$35,676
$35,676
0.0%
Supp Dep Life
7/1/2020
$48,878
$48,878
0.0%
For more than 200 years, companies like yours have trusted us to help them protect and grow their
businesses. We are committed to delivering an industry-leading Group Benefits experience — with
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
solutions that meet your insurance challenges and employee benefits that help make your
company an attractive and motivating place to work. We appreciate your business and look forward
to being your group benefits carrier of choice for many years to come.
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
Renewal Annual Premium
Renewal Per EE/Year Cost
Rate Guarantee
'Yo Change
:,IARTFORD
Account Name:
Policy Number:
Valuation Date:
BA
CITY OF TEMPE
677950G
4/30/2020 by Accident Year
C
FE
From
1/1/2016
1/1/2017
1/1/2018
1/1/2019
1/1/2020
through
12/31/2016
12/31/2017
12/31/2018
12/31/2019
4/30/2020
Cons\tant Premium
$122,171
$125,846
$128,135
$132,562
$45,037
Total Incurred Claims
$72,000
$203,000
$268,101
$18,511
$9,968
Incurred Loss Ratio
58.9%
161.3%
209.2%
14.0%
22.1%
COST RATIO ANALYSIS AND RATING DEVELOPMENT
$135,329
$:397
$97,936
$60.12
-27 6%
3 Years
1
EXPERIENCE
$$53,752
$571,580
103.2%
Manual Rate
Experience Rate
Credibility
Blended Rate
Current Rate
Current Annual Premium
Current Per EE./Year Cost
$0.150
Commissions
0-0%
$0.093
Premium Taxes
2 1%
66%
Total Retention
16.0%
50 113
Permissible Loss Ratio
84 0%
$0.076
Renewal Rate
$0.055
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
COST RATIO ANALYSIS AND RATING DEVELOPMENT
THE
HARTFORD
Account Name:
Valuation Date:
STAND ALONE BASIC AD&D
CITY OF TEMPE
4/30/2020 by Accident Year
EXPERIENCE
From
1/1/2016
1/1/2017
111/2018
1/1/2019
1M/2020
TOTAL
Through 12/3112016
12/31/2017
12/31/2018
12/31/2019
4/30/2020
Constant Premium
$36,275
$39,308
$40,067
$40,385
$13,592
$101827
$8.578
545%
Total Incurred Claims
$0
$0
$0
$6,224
$3,352
Incurred Loss Ratio
0.0%
0.0%
0.0%
15.4%
24.7%
0.0%
Rate Guarantee
3 Years
2
Manual Rate
Experience Rate
Credibility
Blended Rate
% Change
Current Rate
Current Annual Premium
Current Per EE/Year Cost
$0.021
$0,001
25%
$0.016
$0.018
$25,730
$15.80
Commissions
Premium Taxes
Total Retention
Permissible Loss Ratio
Renewal Rate
Renewal Annual Premium
Renewal Per EE/Year Cost
0.0%
21%
160%
84.0%
80.018
$25,730
$15_79
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
From
1/112016
1/1/2017
1/1/2018
1/1/2019
1/1/2020
Through
12/31/2016
12/31/2017
12/31/2018
12131/2019
4/30/2020
Constant Premium
$131,247
$155,635
$159,386
$159,342
$52,355
Total !new red Claims
$0
$0
$0
$8,863
$4,772
inCtAiried Loss Ratio
0.0%
0.0%
0.0%
5 6%
9.1%
$657,964
$13,635
2.1%
TOTAL
THE.
HARTFORD
SUPP E ENTAL LIFE
Account Name:
CITY OF TEMPE
Policy Number:
677950G
Valuation Date:
4/30/2020 by Accident Year
EXPERIENCE
COST RATIO ANALYSIS AND RATING DEVELOPMENT
Manual Rate
Experience Rate
Credibility
$0.149
ff 0 004
Commissions
Premium Taxes
Total Retention
00%
21%
16 0%
84.0%
Blended Rate
$0 096
Permissible Loss Ratio
$0 152
';56,31)2
$279 81
% Change
Rate Guarantee
$0.152
$156,302
$279 81
00%
3 Years
With this rate structure the employer may be electing to partially support employer paid coverages with the rate for the employee paid
coverages. This means that premiums paid for one coverage may cover the cost of another coverage under the Plan. When we quote rates with
such partial support between the employee paid and employer paid coverages we do so with the understanding that the employer and
employee coverages are part of a single ERISA plan sponsored by the employer and that the employer has determined that the rate structure is
consistent with information provided to employees and with its ERISA obligations. if this understanding is not accurate, please contact us.
3
Composite Renewal Rate
Renewal Annual Premium
Renewal Per EE/Year Cost
Composite Current Rate
Current Annual Premium
Current Per EE/Year Cost
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
THEE
HARTFORD
Account Name:
Policy Number:
Valuation Date:
STAND ALONE SUPPLEMENTAL AD&D
CITY OF TEMPE
677950G
4/30/2020 by Accident Year
EXPERIENCE
From
1/1/2016
1/1/2017
111/2018
1/1/2019
1/1/2020
TOTAL
Through
12/31/2016
12/31/2017
12/31/2018
12/31/2019
4/30/2020
Constant Premium
$12,713
$18,346
$19,162
$19,783
$6,519
$76,522
Total Incurred Claims
$0
$0
$0
$2,890
$1,556
$4,446
Incurred Loss Ratio
0.0%
0.0%
0.0%
14.6%
23.9%
5.8%
COST RATIO ANALYSIS AND RATING DEVELOPMENT
R
4
Current Annual Premium
Current Per EE/Year Cost
Current Rate
Manual Rate
Experience Rate
Credibility
Blended Rate
$0.032
$0.002
8%
$0 029
$0.046
$35,676
$94.38
% Change
ate Guarantee
Commissions
Premium Taxes
Total Retention
Permissible Loss Ratio
Renewal Rate
Renewal Annual Premium
Renewal Per EE/Year Cost
0.0%
2.1%
16.0%
84.0%
S0.046
$35,676
$94.38
0.0%
3 Years
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
From
1/1/2016
1/1/2017
1/1/2018
1/1/2019
1/1/2020
Through
12/3112016
12131/2017
12/31/2018
12/31/2019
4/30/2020
Constant Prerreern
$33,856
$44,631
$46,394
$48,097
$16,398
Total Incurred Claims
$0
$0
$0
$12,887
$1,555
h@ctured Loss Ratio
0.0%
0.0%
0.0%
26.8%
9.5%
$189,376
$14,442
7 . 6 %
THE
HARTFORD
S U P P L E M E N T A L D E P E N D E N T L I F E
Account Name:
CITY OF TEMPE
Policy Number:
677950G
Valuation Date:
4/30/2020 by Accident Year
COST RATIO ANALYSIS AND RATING ❑EVELOPMENT
Manual Rate
Experience Rate
Credibility
Blended Rate
$0.221
Commissions
Premium Taxes
Total Retention
Permissible Loss Ratio
0.0%
$0 018
2.1%
30%
16.0%
$0,160
84.0%
Composite Current Rate
$0 198
$0.198
$48,878
$48,878
Current Per EE/Year Cost
$98 23
$98 23
% Change
0 0%
Rate Guarantee
3 Years
5
Composite Renewal Rate
Renewal Annual Premium
Renewal Per EE/Year Cost
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THEat
HARTFORD
Constant Premium Life
Incurred Claims LTD
Incurred Claims LTD
Net Incurred Claims
STD Incurred Claims
IBNR
Manual Rate
Experience Rate
Credibility
Blended Rate
Total Retention
Permissible Loss Ratio
GLOSSARY
The premium that would have been paid had the current rate
been in effect over the entire experience period.
The incurred claims reflect Paid Claims, Premium Waiver
Reserves, Statutory Interest, and IBNR.
The incurred claims reflect the actual claims paid to date plus the
claim reserve and IBNR.
The net incurred claims reflect the incurred claims plus the time
value adjustment.
The Incurred claims include paid claims plus IBNR.
IBNR is the Incurred but not Reported Reserves established for
claims incurred during the time period that have not been
reported.
The Manual Rate is calculated based on your employees'
demographic profile, plan design, industry and volume of
coverage.
The Experience Rate is calculated based upon Premium and
Incurred Claims experience.
Credibility is the extent to which The Hartford believes prior results
will predict future results. Credibility is calculated based on the
number of lives covered and the number of years in the experience
period.
The Blended Rate is a credibility weighted blend of the Experience
Rate and the Manual Rate.
The total retention allows us to recover expenses associated with
administering your benefit program. These expenses contemplate
claims activity, account structure complexity, commissions,
premium tax, and regularly updated expense factors. These
expense components may fluctuate from year to year.
The Permissible Loss Ratio is the percent of Premium The Hartford
allocates to Incurred Claims.
6
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
$4
ai
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11
so
so
SO
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54
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so
111
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oo
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$4
$0
54
4$1414
P r e m i u m
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7
RENEWAL BILLING ASSUMPTIONS
Current Renewal
Rate
Benefit
Bluing Basis
Rates
Rates
Change
Current Annual
Premium
Renewal Annual
Premium
Basic Late
Per $1.000
50.076
00.055
-27 6%
$135,329
$97,936
AD&D
Per 51,000
50.018
50.018
C.0%
625,730
$25,730
Supplemental Lie Employee Smoker
<25
Pe• 51,000
$0.080
$0.080
0 0%
30
$0
25.29
Per $1,000
50.050
50_080
0.C%
$0
SO
V -31
Per 01.000
$01C0
$0.100
0.0%
8334
5364
35-39
Per $1,000
$0.108
53105
0.0%
5732
$732
40-44
Pe-$l,000
00.150
50.150
0.0%
51.422
01,422
45-49
Per 51,000
$0 280
50.280
00'4,
$2,604
$2,854
50-6#
Per $1,0010
$0420
10 420
0.0%
61,008
01,008
55-55
Pe-61,200
50.650
10650
0.0%
52,808
$2,838
6044
Per 51 OCO
$1 200
51.203
0.0%
51.44C
$1,440
65-69
Per $1600
51.830
$1 830
0.0%
50
00
70-74
Per $1,000
53.530
$3.530
D 0%
$0
$0
754
Per $1600
55.710
$5 710
0.0%
80
00
Supplemental Lie -r.r-,ploybc. Non-Smoker
Per S1,000
$0053
50.050
0.0%
0452
5492
<25
Per $1,C00
50.050
$0050
0.0%
82,370
$2,370
2e-29
Per $1600
50.050
$0.050
0.0%
54,137
$4,137
30-34
Per 51,000
$0.080
50.080
0.0%
$16,051
516.051
35-39
Per S1000
SO 100
$0.100
8.0%
$19,416
$19,416
40-44
Per $1,000
03.140
50.140
0.0%
$28,207
$28,207
4549
Per $1,008
50.210
50.210
0 0%
$31,734
531,734
50-54
Per $1,000
50.340
50.34C
0.0%
830,886
530,886
55 59
Par $1,000
SOW)
$0 KO
0.0%
010.800
510.600
60-64
Pe- $1,000
$0.920
00-920
0-0%
5442
$442
65-69
Per $1,000
$1.770
51 770
0.0%
00
$0
70-74
Per $1,0,00
$2_870
$2 870
00%
02,066
52,066
Supplemental Spouse Lde Smoker
<25
Per $1,030
50.080
50.080
0.0%
$0
SO
25-20
Per $1,000
$0 080
00.080
C.0%
$0
so
30-34
Per $1,000
50.100
50.100
0 0%
60
$0
35-39
Per 51,000
50.100
$0 100
0.0%
$120
3120
40.44
Per 61.000
50.150
00 150
0.016
$258
$288
45-49
Per 51,000
$0280
50280
0.0%
$437
$437
30-34
Per $1,000
80.420
50.420
0.0%
$1.361
y$1,361
55-59
Per 51,000
50.050
00.550
0.0%
$0
So
35-04
Per 51 003
$1.200
51 200
0.0%
50
$0
6549
Per 51.000
$1 830
51.830
0.0%
$0
SO
70.74
Per $1,000
53.530
53.530
C.0%
$0
$0
75.
Per $1,000
55.710
S5 710
0.0%
50
53
Supplemental Spouse Life Non-Smoker
<25
Per $1.300
5C.050
$0.C50
0 0%
SO
10
25-29
Per 81.000
$0050
50.050
0 0%
$306
0308
30-34
Per S1.000
$0.050
03.050
3.0%
5984
5984
.35-39
Par 5'. 600
50.060
$0.080
0.0%
53.293
$3,293
40-44
Per 01,000
$0100
$0100
0.0%
56 120
58,123
'sir
per 51.8.00
50 140
59 140
00%
$7.442
$7.442
50-54
Per 31,000
SO 210
$0 210
0.0%
55.998
55,598
Per 51,000
50.340
53 340
0.0%
55,549
$5.649
60.64
Per 51,000
SO 600
50.600
0.05,
05,256
55 250
65-65
Per 01600
140-920
50.920
0.0%
3994
$994
70-74
Per 51 GOO
51.770
St 770
0-0%
51,082
$1 062
754
Per $1,000
$2.670
$2 870
00%
$689
5689
Supplemental Child Life
Per Unt
$3.342
03 342
0.0%
$9.224
59.224
Stand Alone Suupplernental AD&D - i:1:(exlcuding policeffire)
Per 51,000
$0.029
SO 029
0 0%
54,724
$4,724
Stand Alone Supplememal AD&D -EE & Family (exclud mg pobLeirre)
Per $1 030
50.043
$0 043
0.0%
514 938
$14,930
Stand Alone AD&D - EE Only PoliceiFire
Per $1,000
50.055
50.055
0.0%
$5,528
55,526
Stand Alone AD&D - EE & Family PolroefFirr
Per 51,000
$0073
$0.070
0 0%
59,366
09,368
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
VW,
HARTFORD
DISCLOSURE
The Hartford® is The Hartford Financial Services Group, Inc. and its subsidiaries, including underwriting
companies Hartford Life and Accident Insurance Company and Hartford Fire Insurance Company. Home
Office is Hartford, CT. The Hartford is the administrator for certain group benefits business written by
Aetna Life Insurance Company and Talcott Resolution Life Insurance Company (formerly known as
Hartford Life Insurance Company). All benefits are subject to the terms and conditions of the policy.
Policies underwritten by the underwriting companies listed above detail exclusions, limitations, reduction
of benefits and terms under which the policies may be continued in force or discontinued.
This renewal includes one or more products, which are issued on the following forms: Accident Form
Series includes GBD-2000, GBD-2300, or state equivalent, Accidental Death and Dismemberment
Form Series GBD-1000 and GBD-1300, or state equivalent. Critical Illness Form Series includes GBD-
2600, GBD-2700, or state equivalent. Disability Form Series includes GBD-1000, GBD-1200, or state
equivalent. Life Form Series includes GBD-1000, GBD-1100, Z-PORT, or state equivalent. Hospital
Indemnity Form Series includes GBD-2800, GBD-2900, or state equivalent. Group Retiree Health Form
Series includes GBD-2400, GBD-2500, or state equivalent. In NY, Statutory Disability Form Series
includes GBD-1850, or state equivalent and Statutory Family Leave Form Series includes GBD-1851,
or state equivalent. For HI and NJ Temporary Disability Form Series includes GBD-1850, or state
equivalent. Blanket Accident Form Series Includes BTA-1000, BTA-1300, BSR-1000, BSR-1200, or
state equivalent.
S
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
Proposal Questionnaire
"Ratorn . M!;,,3.; Section with ,or Res. ionse"
Questionnaire responses and supporting documentation provided will be used to evaluate the proposal. In order to
evaluate an Offeror's overall experience and competence to perform the Scope of Work described herein, the City may rely
on additional resources beyond the information provided.
1. General
Question
Re s porise
Provide the address of the facility that will provide The primary Life claim center is located in Windsor,
rd
1The Hartford® is The Hartford Financial Services Group, Inc. and its subsidiaries including issuing companies Hartford Life Insurance Company and
Hartford Life and Accident Insurance Company. Home office is Hartford, CT.
All insurance benefits are subject to the terms and conditions of the policy. Policies underwritten by the issuing companies listed above detail exclusions,
limitations, reduction of benefits and terms under which the policies may be continued in force or discontinued. This proposal explains the general purpose
of the insurance described, but in no way changes or affects the policy as actually issued. In the event of a discrepancy between this proposal and the
policy, the terms of the policy apply. Complete detalis are in the Certificate of Insurance issued to each insured individual and the Master Policy as issued
to the policyholder. Benefits are subject tc state availability.
1
services to the City of Tempe.
CT. This team is supported by additional Life Care
Advocates associated with our Claim Centers in
Arizona, California, Minnesota and Florida. Describe
your company and its history — include The Hartford.' is a leader in property and casualty
2
years in business
insurance, group benefits and mutual funds. With more than
200 years of expertise, founded in 1810, The Hartford is
widely recognized for its service excellence, sustainability
practices, trust and integrity. More information on the
company and its financial performance is available at
https:I/www.thehartford.com. The Hartford Financial
Services Group, Inc., (NYSE: HIG) operates through its
subsidiaries under the brand name, The Hartford, and is
headquartered in Hartford, CT.
3
Please provide contact information for the primary
account representative and a backup contact for
the City of Tempe.
• Contact Name
• Phone Number
P r o v i d e c o n t a c t i n f o r m a t i o n b e l o w
• Cell Phone Number
Kati Dewyer
• e-mail address
Client Relationship Manager
The
W: 480.824.5009
________ .
(A
rit
h a t t a z ; : d , r , 0 : : ) . 1
Tony Metzler
Regional Account Executive
P: 480.824.5003
10 Iviotzerlaihel eardcirci .co
rates or fees quoted in your proposal are firm The Hartfo
reserves the right to change rates in a
and will not be recalculated based on actual guarantee period only if there is an increase or
enrollment.
decrease of 10% or more in the number of insured
persons; addition or deletion of a business entity;
discovery of a material misstatement of reported
experience during the pre-sale process. After the
initial rate guarantee period, we may change the
premium with 31 days' notice.
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
"Return this Section with your Response"
This generally occurs only:
•
At policy anniversary during renewal
•
To reflect a material change to policy terms
•
In response to a change in federal or
state law
5 Provide
information
about your organization's
financial ratings
Hartford Life and Accident Insurance Company has
the following financial strength ratings:
a
A.M. Best
A
b
Standard & Poor's
A+
c
Moody's
A2
d
Fitch
On August 29, 2014, Fitch affirmed and withdrew The
Hartford Financial Services Group, Inc. and all
subsidiary ratings. It was determined a Fitch rating
was no longer required.
e
Other
6 Are you able to provide quarterly reports that
include, by month, paid
premium; paid claims;
insurance volume; approved waiver of premium
claims (including details on the
nature of
disability); and conversions?
While this is not a current practice today, we can do
this going forward. Regarding the premium waiver
claims, due to HIPAA, we are unable to include the
nature of disability.
7 Do you agree that all existing covered participants
be grandfathered at current benefit levels without
evidence of insurability?
We will grandfather all existing insureds and their
current amounts as indicated on the census provided
during the presale process
8 The City requests no loss no gain provisions so
that no participant loses coverage due to a change
in carrier. Do you agree to this provision?
Not applicable as The Hartford is the incumbent
carrier.
9 Firm will be responsible for sending all forms,
information,
and
notification
about
state
requirements for policy conversion and portability
to terminated/exiting employees
Agreed.
10 It will be the responsibility of the awarded firm to
annually survey and update the "smoking" status
of insureds and provide updated data to the City.
How will you accomplish this task?
The Hartford suggests the City's participants
annually certify their tobacco usage status by
answering the following question on their enrollment
form: Have you smoked a cigarette, cigar, used pipe
or chewing tobacco, nicotine chewing gum or snuff
during the 12 months prior to today's date?
The City is responsible for adjusting their invoice
and participants payroll deductions the month
following the status change (such as a change to
non-smoker/smoker status), or as agreed upon
during implementation.
11 Do you agree to the Terms and Conditions of this
RFP?
We accept the terms and conditions regarding the
purchase of insurance from The Hartford. When the
insurance coverage is in effect, however, the terms
and conditions of our insurance contract, a
document which is filed with the state departments
of insurance, must prevail and control our
relationship with the Policyholder and its insureds.
Under applicable insurance law, the insurance
contract must constitute the entire contract of
insurance.
Proposal Questionnaire
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
Proposal Questionnaire
"Return this Section with yDur Rcr
a If No, explain to right
We have provided our deviations to the Terms
and Conditions within the Deviations and
Exceptions document.
12
List
three
(3)
governmental
or
corporate
references for which you currently provide similar
services.
• Organization/Firm Name
a Contact Name
• Phone Number
Provide Reference Information Below
As the current provider of the City's Life, AD&D
coverages, we believe you understand our services
and capabilities. However, if you require additional
references, we can provide them.
See above
See above
2. Basic Life Insurance
Question
Response
1 i Are you able to match the current waiver of Confirmed.
premium benefit exactly for all plans, as listed in
each benefit plan?
a I If not, list all deviations.
What is the length of your proposed elimination The standard Premium Waiver provision requires
period for waiver of premium?
that the following conditions are satisfied:
• The covered person must be less than age 60,
insured and disabled.
• The standard elimination period to qualify for
Premium Waiver is 9 months; however, for the City
of Tempe the elimination period is 6 months
• We must receive acceptable proof of the insured
person's condition within one year of his/her last
day of work.
3 Do you require an employee to be actively-at-work We will provide our Enhanced Continuity of
and dependents to be non-hospital confined?
Coverage provision to address concerns that employees
might lose coverage due to a change in insurance carriers.
This provision extends coverage to employees insured
under the prior plan on the day before our policy effective
date, whether or not they were actively at work on that day.
Any dependents insured under the prior plan on the day
before our policy effective date will not be subject to any
deferred effective date provision ("performing normal
activities requirement").
The amount of coverage is equal to the lesser of the
amount under the prior policy or the amount under our
policy, reduced by any coverage amount in force, paid or
payable under the prior policy or any other amount that
would have been payable if timely election had been made.
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
Proposal Questionnaire
"Return this Section with your Response"
I
I Coverage under this provision ends on the first to
occur: 12 consecutive months from our policy
effective date, the last day you would have been
covered under the prior policy, the date your
insurance terminates for a reason under the
termination provision in the contract, or you become
actively at work as defined in the contract.
a-1 If yes, please describe your definition for each
and how you would handle takeover from the
current carrier so that no covered individual
loses coverage,
No employee will gain or lose coverage or receive a
greater or a lesser benefit due to change in carriers,
provided that the employee was eligible for benefits
the day before our policy's effective date.
4 Is retention calculated as a percentage of claims,
a percentage of premium, or a per capita basis?
For non-participating accounts we are unable
to disclose a specific breakdown of the
various components as this is considered
proprietary information.
For participating accounts, we estimate
retention charges based:
•
Operational Charges
•
Premium Taxes, Licenses & Fees
•
Commissions
a Will you guarantee your retention for the first
year?
The Hartford will maintain retention for the length of
the rate guarantee assuming there are no changes to
the plan design.
b Will you guarantee your retention for multiple
years?
The Hartford will maintain retention for the length of
the rate guarantee assuming there are no changes to
the plan design.
5 What level of credibility will be applied to the City's
claims when the first renewal is performed?
Our renewal methodology uses historical experience
to project future claim liability. Experience is
weighted based on its credibility, and if necessary,
blended with manual rates. Credibility is determined
using account-specific information such as number
of lives, demographics, plan design and claim
experience.
Paid premiums are adjusted for prior rate actions
that allow experience to be evaluated on a constant
premium basis.
Based on the case size, claim activity, and funding
basis (non-PartIcipating, Participating, etc.) a case-
specific retention is calculated. The resulting
relationship between actual plan performance and
total costs of the plan (claims and administration)
is a primary component in determining whether rate
action is necessary.
Your policy's renewal schedule allows for changes in
premium rates andfor plan changes. The Hartford is
flexible on the timing of initial and subsequent
renewals, and welcomes you to discuss this with
your Sales Representative or Client Relationship
Manager. Any change in premium rates are effective
as of the first of the month coincident with the
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
"Return this Section with your RL,Gponsn"
expiration of the current rate guarantee period, or
as otherwise specified.
Life coverage is fully credible (100%) at 25,000 life
years. The Hartford uses all available incurred and
paid claim experience up to five full years to project
future claim liability and set renewal rates.
Incurred claims include experience of paid claims,
reserves for waivers and IBNR, pooling charges for
Life (Participating, only) and Claim Adjustment
Charges (for Portability, Living Benefit Option and
Death Benefit Only, where applicable).
6 How are IBNR reserves established?
IBNR reserves for Life are established using a
table rate based on the exposure. The factor is
applied to the paid claims and paid premium.
We standardly use one formula for setting IBNR Life
reserves; this formula will be the same for the City
as it is for other accounts.
a What percent of premium or claims do you use
for establishing the reserve?
i
Premium waiver reserves are established at the
individual claimant level using the claimants age,
gender, date of disability and coverage amount to set
the reserve.
7 Are waivers of premium claims reserved as some
constant percent of face value or is it adjusted by
age and severity of the disability?
Approved Premium Waiver claim reserves are
established using claimant specific data, including
date of birth, date of disability, gender and face
amount of the claim, This is true for both Basic and
Supplemental Life insurance claims.
The Hartford also sets incurred but not reported
(IBNR) reserves for claims. IBNR reserves are set as
a percentage of annual premium and/or annual
claims, depending on the size of the risk, credibility
of the experience, and various plan design features.
8 Are you able to maintam Beneficiary information i
online? How would employees register?
Yes. The enrollment platform is the system of record
and maintains beneficiary designations when using
the online enrollment capabilities. We can also
manage beneficiaries as a stand-alone offering
through on online platform.
9 Portability—Will you allow ail life and supplemental
life insurance policy will remain in force (becoming
an individual rather than group policy) as long as
the premiums are paid.
Yes. We offer portability as an option on any group
offering Basic Life or Supplemental Life coverage to
their active employees and will require no additional
load to the active rates. This is a Group Term Life
policy available to insureds who terminate
employment with an active employer. Portability
premiums are based on a specified table at group
rates that increase with age. An individual's
portability rate changes with age; it is not frozen at
the age level at which coverage was ported. These
rates are subject to change based on the experience
of the portability pool. Portability is an alternative to
, conversion. No service fee is charged to
employees who port coverage.
Proposal Questionnaire
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
"Return this Section with your Response"
An employee who ports their or their dependent Life
coverage will be allowed to port an equal amount of
AD&D up to the portability maximum.
10 List portability rates.
Thepremium
portability
ratesthatthe employee
areoutlinedin the
Portability
Quarterly
Premiumpe
$1,000byAge
pays for
chart below:
Plus
Age
Rate
<30
0.21
30-34
0.24
35-39
0.33
40-44
0.51
45-49
0.84
50-54
1.44
55-59
2.40
60-64
3.81
65-69
5.91
70-74
9.90
3. Supplemental Insurance
Question
Response
1 Do you have a required minimum participation?
For contributory coverage, our underwriting
requires we maintain the current participation level
of 34%. The Hartford suggests the use of
personalized enrollment materials, since they
usually increase participation levels to a high level.
For non-contributory coverages, we require 100%
participation of eligible employees.
a
What happens if this minimum participation is
not achieved?
The Hartford reserves the right to re-price if the
quoted minimum enrollment threshold is not met.
2 Are you willing to hold an open enrollment and
allow new participants to enroll (subject to GI
limits) or for existing participants to increase life
insurance amounts without medical evidence
(but subject to GI limits)?
Modified Open Enrollment for LIFE coverage
only The Hartford proposes the City a Modified
Open Enrollment instead of an Open Enrollment.
The Hartford believes that Open Enrollments
invite adverse selection and could potentially
harm the stability of your plan.
The following describes The Hartford's standard
offerings for a Modified Open Enrollment:
•
Eligible employees who are not currently
enrolled may elect the first increment of
coverage without E0I, provided the first
increment of coverage does not exceed
the Guarantee Issue level of the plan
•
Eligible employees who are currently enrolled
may elect to increase coverage by one
increment without EOI, provided the
additional increment does not exceed the
Guarantee Issue level of the plan
Proposal Questionnaire
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
Proposal Questionnaire
°rt this Section with your Re s risf•Y'
List portability rates.
•
Standard E01 requirements still apply
for coverage amounts in excess of the
first increment, in excess of one
additional increment or amounts in
excess of the Guarantee Issue level
The premium rates that the employee pays for
portability are outlined in the chart below:
<30
0.21
30-34
0.24
35-39
1 0.33
45-49
50-54
55-59
0 .5814
1.44
2.40
4
Are there any restrictions around participants who
wish to port upon termination?
60-64
3.81
65-69
5.91
70-74
9.90
Portability is subject to the following limitations
and exclusions:
• Portability is not available to those entering
active military service. Employees who port
coverage must be below the Social Security-
defined retirement age. Coverage must be
requested within 31 days following the date the
active Group Life coverage ends, or within 15
days from the date the employer notifies the
employee of the right to port. E01 is not
required to port coverage.
• We can provide portability where allowed by
state law. The state of residence is not
necessarily the same as the state in which the
active policy is issued or the employer is
located. Portability is not available if coverage
terminates due to termination of the Group Life
policy or if the individual is over the Social
Security Normal Retirement Age.
• Portability amounts are subject to a 75%
reduction at age 65 and portability coverage
terminates at age 75. The insured is eligible to
convert the amount of coverage lost under
the age reduction and when the portability
policy terminates.
• A benefit will not be paid if death due to suicide
occurs during the first two years of coverage
under the Portability policy. However, in that
event, unused premium will be refunded.
Rate
Portability Plus
Quarterly Premium
per $1 .000 by Age
AgS
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
"Return this Section with your Response"
5 Will all new hires be guaranteed insurability up
to the maximum level of policies without
medical evidence?
The auarantee issue limit for:
•
The employee is $200,000
•
The spouse is $50,000
•
The child is $10,000
The Hartford requires EOI for any employee, spouse
(or domestic partner if allowed by state law), or
child when amounts are selected above the
guarantee issue limit. EOI due solely to a salary
increase will not be required unless such an
increase puts the Supplemental Life Insurance
coverage over the guaranteed issue limit.
EOI will be required if an individual elects to Increase
their coverage or if an individual's coverage
increases because of a salary increase of $25,000 or
more within one year.
6 Will employees be able to purchase supplemental
AD&D without purchasing supplemental life?
Confirmed.
Proposal Questionnaire
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
"Return
Sec,. ion with y
Resporis.,
4. Current Plan Designs —
4.1
Basic Life — Provided by the City
F
Cfass ifieatior4
i Basic Coverage Provided
1,,......i.- ....i-i-i- • -
_.
.
.
Indicate if you "match' or
stout deviation from request
City Managers
2x Basic Yearly Earnings to a maximum
of $500,000
Match
City Attorney
1.5x Basic Yearly Earning to a maximum
of $500,000
Match
Fire Union Employees
$75,000 plus lx Basic Yearly Earnings to
a maximum of $200,000
Match
RI
Mayor and Council Members
$50,000
Match
Police Union Employees +
Detention Sergeants
$50,000 plus lx Basic Yearly Earnings to
a i maximum of $200,000
Match
Al! Other Employees
lx Basic Yearly Earnings to a maximum
of $200,000
Match
Coverage Reduction Ages
Percentage Provided
70
i
65%
M a,tch
75
45%
Match
Additional Benefits Provided
Waiver of Premium
1 Total disability beoinnino before 60in birthday
Match
Accelerated Benefit
Portability
Conversion
Not to exceed 80% of Life Insurance in force
Life insurance policy will remain in force
(becoming an individual rather than group
policy) as long as the premiums were paid.
Lesser of $2,000 or the amount of Life
Insurance which stops, minus the amount of
other group insurance for which the
participant becomes eligible for within 31
days of the date the insurance stops.
Match
Match
Match
The yearly salary/wage is for base employee pay and does not include bonuses, commissions, or
overtime pay. Benefit rounded to the next higher $1,000 multiple.
List any enhancements that you will provide at no additional cost
Dollar or Percent
of Principle Sum
Proposal Questionnaire
Benefit
Any plan design changes can be discussed.
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
"Return this Section with your Response"
4.2
AD&D — Provided by the City
Claggifioation
) Coverage intro-natio':
-iiii.irESTOrni)
matr.rt or sta't?
:i,.= [attar from reQuest
All full-time active employees working a
minimum of 20 hours per week, other than the
Mayor, Councilmember, and City Managers
lx Annual Earning to a
maximum of $200,000
Match
Mayor and Council Member
$50,000
Match
All active city managers
lx Annual Earnings to a
maximum of $500,000
Match
Coverage Reduction Ages
Percentage Provided
70
65%
Match
75
45%
Match
80
30%
Match
85
15%
Match
1:)r.0
Coverage
indicate if you matcn' or state
Provided
devratior, from request
Loss of life
100%
Match
Loss of both hands
100%
Match
Loss of both feet
100%
Match
Loss of entire sight of both eyes
100%
Match
Loss of one hand and one foot
100%
Match
Loss of one hand and entire sight of one eye
100%
Match
Loss of one foot and entire sight of one eye
100%
Match
Loss of speech and hearing (both ears)
100%
Match
Movement of both upper and lower limbs (Quadriplegia)
100%
Match
Movement of both lower limbs (Paraplegia)
75%
Match
Movement of three limbs (Triplegia)
75%
Match
Movement of upper and lower limbs of one side
(Hemiplegia)
50%
Match
Loss of one hand
50%
Match
Loss of one foot
50%
Match
Loss of sight of one eye
50%
Match
Loss of speech
50%
Match
Loss of hearing (both ears)
50%
Match
Movement of one limb (Uniplegia)
25%
Match
Loss of thumb and index finger of the same hand
25%
Match
Proposal Questionnaire
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
List any enhancements that you will provide at no additional cost
Bt4r3efil
1 1.
111111W--
7 D o l l a r o r P e r o W i 7 V i R I n c i p t a
S u m
Any plan design changes can be discussed
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
"Return this ,SeCtiCii' Wit a Ou.r
4.3
Commuter and Business Travel Insurance — Provided by the City
This coverage is paid in addition to any other provided coverage.
. Description
i
(1;:evieragt:I
r'.• i
r.f.t1:ff?;‘
, Wdicete itvoLii, 'Match or.
,
'
...t C..71: rdi,l'iiiti:Ut7, TTi..ir:•r:eq-
Principal Sum
$250,000 I Match
Coverage for Spouse when accompanying the insured
1_
$25,000 J Match
Coverage for Children when accompanying the insured (each child) 1
$10,000 i Match
Total Limit of Liability
I $2,000,000 I The aggregate limit per
accident is $2,000,000
Coverage Reduction Ages
Percentage
Provided
70
65% The Principal Sum for
Insured Person's Ages 70-
74 are reduced by 65%
75
45% lThe Principal Sum for
Insured Person's Ages 75-
79 are reduced by 45%
80
30% The Principal Sum for
Insured Person's Ages 80-
84 are reduced by 30%
85
15% The Principal Sum for
Insured Person's Age 85
and older are reduced by
15%
i i
The Commuter and Business Travel Accident Insurance also provides the following additional benefits:
The Commuter and Business Travel Accident Insurance also provides the following additional benefits:
: benefil,
I.
Percent of -Principle s Maximum tar1
Indicate if you -match" or state 1
i-
Sim
Sikkfifil
deviation from request.
Adaptive Home Vehicle
10%
$25,000
Match
Education benefit
2.5%
$2,500 S Match
Spouse Education Benefit
2.5% I $2,500
Match
Rehabilitation benefit
10%
$25,000
Match
Seat belt benefit
10% i $25,000
Match
Airbag benefit
5%
$10,000 i Match
Proposal Questionnaire
Peril
• Cr :,ens --c4it.
Indicate If.yo-t!.*.r.n::_Atzt.7 on
stte dev,a-i;ortiord r,,iy2.Jest,
J
Loss of Life
100%
Match
Loss of any two: hand, foot or eyesight
100%
Match
Loss of Speech and Hearing (both ears)
w
100%
Match
Quadriplecia
100%
Match
Loss of one hand or foot, and sight in one eye
l
100%
Match
I Paraplegia
75%
Match
Loss of movement cf both upper and lower limbs on one side of
body (Hemiplegia)
1 50%
Match
Either hand or foot
50%
Match
Sight of one eye
50%
Match
Loss of Speech
50% I Match
Loss of Hearing (both ears)
50% I Match
L Hemiplegia
50% ' Match
I Loss of thumb and index finger on the same hand
i
25%
Match
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
"Return this Section with your Response"
I Therapgutic Counseling
10% l
$25,000
Match
List any enhancements that you will provide at no additional cost
Benefit
Bereavement Counseling
Coma
Dalla- Di Percer,
$100 per visit to a max of $500
1% for each month after the 30 day Waiting Period
P roposal Questionnai re
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
Proposal Questionnaire
"'Return this Section with your Response"
4.4
Supplemental Life Insurance — Purchased by Employee
aes0P$11,1
,
=
•Woye. rage informitien
•
$20,000 to $500,000
' .,,Ts- ._-_,:z., .z.. '.
.o..zr. I ..,
;:
Employee Benefit
i Match
Guaranteed Issue Amount
Less of $200,000 or 3x Basic Yearly
Earnings
IMatch
Benefit increments
$10,000
I Match
Spouse or Domestic Partner Benefit
$10,000 to $250,000
Match
Spouse Guaranteed Issue Amount
$50,000
t Match
Spouse Benefit Increments
$10,000
Match
Dependent Benefit
$5,000 or $10,000
Match
Dependent Guaranteed Issue Amount
$10,000
Match
Dependent Age
i 14 days to 26 years
Match
Coverage Reduction Ages
Percentage Provided
70
65%
I Match
75
45%
j Match
List any enhancements that you will provide at no additional cost
I Benefit
li
t.5oiar or Percent of
Principle Sum
Any plan design chances can be discussed.
4.5
Supplemental AD&D — Purchased by Employee
Description
i Cr,vemoo Provided
1 indicate
if you 'match'
or
state deviation from re uesi
Employee Benefit
Between $25,000 and $500,000 in units of $25,000
Match
Employee
Benefit
Maximum
Benefit amounts over $25,000 cannot be greater than 10x
i Earnings
Match
Spouse Benefit
40% of Employee
Match
Dependent Benefit
10% of Employee Benefit
i Match
Coverage
Reduction Ages
Percentage Provided
70
65%
l Match
80
30%
Match
85
15%
Match
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
75
45%
i Match
I
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
"Return this Section with your Response"
r-Peril
_
4111.1111111
I Coverage
i Provideu
1- Dependenl
Indicate if yoTatal All
Child
state d'vatini_, rrv-- agues'
Loss of life
1100%
100%
The Principal Sum that
applies to each person
covered under The Policy
as Your Dependent, on
the date of accident, is
determined by
multiplying Your
Principal Sum by the
percentage determined
below: Spouse only 50%
Spouse and Dependent
Child(ren) 40%110%
Dependent Child(ren)
only 15%
Principal Sum for any one
Child cannot exceed the
lesser of the amount
calculated above or
$50,000.
Loss of both hands
100%
200%
See above for
Dependents
Loss of both feet
100%
200%
See above for
Dependents
Loss of entire sight of both eyes
100%
200%
See above for
Dependents
Loss of one hand and one foot
100%
200%
See above for
Dependents
Loss of one hand and entire sight of one eye
100%
200%
See above for
Dependents
Loss of one foot and entire sight of one eye
100%
1 200%
See above for
Dependents
Loss of speech and hearing (both ears)
100%
200%
See above for
Dependents
Movement of both upper and lower limbs
(Quadriplegia)
100%
200%
See above for
Dependents
Movement of both lower limbs (Paraplegia)
75%
150%
See above for
Dependents
Movement of three limbs (Triplegia)
75%
150%
See above for
Dependents
Movement of upper and lower limbs of one
side (Hemiplegia)
50%
100%
See above for
Dependents
Loss of one hand
50%
100%
See above for
Dependents
Loss of one foot
50%
100%
See above for
Dependents
Loss of sight of one eye
50%
100%
See above for
Dependents
Loss of speech
50%
100%
See above for
Dependents
Loss of hearing (both ears)
50%
100%
See above for
Dependents
Movement of one limb (Uniplegia)
25%
50%
See above for
Dependents
Proposal Questionnaire
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
Proposal Questionnaire
i this Section with youi
I Loss of thumb and index finger of the same hand
I 25%
1 50%
I See above for
Dependents
*Up to a maximum of $50,000
The supplemental AD&D also provides the following additional benefits:
Benefit
Percent ot
aft!filory, Ptoilio
InActitE ft yol I match- or
state deviatiott,illinn requebi
Prtmc)pie Sun!
6,TI-..,f4.
Seat belt benefit
5%
$5,000
Match
Child education benefit
5%
$5,000
Match
Day care benefit
3%
$3,000
Match
Rehabilitation benefit
$10,000
Match
Spouse education benefit
E$5,000
Match
HIV occupational accident benefit
20%
Match
Other benefits provided
Coma benefit
Included
Waiver of premium
Included
Conversion right
Included
Dependent child dismemberment
benefit
I
1
Included
List any additional benefits that you will provide at no additional cost
Benefit
Ptiit)otple:StirOi.
Dollar or, PertVerit
i
]
Any plan design changes can be discussed.
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
Price Sheet - Life and AD&D Insurance 20-109
Hartford Life and Accident Insurance Company
Rates are monthly cost per $1000 of coverage*
City Provided Coverage
Current
Year
City Provided Coverage
Basic Life
Volume
$148,403,41
Number
Insured
1,628
Rate
0.0550
Extended
$
0
AD&D
$119,113,321
1,628
0.0180
0
Comm uter/Travel Insurance (annual rate/employee)
1,628
Supplemental Life - Non-Smoker
Age
Volume
Insured Rate
Extended
<25
$820,000
5 0.0500
$
0
25-29
$3,730,000
25 0.0500
$
0
30-34
$6,635,000
48 0.0500
$
0
35-39
$16,440,000
100 0.0800
$
0
40-44
$15,860,000
90 0.1000
$
0
45-49
$16,980,000
91 0.1400
$
0
50-54
$12,593,000
84 0.2100
$
0
55-59
$7,470,000
68 0.3400
$
0
60-64
$1,650,000
20 0.6000
$
0
65-69
$40,000
1 0.9200 $
0
70-75
$0
1.7700
> 75
$60,000
1
2.8700 $
0
supplornentw t iff %itinnkAr
Age
Volume
Insured
Rate Extende
<25
$0
0
0.0800
25-29
$0
0
0.0800
30-34
$320,000
2
0.1000 $
0
35-39
$610,000
4
0.1000 $
0
40-44
$790,000
6
0.1500
45-49
$790,000
4
0.2800
50-54
$50,000
1
0.4200 $
0
55-59
$260,000
3
0.6500 $
0
60-64
$100,000
1
1.2000 $
65-69
$0
0
1.8300 $
0
70-75
$0
0
3.5300 $
0
> 75
$0
0
5.7100 $
0
Supplemental Child Coverage
Option
i of Policies
Cost
Extended
$5,000 Dependent Child
32
1.8000
$10,000 Dependent Child
198
3.6000
Voluntary AD&D - Excluding Police and Fire
ClassIficaton
Volume
Insured Rate
Extended
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
Employee only
$13,000,000
100
0.0290$
0
Employee and Family
$28,900,000
163
0.0430$
0
Voluntary ADSED - Police and Fire
Classificaiton
Volume Insured
Rate Extended
Employee only
$8,3771,000
54
0.0550$
0
Employee and Family
Total Monthly Co
Total Annual Co
$11,650,000
st
st
59
0.0700 $
0
*Commuter/Travel and Supplemental Child coverages are priced per category or
policy Provide rate even if there is no current volume
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
Year 2
Yedr 3
Year 4
Year 5
Rate Extended
Rate Extended
Rate
Extended
Rate Extended
0.0550
0
0.0550
N/A
N/A
0.0180
0
0.0180
0
N/A
N/A
Rate Extended Rate
Extended
Rate Extended
Rate Extended
0.0500 $
0
0.0500 $
0
N/A
N/A
0.0500 $
0
0.0500 $
0
N/A
N/A
0.0500 $
0
0.0500 $
0
N/A
N/A
0.0800 $
0
0.0800 $
0
N/A
N/A
0.1000 $
0
0.1000 $
0
N/A
N/A
0.1400 $
0
0.1400 $
0
N/A
N/A
0.2100 $
0
0.2100 $
0
N/A
N/A
0.3400 $
0
0.3400 $
0
N/A
N/A
0.6000 $
0
0.6000 $
0
N/A
N/A
0.9200 $
0
0.9200 $
0
N/A
N/A
1.7700
1.77001 $
0
N/A
N/A
2.8700
0
Rate Extended
2.8700 $
0
Rate
Extended
N/A
Rate Extended
N/A
Rate Extended
0.0800
0.0800
N/A
N/A
0.0800 $
0.0800
N/A
N/A
0.1000 $
0
0.1000 $
0
N/A
N/A
0.1000 $
0
0.1000 $
0
N/A
N/A
0.1500 $
0
0.1500 $
0
N/A
N/A
0.2800 $
0
0.2800 $
0
N/A
N/A
0.4200 $
0
0.4200 $
0
N/A
N/A
0.6500 $
0
0.6500 $
0
N/A
N/A
1.2000 $
0
1.2000 $
0
N/A
N/A
1.8300
1.8300 $
N/A
N/A
3.5300
3.5300
N/A
N/A
5.7100
5.7100
N/A
N/A
Cost
Cost Extended Cost
Extended
Extended
Cost Extended
1.8000
1.8000
N/A
N/A
3.6000
Rate Extended
3,6000
Rate
Extended
N/A
Rate Extended
N/A
Rate Extended
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
0.0290 $
0
0.0290$
0
N/A
N/A
0.0430
0
0.0430$
0
N/A
N/A
Rate Extended
Rate Extended
Rate Extended
Rate Extended
0.0S$0
0
0.0550$
0
N/A
N/A
0.0700
0
0.0700$
0
N/A
N/A
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
"Return this Section with your Response"
Complete the attached Excel sheet labeled
Exhibit A — Life and ADD Pricing Sheet.
Less prompt payments discount terms of N/A % N/A days/ or net thirty (30) days. (To apply after receipt and acceptance of
an itemized monthly statement.) For evaluation purposes, the City cannot utilize pricing discounts based upon payments being
made in less than thirty (30) days from receipt of statement.
Ordering and invoice Instructions
Invoices shall be issued directly to the ordering department. Invoices shall be accurate and complete including the information
shown below. Failure to provide a properly documented invoice may cause a delay in receipt of payment. The City will not
process an invoice for payment until it has been approved by the ordering department and forwarded to Accounts Payable.
The City endeavors to process invoices within 30 days after receipt of an accurate and complete document.
Invoices shall include:
1.
Line item listing of all ordered items to include description of items;
2.
Unit cost and extended cost for each line item;
3.
Applicable Tax;
4.
Payment Terms;
5.
Purchase Order Number;
6.
Name of selling organization clearly stated on invoice along with address;
7.
Phone number and or e-mail address for contact person to clarify invoicing questions;
Invoices that do not follow the above minimum invoicing requirements will not be paid. Payment must be applied to only invoices
referenced on check/payment stub. The City reserves the right to process payments via check or P-Card.
Accounting Contacts:
Yesenia Loredo-Flores
Letters A— H and Numbers
Carlene Foster
Scott Gruber
Letters I — Z
General AP Inquiries and AP Checks
Pricing Section
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
Vendor' s Offer I F o l m 2 0 1 . 1 3 1
No
X
No
Will your company accept Payment via ACH (Automated Clearing House) for payment?
Yes
Payment Options
Will your company accept the City's Master Card for payment?
Not applicable.
Company Tax Information
If a Tempe-based firm, provide Tempe Transaction Privilege (Sales) Tax No.:
Philadelphia, PA. 19178-3690
City, State, Zip:
Remit to Information
Company Name (as it appears on invoice):
The Hartford
Company Payment Remit to Address:
S t r e e t A d d r e s s ;
P . O . B o x 7 8 3 6 9 0
Cell Number: (480) 343-7477
E-mail Address: Tony.Metzlertthehartford.com
Phone Number: (480) 824-5003
Contact Person: Tony Metzler
Hartford, CT 06155
City, State, Zip:
One Hartford Plaza
Street Address:
Company Purchase Order Mailing Address:
Hartford Life and Accident Insurance Company
Company Name:
DocuSign Envelope ID: 953636CA-7F38-404C-
CB2CBDF5738.13
"Return this Se.ctk
iith
F7,:porsf„?.."
Offeror must complete, sign and submit this form to the Procurement Office with the proposal response. An unsigned
"Vendor's Offer', late proposal response, and/or a materially incomplete response will be considered nonresponsive and
rejected. Offeror is to type or legibly write in ink all information required below. A scanned copy of this page is acceptable.
THIS PROPOSAL IS OFFERED BY
REQUIRED SIGNATURE OF AUTHORIZED OFFEROR
By signing this Vendor's Offer, Offeror acknowledges acceptance of all terms and conditions contained herein and that prices offered
were independently developed without consultation with any other Offeror or potential Offeror. Failure to sign and return this form
with proposal response will be considered nonresponsive and rejected
DocuSignod by:
slk.t1t. 61,1 saLksti
urecefAuthorized Offer
05/12/2020
Date
Sheila W. Sokolski
Assistant Vice President
Print or Type Name of Authorized Individual
Title of Authorized Individual
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
Anti- Discrimination Policy
Tempe.
wtives.1;: tit' drsert
COMPLIANCE WITH CITY'S ANTIDISCRIMINATION
ORDINANCE NO. 02016.25
The Tempe City Council approved Ordinance No. 02016.25 that requires vendors who are being recommended for
award to provide evidence of their compliance with the City's antidiscrimination policy as shown below-
Sec. 2-601. Policy.
It is declared to be the policy for the citizens of Tempe, Arizona, to be free from discrimination in public accommodations,
employment, and housing, and contrary to public policy and unlawful to discriminate against any person on the
basis of race, color, gender, gender identify, sexual orientation, religion, national origin, familial status, age, disability, or
United States military veteran status, in places of public accommodation, employment, and housing; and contrary
to the policy of the city and unlawful for vendors and contractors doing business with the city to discriminate, as set
forth in this article.
Sec. 2-603. Unlawful Practices.
The following shall constitute a violation of this article:
For a city vendor or city contractor, because of race, color, gender, gender identify, sexual orientation,
religion, national origin, familial status, age, disability, or United States military veteran status, to refuse to hire or
employ or bar or discharge from employment any person, or to discriminate against such person in compensation,
conditions, or privileges or employment. City vendors and contractors of fifteen (15) or more employees shall provide
a copy of its antidiscrimination policy to the Procurement Officer to confirm compliance with this article. Employers
having fourteen (14) or less employees may attest in writing to compliance with this article.
Vendor Requirements
Vendors who have fifteen (15) or more employees shall include with their bid/proposal submittal a copy of its
antidiscrimination policy that must mirror the City's policy as stated above. Suppliers who have fourteen (14) or
less employees may include their antidiscrimination policy or complete a written affidavit of compliance per the attached.
To be completed by responding company and returned with submittal:
X
Our company has 15 or more employees and has included its antidiscrimination policy that mirrors the
City's policy;
Our company has fourteen (14) or less employees and is attaching the signed AFFIDAVIT OF
COMPLIANCE WITH TEMPE CITY CODE CHAPTER 2 ARTICLE VIII SECTION 2-603(5).
Please include this document along with the company's antidiscrimination policy or the completed affidavit
with offer submittal
The Hartford is an equal opportunity employer that requires that all individual employment decisions be based
on that individual's performance, qualifications, and abilities. The Hartford does not permit and will not
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
tolerate discrimination in employment opportunities or practices on the basis of race, color, sex, religion,
age, national origin, disability, veteran status, sexual orientation, gender identity or expression, marital
status, ancestry or citizenship status, genetic information, pregnancy status, or any other characteristic
protected by law. The Hartford maintains an Equal Employment Opportunities Policy and complies with
Executive Order 11246.
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
Alert — If you received this solicitation via a third-party plan-holder company and did
not directly download it from the City of Tempe's Procurement home page you might not
have received any addendums that were published during the bidding period. To ensure
you are notified of addendums it is critical that you download this solicitation from the
City's web site per the below link:
https://ww2.tempe. Ci ov/bi ds/
The following checklist has been provided to assist you in submission of your offer.
This list should not be considered complete, other information or documents may be necessary as part of your submission.
The items listed are the primary documents and information that must be completed and/or included with your proposal,
Please include any additional information or documents that will clarify your submittals.
This document has been issued in Word format to allow the responding firm the ability to provide requested information,
answer questions and provide pricing within the actual document.
Description
Included
1.
One signed and completed copy of the Proposal response — only
sections marked 'Return this Section with your Respons'
ar
e required but you may include supplemental materials you
believe necessary to clarify your submittal.
1
a.
Signed and Completed Vendors Offer Form
•
7
2.
Due to the COVID Virus, please submit a single e-copy of the
signed and completed proposal. The City's e-mail is capable of
accepting up to a 10MB attachment. Please try and keep the
proposal under this size limit. However, if you need to exceed
10MB, please break the proposal up into two sections and e-mail in
two separate messages clearly indicating the solicitation number on
the subject line and denoting Part 1 and Part 2 response. We will be
unable to accept any hard copies of the proposal so please e-mail
the response as noted above.
1
3.
Proposal Questionnaire and Plan Design
•
.
('
4.
Pricing Section (Excel Document)
-,,
5.
If company has 14 or less employees include a signed and
completed Affidavit of Compliance with Tempe City Code Chapter 2
Article VII Section 2-603(5) (form attached)
6.
If company has 15 or more employees include a copy of its anti-
discrimination policy
i
7.
Signed Addenda (if applicable)
1
Checklist for Submittal
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
Tempe.
Addendum to Solicitation
DocuSign Envelope ID: r14283CF-88F2-4AE9-A
:27E40B76261
City Procurement Office/City of i empe • PO Box 5002 • 20 East 6th Street • Tempe, AZ 85280 • (480) 350-
8324 • www.tempe.gov/procurement
Malting witviu,.
desert
Issue Date; April 24, 2020
This addendum will modify and/or clarify:
Solicitation No. 120-109
and is
Addendum No I 1
Procurement Description
City Provided Life and AD&D and
Voluntary Supplemental Insurance
I. The RFP Due Date/Time is hereby changed from Tuesday, May 5, 2020 to Tuesday, May 12, 2020, 3:00 PM Arizona
Local Time.
2. The following Exhibits have been added to the solicitation as part of this addendum All added exhibits contain PII and is
therefore locked from general view. In order to unlock this document, you must send a request for the password by
emailing Patricia Acosta(rZtempe.gov. It is the same password used for Exhibits G & H from the original RFP.
• Exhibit I— Smoking Status Addendum 1
• Exhibit j — Vol ADD Rev 4.17.20 Addendum 1
• Exhibit K — Vol Life Child Rev 4.17.20 Addendum 1
• Exhibit L — Vol Life EE Rev 4.17.20 Addendum 1
• Exhibit M — Vol Life Spouse Rev 4.17.20 Addendum 1
• Exhibit N — Census Rev 4.17.20 Addendum 1
3. Revised Questionnaire attached. Please complete the revised questionnaire with the adjusted limits shown below.
• 20-109 Rev Proposal Questionnaire Addendum 1
4. Proposal Questionnaire 4.1 Current Plan Designs: Basic Life — Provided by City as been modified as follows:
Classification
Basic Coverage Provided
Indicate if you "match"
or state deviation from
request
City Managers
2x Basic Yearly Earnings to a maximum of
44007000 $500,000
1.5x Basic Yearly Earning to a maximum of
City Attorney
4.24-54400 $500,000
5. Proposal Questionnaire4.2 Current Plan Designs: AD&D — Provided by the City has been
modified as follows:
Classification
All active city managers
Coverage information
lx Annual Earnings to
a i maximum of $500,000
Indicate if you 'match" or
state deviation from request
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
DocuSign Envelope ID: F142133CF-88F2-4AE94 .27E40B76261
6. Proposal Questionnaire 4.4 Current Plan Designs: Supplemental Life Insurance — Purchased by Employee
has been modified as follows:
Description
Cove rage Information
Indicate if you "match"
or state deviation from
request
Spouse or Domestic Partner Benefit
$20,000 $10,000 to $-500714Q0
$250,000.
7. Questions and Answers are provided below:
Q: Do you currently use a benefits administration platform for your enrollment? If so, can the name of the vendor be
released??
A: Our current vendor has a platform that we use for open enrollment. Other than that, during the plan year, we use
PeopleSoft for enrollment.
Q: The certificate provided states the Spouse Supplemental Life maximum is $250,000. The RFP states it is
$500,000. Please explain.
A: Employee Supplemental Life maximum is at $500,000 and Spouse is at $250,000. Please note there are a few
policy holders that have been grandfathered in at $500,000, but the normal limit is $250,000.
Q: The certificate provided has different Basic AD&D coverage amounts for City Managers is I times annual earnings up
to $500,000. The RFP states it is 2 times annual earnings up to $500,000. Please explain.
A: Basic AD&D for City Manager is only 1X annual earnings up to $500,000
Q: The certificate provided states City Attorney's receive a Basic AD&D amount of 1 times annual earnings up to $265,000.
The RFP does not provide an amount. Please explain.
A: City Attorney Basic AD&D is I times annual earnings up to $265,000
Q: Please confirm if Collectively Bargained Fire Employees, Police Employees and Detention Sergeants are eligible for
Basic AD&D coverage.
A: Yes
Q: The certificate provided does not provide a difference between any classes for Supplemental AD&D. Please
explain why Police and Fire pay a different rate than other classes.
A: Updated census information included Classes. Supplemental ADD rates are provided by current vendor for the
Sworn employees.
Q: Please provide a Basic Life and AD&D census that provides either class number or coverage amount for Basic Life and
Basic AD&D.
A: Updated census information included classes
Q: Please provide a Voluntary Employee and Spouse Supplemental Life census that includes Date of Birth, Gender,
coverage amounts in numeric form and indicates who is smoker and non-smoker.
A: Updated census information included a separate spreadsheet with smokers. "Census" spreadsheet included DOB,
Gender.
Q: Please provide a Voluntary AD&D census that includes Employee and Family elections in numeric form, gender
and Date of Birth.
A: "Census" spreadsheet included these fields and there is a separate spreadsheet with EE and Family elections with
the amount of election.
Q: Does the selected carrier for Life Insurance also need to be able to provide the Commuter Policy or, can these be split
between carriers?
A: We prefer one carrier to provide all coverages.
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Q: Census: Please provide labeled classes for each Basic Life employee.
A: Please see updated Census
Q: Experience: Provide full experience report with 5 or more years of premium, claims, lives, and volume by month for
Basic and Supplemental Life coverages. Group has been with Hartford since 2010.
A: Experience was provided, or 2017-2018, 2018-2019, 2019-current. Please see Exhibit E. Life Liability Report
Summar3,, 2017-2020.
Q: Experience: Provide Life rate history for all experience periods along with any plan changes.
A: There have been no plan changes. Rates can also be viewed on the invoice example provided in Exhibit F.
Basic Life.• .076/$1000
Basic ADD: .01811000
Child life: $1,80 — 5K or 3.60 — 10K
Vol AD&D
Employee: .029/$1000
Employee + Family: .043/31000
Sworn employees Vol ADeM:
Employee: .05541000
EE Family: .070/$1000
Vol Supp L fe = depends on age.
Q: Open Enrollment: Confirm if there have been Open Enrollments offered to the group where late entrants can
elect coverage up to the GI without providing evidence of insurability. If so, what were those GI levels and were
there any limitations?
A: The City has a Modified Open Enrollment (MOE) annually - Employees are allowed to increase their Supp Life benefit
by $20,000 to the GI (the lesser of 8200,000- or 3-times annual Earnings. This includes going from no coverage to
$20.000 coverage with no EOL The MOE only applies to the Employee coverage (not the Spouse). E01 will be needed
for any increase for the Spouse.
Q: Experience from 2014 to present, including:
Reported & Paid Life Claims;
A: Experience was provided for 2017-2018, 2018-2019, 2019-current. Please see Exhibit E: Life Liability Report Summary
2017-2020.
Q: Life Reporting;
A: There have been no plan changes.
Q: Life Premium Waiver Status
A: There are currently 3 people with waiver of premium
Q: •Revised Employee census that includes class assignments for Life, Basic ADD, and Vol
ADD A: Please see the updated attachments as part of this addendum.
Q: • Revised Supplemental census that includes the following: Smoker status; Voluntary ADD volumes & family status;
EE ID on employee & dependent tabs (or some other unique identifier)
A: Please see the updated attachments as part of this addendum.
Q: The RFP did not mention commissions, should we assume they are net?
A: Yes, Net Commission
Q: Is Hays Companies the broker agency?
A: Yes
Q: Does the Basic Life census include only eligible employees? Feb bill reports 1,628 eligible whereas the census includes
1,709 (31 arc in WP or hired after 2/1; leaving 1,678; looting to understand the discrepancy of 50 extra lives).
A: The updated Census resolves the discrepancy.
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Q: How does the City currently handle billing with Hartford?
Inquiring in reference to:
a.
Questionnaire (p. 22): "It will be the responsibility of the awarded firm to annually survey and update the
"smoking" status of insureds and provide updated data to the City. How will you accomplish this task?"
A: Smoking status is captured when employee is first enrolled. if their status changes over time, and the City was not
notified, then they have not be updated.
. Pricing Section (p. 31): "Invoices shall be issued directly to the ordering department... Invoices that do not follow the
above minimum invoicing requirements will not be paid."
A: Human Resources will be billed for coverage. The contact person's information will be provided after contract award.
Q: Can we get a report from the current carrier of any death claims made in the past 12 months at least, longeftimeframe
if possible.
A: Please review Exhibit E: Life Liability Report Summary 2017-2020.
Please ensure that you sign and submit this addendum with your proposal response by the due date found above.
The balance of the specifications and bid solicitation instructions to remain the same. Bidders/Proposal Offerors are to
acknowledge receipt and acceptance of this addendum by returning of signed addendum with bid/proposal response. Failure to
sign and return an addendum prior to bid/proposal opening time and date may make the bid/proposal response nonresponsive
to that portion of the solicitation as materially affected by the respective addendum.
Hartford Life and Accident insurance Company
Name of Company
Sheila.Sokolskithehartford.com
Email Address
Hartford, CT. 06155
City
State Zip
Sheila W. Sokolski, Assistant Vice President
By — Name and Title (Please Print)
18601547-2913
TeiguTgd by:
catiriet, o3 s-otbui
' siSignature
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
THE
HARTFORD
City of Tempe
RFP# 20-109/ General Information and Standard Terms and Conditions
Section/ Deviations and Exceptions
General Information:
28. Confidential Information and Public Record: After award of a Contract, proposals shall be
available for public inspection, except to the extent that the withholding of information is required or
permitted by law. Pursuant to A.R.S. § 35-214, and 41-1330 et seq., all records relating to the Request
for Proposal and Contract shall be subject to inspection at all reasonable times by the City for five (5)
years after completion of the Contract. Such records shall be produced by Bidder or Contractor at the
time and place designated by the City.
The Hartford can agree to item 28, with the addition of the text in blue as follows:
28. Confidential Information and Public Record: After award of a Contract, proposals shall be
available for public inspection, except to the extent that the withholding of information is required
or permitted by law. Pursuant to A.R.S. § 35-214, and 41-1330 et seq., all records relating to the
Request for Proposal and Contract shall be subject to inspection at all reasonable times by the
City for five (5) years after completion of the Contract. Such records shall be produced by Bidder
or Contractor at the time and place designated by the City. Notwithstanding any of the foregoing,
audits may be conducted upon the parties' execution of a mutually agreeable audit confidentiality
agreement subject to The Hartford's security and confidentiality policies. and once The Hartford has
received signed authorizations from claimants and beneficiaries if confidential claim information is in
scope for the audit.
Standard Terms and Conditions:
1. Applicable Law: This Contract shall be governed by, and the City and Contractor shall have all
remedies afforded each by the Uniform Commercial Code as adopted in the State of Arizona, except as
otherwise provided in this Request for Proposal and resultant Contract, and all statutes, or ordinances
pertaining specifically to the City. This Contract shall be governed by State of Arizona law and suits
pertaining tc this Contract may only be brought in courts located in Maricopa County, Arizona.
Noted; however, the Uniform Commercial Code does not apply to insurance services.
8. Contract Formation: This Contract shall consist of this Request for Proposal and the vendor's proposal
Offer submitted, as may be found responsive and approved by the City. In the event of a conflict in language
between the documents, the provisions of the City's Request for Proposal shall govern. The City's Request
for Proposal shall govern in all other matters not otherwise specified by the Contract
1
© 2020 by The Hartford. Classification: Company Confidential No part of this document may es reproduced, published cr used without the permiss!on of The Hartfc,d.
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
between the parties. All previous contracts between the Offeror and the City are not applicable to this
Contract or other resultant contracts. Any contracted vendor documents that conflict with the language and
requirements of the City's solicitation are not acceptable and void the Contract.
The Hartford can agree to item 8, with the addition of text in blue as follows:
8. Contract Formation: This Contract shall consist of this Request for Proposal and the vendor's
proposal Offer submitted, as may be found responsive and approved by the City. In the event of
a conflict in language between the documents, the provisions of the City's Request for Proposal
shall govern. The City's Request for Proposal shall govern in all other matters not otherwise
specified by the Contract between the parties. All previous contracts between the Offeror and the
City are not applicable to this Contract or other resultant contracts. Any contracted vendor
documents that conflict with the language and requirements of the City's solicitation are not
acceptable and void the Contract. Notwithstanding any of the foregoing, when the insurance coverage
is in effect, the terms and conditions of our insurance contract, a document that is filed with the state
department of insurance, must prevail and control our relationship with the Policyholder and its
insureds. Under applicable insurance law, the insurance contract must constitute the entire
contract of insurance.
11. Cooperative Use of Contract: Any Contract resulting from this solicitation shall be for the use of the City
of Tempe. In addition, public and nonprofit agencies that have entered into a Cooperative Purchasing
Agreement with the City of Tempe's Department of Procurement are eligible to participate in any
subsequent Contract. Additionally, this Contract is eligible for use by the Strategic Alliance for Volume
Expenditures (SAVE) cooperative. See http://vvww.mesaaz.00v/business/purchasing/save for a listing of
participating agencies. The parties agree that these lists are subject to change. Any such usage by other
municipalities and government agencies must be in accord with the ordinance, charter and/or rules and
regulations of the respective political entity.
Any orders placed to, or services required from, the successful Contractor(s) will be requested by each
participating agency. Payment for purchases made under this agreement will be the sole responsibility of each
participating agency. The City shall not be responsible for any disputes arising out of transactions made by
others. Contractor shall be responsible for correctly administering this Contract in accordance with all terms,
conditions, requirements, and approved pricing to any eligible procurement unit.
Noted; however, the cost of insurance Is dependent on each individual group's experience. Therefore,
the quote provided to the City may not be valid for another group with differing experience and
population. Any group wishing to purchase coverage from The Hartford will need to provide us with
population information that will allow us to provide the group with appropriate rates.
12. Dispute Resolution: This Contract is subject to arbitration to the extent required by law. If arbitration
is not required by law, the City and the Contractor agree to negotiate with each other in good faith to
resolve any disputes arising out of the Contract. In the event of any legal action or proceeding arising out
of this Contract, the prevailing party shall be entitled to recover its reasonable attorneys' fees and costs
incurred with said fees and costs to be included in any judgment rendered.
t9 2020 by The Hartford. Classification: Company Confidential. No pad of this document may be reproduced, published or used without the permission of The Hartford.
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
The Hartford can agree to item 12, with the addition of the text in blue and the deletion of the text
in green as follows:
12. Dispute Resolution: This-Coat-met is subject to arbitration to the extent required by law—lf
arbitration-is-not-required-by-law,tThe City and the Contractor agree to negotiate with each other in
good faith to resolve any disputes arising out of the Contract, In the event of any legal action or
proceeding arising out of this Contract, the prevailing party shall be entitled to recover its
reasonable attorneys' fees and costs incurred with said fees and costs to be included in any
judgment rendered.
15. Estimated Quantities: This Request for Proposal references quantities as a general indication of the
City's needs. The City anticipates considerable activity resulting from Contracts that will be awarded as a
result of this Request for Proposal; however, the quantities shown are estimates only and the City reserves
the right to increase or decrease any quantities actually acquired, in its sole discretion. No commitment of any
kind is made concerning quantities and Offeror hereby acknowledges and accepts same.
Not applicable to insurance services.
18. Force Majeure:
A. Except for payment of sums due, neither party shall be liable to the other nor deemed in default under
the Contract only in the event that and to the extent that such party's performance of the Contract is
prevented by reason of force majeure. Force majeure means an occurrence that is beyond the control of
the party affected and occurs without its fault or negligence. Without limiting the foregoing, force majeure
includes acts of God, acts of the pubiic enemy, war, riots, mobilization, labor disputes, civil disorders, fire,
floods, lockouts, injunctions, failures or refusal to act by government authority, and other similar
occurrences beyond the control of the party declaring force majeure which such party is unable to prevent
by exercising reasonable diligence.
The Hartford can agree to item 18, with the addition of text in blue as follows:
18. Force Majeure:
A. Except for payment of sums due, neither party shall be liable to the other nor deemed in default
under the Contract only in the event that and to the extent that such party's performance of the
Contract is prevented by reason of force majeure. Force majeure means an occurrence that is
beyond the control of the party affected and occurs without its fault or negligence. Without limiting
the foregoing, force majeure includes acts of God, disease, pandemic, or other health emergency,
acts of the public enemy, war, riots, mobilization, labor disputes, civil disorders, fire, floods,
lockouts, injunctions, failures or refusal to act by government authority, and other similar
occurrences beyond the control of the party declaring force majeure which such party is unable to
prevent by exercising reasonable diligence.
C 2020 by The Hartrord Classificatfon: Company Confidential, No part of this document may Oa reorooticeg. publisiled ex used witrout tte permission of The Harteord.
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
20. Indemnification: To the fullest extent permitted by law, the Contractor shall defend, indemnify and hold
harmless the City, its agents, officer, officials, and employees from and against all claims, damages, losses
and expenses (including but not limited to attorney's fees, court costs, and the costs of appellate proceedings),
arising out of, or alleged to have resulted from the acts, errors, mistakes, omissions, work, services, or
professional services of the Contractor, its agents, employees, or any other person (not the City) for whose
acts, errors, mistakes, omissions, work, services, or professional services the Contractor may be legally liable
in the performance of this Contract. Contractor's duty to hold harmless and indemnify the City, its agents,
officers, officials and employees shall arise in connection with any claim for damage, loss or expense that is
attributable to, bodily injury, sickness, disease, death, or injury to, impairment, or destruction of any person or
property, including loss of use resulting from, or caused by any acts, errors, mistakes, omissions, work,
services, or professional services in the performance of this Contract by Contractor or any employee of the
Contractor or any other person (not the City) for whose acts, errors, mistakes, omissions, work, or services the
Contractor may be legally liable. The amount and type of insurance coverage requirement set forth herein will
in no way be construed as limiting the scope of indemnity in this paragraph. This provision shall survive the
term of this Contract.
The Hartford can agree to item 20, with the addition of the text in blue and the deletion of the text in
green as follows:
20. Indemnification: To the fullest extent permitted by law, the Contractor shall defend, indemnify and
hold harmless the City, its agents, officer, officials, and employees from and against all claims,
damages, losses and expenses (including but not limited to attorney's fees, court costs, and the costs
of appellate proceedings), arising out of, or alleged to have resulted from the negligent acts, errors,
mistakes, omissions, work, services, or professional services of the Contractor, its agents,
employees, or any other person (not the City) for whose acts, errors, mistakes, omissions, work,
services, or professional services the Contractor may be legally liable in the performance of this
Contract. Contractor's duty to hold harmless and indemnify the City, its agents, officers, officials and
employees shall arise in connection with any claim for damage, loss or expense that is attributable to,
bedily-injur*-s-ioli-nessT-diseaser-eleath, or-init.ify-kOmpa-i-rmont, or-destr-usion-of-any-person-of pr-opert-
yi-nG4u-cling -loss of use resulting from, or caused by any negligent acts, errors, mistakes, omissions,
work, services, or professional services in the performance of this Contract by Contractor or any
employee of the Contractor or any other person (not the City) for whose acts, errors, mistakes,
omissions, work, or services the Contractor may be legally liable. The amount and type of insurance
coverage requirement set forth herein will in no way be construed as limiting the scope of indemnity in
this paragraph. This provision shall survive the term of this Contract.
22. Key Personnel: Contractor shall provide adequate experienced personnel, capable of and devoted to
the successful accomplishment of work to be performed under this Contract during the Contract term and
any renewal periods. The Contractor must agree to assign specific individuals to the key positions.
A. The Contractor agrees that, once assigned to work under this Contract, key personnel shall not be
removed or replaced without prior written notice to the City.
0 2020 by The Hartford. Classification Company Confidential. No part of this document may be reproduced, published or used without the permission of The Hartford
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
B. If key personnel are not available for work under this Contract for a continuous period exceeding thirty
(30) calendar days or are expected to devote substantially less effort to the work than initially anticipated,
the Contractor shall immediately notify the City, and shall replace each person with personnel of
substantially equal ability and qualifications upon prior City approval.
The Hartford can agree to item 22, with the addition of the text in blue and the deletion of the text in
green as follows:
22. Key Personnel: Contractor shall provide adequate experienced personnel, capable of and
devoted to the successful accomplishment of work to be performed under this Contract during the
Contract term and any renewal periods. The Contractor must agree to assign specific individuals to
the key positions.
A. The Contractor agrees that, once assigned to work under this Contract, key personnel shall
not be removed or replaced without prior written notice to the City. Contractor will make every
effort to notify and consult with the City prior to any change to the Account Manager team; however.
this may not be possible in every circumstance. Contractor retains ultimate responsibility for its
personnel decisions.
B. If key personnel are not available for work under this Contract for a continuous period exceeding
thirty (30) calendar days or are expected to devote substantially less effort to the work than initially
anticipated, the Contractor shall immediately notify the City, and shall replace each person with
personnel of substantially equal ability and qualifications upon-prior City apps-ey,ah
24. No Assignment: No right or interest in this Contract shall be assigned by Contractor and no deiegation
of any
duty of Contractor shall be made without prior written permission of the City, which corsent may
be granted or withheld in City's unfettered discretion.
The Hartford can agree to item 24, with the addition of the text in blue and the deletion of the text in
green as follows
24. No Assignment: Other than to internal affiliates, allo right or interest in this Contract shall be assigned
by Contractor and no delegation of any duty of Contractor shall be made without prior written
permission of the City, which consent may be granted or withheld in City's unfettered discretion.
33. Records: Pursuant to provisions of Title 35, Chapter 1, Article 6 Arizona Revised Statutes §§ 35-214 and 36-
215, Contractor shall retain, and shall contractually require each subcontractor to retain, all books, accounts,
reports, files and other records relating to the acquisition and performance of the Contract for a period of five
(5) years after the completion of the Contract. Upon the parties' execution of a mutually agreeable audit
confidentiality agreement subject to The Hartford's security and confidentiality policies, and once The
Hartford has received signed authorizations from claimants and beneficiaries if confidential claim information is in
scope for the audit, all such documents shall be subject to inspection and audit at
O 202C ty Tne "lartford. Class-Apeon: Company Confidential. No part of this document may to reproduced, p,,Ctishc:!cr used rhea t rte permission of The Hartford.
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
reasonable times. Upon request, a legible copy of any or all such documents shall be produced at the
offices of the City Attorney or Procurement Office.
The Hartford can agree to item 33, with the addition of the text in blue and the deletion of the text
in green as follows:
33. Records: Pursuant to provisions of Title 35, Chapter 1, Article 6 Arizona Revised Statutes §§ 35-
214 and 36-215, Contractor shall retain, and shall contractually require each subcontractor to retain,
all books, accounts, reports, files and other records relating to the acquisition and performance of
the Contract for a period of five (5) years after the completion of the Contract. Upon the parties'
execution of a mutually agreeable audit confidentiality agreement subject to The Hartford's security
and confidentiality policies, and once The Hartford has received signed authorizations from claimants
and beneficiaries if confidential claim information is in scope for the audit, AaII such documents
shall be subject to inspection and audit at reasonable times. Upon
r-equest,-a-legible-ce
doowne
uc ed -at -the-offices-of-the- City
Attorney or-Procurement-Office:
42. Warranties: Contractor expressly warrants that all materials and/or goods delivered under the Contract
shall conform to the specifications of this Contract and be merchantable and free from defects in material
and workmanship, and of the quality, size and dimensions specified herein. This express warranty shall not
be waived by way of acceptance or payment by the City, or otherwise. Contractor expressly warrants the
following:
A. All workmanship shall be finest and first-class;
B. All materials and goods utilized shall be new and of the highest suitable grade for its purpose; and
C. All services will be performed in a good and workmanlike manner. Contractor's warranties shall survive
inspection, acceptance and/or payment by the City, and shall apply to the City, its successors, agents and
assigns.
The Contractor agrees to make good by replacement and/or repair, at its sole expense and at no cost to
the City, any defects in materials or workmanship which may appear during the period ending on a date
twelve (12) months after acceptance by the City, unless otherwise specified herein. Should Contractor fail
to perform said replacement and/or repair to City's satisfaction within a reasonable period of time, City may
correct or replace said defective or nonconforming materials and recover the costs thereof from Contractor.
This warranty shall not operate to reduce the statute of limitations period for breach of contract actions or
otherwise, or reduce or eliminate any legal or equitable remedies.
Not applicable to insurance services.
43. Work for Hire and Ownership of Deliverables: Contractor hereby agrees and covenants that all the
results and proceeds of Contractor's work and/or services for the Project specified herein, for Contractor
2020 by The Hartford. Classification: Company Confidential. No part of this document may be reproduced, published or used without the permission of The Hartford.
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
and all of its agents, employees, officers and subcontractors, shall be owned by the City, including the
copyright thereto, as work for hire. In the event, for any reason such results and proceeds are not deemed
work for hire, Contractor agrees and covenants that it shall be deemed to have assigned to the City all of its
right, title and interests in such results, proceeds and content to the City, without limitation. Contractor agrees
to indemnify and hold the City harmless from and against al! claims, liability, losses, damages and expenses,
including without limitation, legal fees and costs, arising from or due to any actual or claimed trademark,
patent or copyright infringement and any litigation based thereon, with respect to any work, services and/or
materials contemplated in this Contract. Contractor agrees to pay to defend any and all such actions brought
against the City. Contractor's obligations hereunder shall survive acceptance by the City of all covenants herein
as well as the term of the Contract itself.
The Hartford can agree to item 43, with the addition of the text in blue and the deletion
of the text in green as follows:
43. Work for Hire and Ownership of Deliverables: Gen tra ctor-herelay-ag-rect-;an d -covenants-that-all
the-results-a ncl-prods-of-Contra etorls-wark-a
ec-if+ed-hereita -h e re,-for
Contra ctor-an-d-all-of-its-ag entsT-en-i-ploy-ees,officers-afi d-s-u boo ntr acts rsTsh alit) e -own ed by th e-Gity-
F
inolu-el-i-n-e-the-copyright-thereto:as
-work-for-
hire—i-n-the-eventfor-any-reason-s-ue-h-results-and
pcoeeects-are-not-due-mud-wor-k-for-htre-ContraGtoragrees-a-ntl-eovenants-that it shall-be-deemed-to
have-assigned-to-the -City -a 14-of-its -rig-ht nd -inter-ests in -such-results. proceeds a n-d-oontent-to
the-City, without limitation: Contractor is unable to grant any one customer ownership of its
documentation or services. However. the Contractor will grant to the City license to use Contractor's
intellectual property contained in any deliverables provided to the City while Contractor is providing
insurance Services to the City. All deliverables discovered, created or developed by Contractor under this
Agreement shall be and will remain the sole and exclusive property of the Contractor with licensed rights
of use granted to the City in accordance with this Agreement. Contractor agrees to indemnify and
hold the City harmless from and against all claims, liability, losses, damages and expenses,
including without limitation, legal fees and costs, arising from or due to any actual or claimed
trademark, patent or copyright infringement and any litigation based thereon, with respect to
any work, services and/or materials contemplated in this Contract. Contractor agrees to pay
to defend any and all such actions brought against the City. Contractor's obligations hereunder
shall survive acceptance by the City of all covenants herein as well as the term of the Contract
itself.
g, 2620 by The Rani-W. Classification Company CartkieTW. No part of this document may be reproduced, published or use* 10.•;:lit the permission of The Harztai
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
ArnRH'
CERTIFICATE OF LIABILITY INSURANCE
1144.--.----
DATE (ISIM/DD/YYTT)
04/20/2020
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES
NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE
DOES NOT CO NSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER( S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION
IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A stat ement on this
certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER
Corporate Risk Management
690 Asylum Avenue
Hartford
CT 06105
CONTACT
NAME:
Erik Haslun
PHONE
FAX
Aajc, No, Exo:
(860) 520-2745
(A/C, No):
ADDRESS: erik.hasiuntathehartford.com
INSURERS AFFORDING COVERAGE
NAICF
INSURER A: Hartford Fire Insurance Company
19682
INSURED
The Hartford Financial Services Group, Inc. and all
subsidiaries, including Hartford Fire insurance Company
One Hartford Plaza
Hartford
CT 06155
INSURER e : Hartford Insurance Company of the Midwest
37478
INSURER c: Houston Casualty Company
42374
INSURER D
INSURER E :
INSURER F :
COVERAGES
CERTIFICATE NUMBER:
REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INS
R
TYPE OF INSURANCE
ADD
LMg, SUER
1NVD
POLICY NUMBER
POUCY EFF
(MM/DD/YrIll POLICYEXP
(MM/DD/YYTY)._
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
Y
Y 02 CSE S14432
12/01/19
12/01/20
EACH OCCURRENCE
$
5,000,000
CLAIMS-MADE
X
OCCUR
DAMAGE TO RENTED
PREMISES (Ea occurrence) $
5,000,000
X
Contractual Liability
MED EXP (Any one person) $
10,000
X
Host Liquor Liability
PERSONAL & ADV INJURY $
5,000,000
GEN'L AGGREGATE
POLICY
OTHER:
LIMIT APPLIES PER:
PR
JECT f
I LOC
GENERAL AGGREGATE
$
5,000,000
X
pRODUOTS - COMP/OP AGG $
5,000,000
S
A
X
AUTOMOBILE
LIABILIT
YANYAUTO
OWNED
AUTOS ONLY
HIRED
AUTOS ONLY
SCHEDULED
AUTOS NON-
OWNED
AUTOS ONLY
Y
Y 02 CSE S14433
12/01/19
12/01/20
COMBINED SINGLE
LIMIT(Eaaccident)
$
5,000,000
BODILY INJURY (Per person) S
BODILYINJURY(Peraccident)
$
PROPERTY DAMAGE
(Per accident)
$
S
UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS-MADE
"
EACH OCCURRENCE
S
AGGREGATE
$
DED
RETENTIONS
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANYPROPRIETORIPARTNER/EXECUTIVE
OFFicEpJmEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
Y I N
N
NIA
Y
02 CSE 814428
12/01/19
12/01120
X PER
OTH-
STATUTE
ER
E.L. EACH ACCIDENT
$
5,000,000
E.L. DISEASE - EA EMPLOYEE
$
5,000,000
E.L. DISEASE- POLICYLIMIT $
5,000,000
C
Professional Liability
n/a
n/a 24-MG-20-A12318
04/15/20
04/15/21
Per Claim
$15,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more apace Is required)
The City of Tempe, its agents, representatives, directors, officials, employees, and officers will be added as additional insureds on the Commercial General and
Automobile liability policies upon execution of contract
CERTIFICATE _HOLDER
CANCELLATION
City of Tempe
20 E. 6th Street (Second Floor)
PO Box 5002
Tempe, Arizona 85280
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
CAA
© 1988 - 2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03)
The ACORD name and logo are registered marks of ACORD
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
ETempeII
irot.
.
in Malzinq vinws fl t'U clesnl
Only complete this document if you have 14 or less employees.
AFFIDAVIT OF COMPLIANCE WITH TEMPE CITY CODE
CHAPTER 2 ARTICLE VIII SECTION 2-603(5)
Not applicable as we have more than 14 employees
Per Tempe City Code Chapter 2 Article VIII Section 2-603(5), it is unlawful for a City vendor or City contractor,
because of race, color, gender, gender identity, sexual orientation, religion, national origin, familial status,
age, disability, or United States military veteran status, to refuse to hire or employ or bar or discharge from
employment any person, or to discriminate against such person in compensation, conditions, or privileges of
employment.
City vendors and contractors shall provide a copy of their antidiscrimination policy to City to confirm
compliance with this requirement or attest in writing to compliance.
•
CONTRACTOR means any person who has a contract with the City.
VENDOR means a person or firm in the business of selling or otherwise providing products,
materials, or services.
CONTRACTOR/VENDOR, select one:
Current copy of antidiscrimination policy attached
OR
I hereby certify
(contractor/vendor) to be in compliance with
Tempe City Code Chapter 2 Article VIII Section 2-603(5).
Date:
Signature
Print Name
Title
Company
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
"Return this Section with your Response"
Offeror must complete, sign and submit this form to the Procurement Office with the proposal response. An unsigned
"Vendor's Offer", late proposal response, and/or a materially incomplete response will be considered nonresponsive and
rejected. Offeror is to type or legibly write in ink all information required below. A scanned copy of this page is acceptable.
Street Address:
One Hartford Plaza
City, State, Zip:
Hartford, CT 06155
Contact Person: Tony Metzler
Phone Number: (480) 824-5003
E-mail Address: Tony.Metzler@thehartford.com
Cell Number: (480) 343-7477
Remit to Information
C o m p a n y N a m e ( a s i t a p p e a r s o n i n v o i c e ) :
T h e H a r t f o r d
C o m p a n y
P a y m e n t R e m i t t o A d d r e a s :
Street Address:
P.O. Box 783690
City, State, Zip:
Philadelphia, PA. 19178-3690
Company Tax Information
If a Tempe-based firm, provide Tempe Transaction Privilege (Sales) Tax No.:
Not applicable.
Payment Options
THIS PROPOSAL IS OFFERED BY
REQUIRED SIGNATURE OF AUTHORIZED OFFEROR
By signing this Vendor's Offer, Offeror acknowledges acceptance of all terms and conditions contained herein and that
prices offered were independently developed without consultation with any other Offeror or potential Offeror. Failure to sign
and return this form with proposal response will be considered nonresponsive and rejected
,.--DocuSigned by:
05/12/2020
•
JSign Envelope ID: 953636CA-7F38-4134C-, CB2CBDF5738B
,\)?
Vendor's Offer ( Fo rm 201 B )
Company Name:
Hartford Life and Accident Insurance Company
Company Purchase Order Mailing Address:
No
X
X
No
Print or Type Name of Authorized Individual
Title of Authorized Individual
Assistant Vice President
Sheila W. Sokolski
-
S ' e t t t , s L i
Date
Yes
Yes
Will your company accept the City's Master Card for payment?
Will your company accept Payment via ACH (Automated Clearing House) for payment?
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
Goodman, Lisa
From:
Metzler, Tony (GB Sales + Distribution) <Tony.Metzler@thehartford.com>
Sent:
Tuesday, May 12, 2020 2:13 PM
To:
FS-BIDS
Subject:
City of Tempe - The Hartford's Proposal Response [CONFIDENTIAL)
Attachments:
City of Tempe - The Hartford's Proposal Response.zip
Importance:
High
Hello,
Thank you for the opportunity to respond to your RFP. Attached is our full response for your review. It has been a
privilege to be your Life and AD&D provider and we appreciate the opportunity to continue to meet your Life and AD&D
needs. It is our mission to provide an unparalleled standard of Group Benefits experience for you, at every touch point to
help you attract and retain valuable employees. We welcome the opportunity to continue to provide the best solution to
meet your Life and AD&D benefit needs. We realize you have a choice in carriers when providing these important
benefits to your customers, and we thank you for considering The Hartford. We look forward to hearing the results of
your review. Please let us know if you have any questions.
Thanks again for the opportunity!
Tony
Tony Metzler
Regional Account Executive
The Hartford Group Benefits
Cell: (480) 343-7477
Fax: (855) 844-1121
www.thehartford.com
The Hartford's COVID-19 Resource Center
COVID-19: Learn More About il",c'ijor.s. We Have Taken
COViO-19 Response: New York's New Paid Sick Leave DBL & PFL Famiqes
First Coronavirus Response Act & How The Hartford WiU Help,
************************************************************
This communication, including attachments, is for the exclusive use of addressee and may contain proprietary,
confidential and/or privileged information. If you are not the intended recipient, any use, copying, disclosure,
dissemination or distribution is strictly prohibited. If you are not the intended recipient, please notify the sender
immediately by return e-mail, delete this communication and destroy all copies.
************************************************************
1
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
Contract Award Notice
Internal Services
Procurement Office
20 E. oh Street
Tempe, AZ 85281 iTempe.
Maim t4 wave!.
ue,era
Contract Number: T20-109-01
Description: City Provided Life, AD&D, and Voluntary Supplemental Insurance
84281
Award Period
Hartford Life and Accident Insurance
Beginning: 06/25/2020
City Provided Life, AD&D, and Voluntary Supplemental Insurance
Ending: 06124/2021
PO Box 783690
Philadelphia, PA 19178-3690
Potential Renewals 4
Phone Number: 480.824.5003
Celiphone Number: 480.343.7477
Email Address: Tony.metzler@thehartford.com
This Contract Award Notice is issued for the purchase of goods, materials and/or services as requested by the above noted
solicitation/contract number. The contract shall remain in effect as noted in the award period block unless extended, renewed
or canceled per terms and conditions of the solicitation.
It is to be noted that any contracted vendor document(s) that conflict with the language and requirements of the City's
solicitation are not acceptable and will void the contract. In addition, contracted vendor is not to begin work or make delivery
of awarded items until any and all required insurance and/or performance bonds are posted with the City Procurement Office.
If contracted vendor has a change of address for mailing payments and/or for mailing future bid solicitations, it is the vendor's
responsibility to notify the City Procurement Officer identified with this contract and to ensure all such mailing address
information is kept current:
Please note that your City of Tempe contract number should appear on all shipping documents, invoices and statements.
Award Information
Rates are monthly cost per $1000 of coverage and firm for 3-years
(Exception is Commuter/Travel which is priced on annual basis
Year I.
Year 2
Year 3
City Provided Coverage (City Paid)
Rate
Rate
Rate
Basic Life
0.0530
0.0530
0.0530
AD&D
0.0100
0.0100
0.0100
Commuter/Travel Insurance (annual rate/employee)
8707.00
8707 00
8707.00
Supplemental Life - Non-Smoker (Employee Paid)
Age
Rate
Rate
Rate
<25
0.0500
0.0500
0.0500
25-29
0.0500
0.0500
0.0500
30-34
0.0500
0.0500
0.0500
35-39
0.0800
0.0800
0.0800
40-44
0.1000
0.1000
0.1000
45-49
0.1400
0.1400
0.1400
50-54
0.2100
0.2100
0.2100
55-59
0.3400
0.3400
0.3400
60-64
0.6000
0.6000
0.6000
65-69
0.9200
0.9200
0.9200
70-75
1.7700
1.7700
1.7700
> 75
2.8700
2.8700
2.8700
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
41
Supplemental Life - Smoker (Employee Paid)
Age
RateRate
Rate
<25
0.0800
0.0800
0.0800
25-29
0.0800
0.0800
0.0800
30-34
0.1000 0.1000
0.1000
35-39
0.1000 0.1000
0.1000
40-44
0.1500
0.1500
0.1500
45-49
0.2800
0.2800
0.2800
50-54
0.4200
0.4200
0.4200
55-59
0.6500
0.6500
0.6500
60-64
1.2000
1.2000
1.2000
65-69
1.8300 i
1.8300
1.8300
70-75
3.5300
3.5300
3.5300
> 75
5.7100
5.7100 5.7100 i
'.--Suppb.,,,las_tal Chid Coverage (Employee Paid)
Option
Cost
Cost
Cost
$5,000 Dependent Child
1.8000
1.8000
1.8000
$10,000 Dependent Child
3.6000
3.6000
3.6000
Voluntary AD&D - Excluding Police and Fire (Employee Paid)
Classificaton
Rate
Rate
Rate
Employee only
0,0290
0.0290 i
0.0290
Employee and Family
0.0430
0.0430
0.0430
Voluntary AD&D - Police and Fire (Employee Paid)
Classificaiton
Rate
Rate
Rate
Empioyee only
0.0550 0.0550
0.0550
Employee and Family
0.0700 0.0700
0.0700 i
Shireen Boone P.'.
Procurement Officer
4
Michael Greene, C.P.M., CPPO
Procurement Administrator
All terms and conditions of this Award Document are per the City's Solicitation Document
I 1
A P R
''F<DER,
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
From:
To:
Subject:
Date:
Attachments:
Woicik, Daniel
Rodriguez, Nancy
RE: Tempe - Hartford Contract
Thursday, April 29, 2021 11:56:16 AM
Screenshot 2021-04-29 115444.onq
Hi Nancy,
Council just approved this contract and it will be in effect for FY 21/22 and expiring in 2025.
v/r
Daniel Wojcik
From: Rodriguez, Nancy <NRodriguez@GLENDALEAZ.com>
Sent: Thursday, April 29, 2021 11:50 AM
To: Wojcik, Daniel <Daniel_Wojcik@tempe.gov>
Subject: Tempe - Hartford Contract
Hello Daniel,
I'm reaching out again to find out if Tempe has renewed the Hartford contract for the FY 21/22. We
have been in contact with Hartford regarding linking to the Tempe contract, just want to make sure it
will be in force for FY 21/22. Thanks for your help, Daniel.
Kind Regards,
Nancy
• Questions about the PSPRS Deferred Retirement Option Plan, schedule a
virtual meeting using the link below
• Getting ready to retire from PSPRS DROP, schedule an in-person meeting by using
the link below
https://calendly.com/psprsnancy
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
Nancy Rodriguez
HR Analyst
Human Resources & Risk Management
nrodriguez@glendaleaz.com
Glendale
P 623.930.2078
5850 W Glendale Ave Ste 1356
Glendale, AZ 85301
We improve Me lives o the people we -7„2.sve every day_
Community • Integrity • Excellence • Innovation • Learning
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
Prepare. Protect. Prevail.
EXHIBIT B
THE
HARTFORD
Business Insurance
Employee Benefits
Auto
Home
HARTFORD FIRE INSURANCE COMPANY
Business Travel Accident New Business Quote
March 17, 2021
Paula Campbell
Hays Companies
3200 East Camelback Road, Suite 129
Phoenix, AZ 85018
Dear Paula,
Based on the information provided, The Hartford is pleased to provide you with the following Business
Travel Accident quote for City of Glendale.
Proposed Policy Term:
Policy Effective Date
Policy Expiration Date
July 1, 2021
July 1, 2022
Risk Address:
5850 W. Glendale Avenue
Glendale, AZ 85301
Eligibility:
CLASS
DESCRIPTION
TOTAL NUMBER
OF INSUREDS
Class 1:
All active employees of the Policyholder domiciled in the US
2,312
Class 2:
All eligible Spouses, who are traveling with the Employee at the
direction and expense of the Policyholder.
Estimated
Class 3:
All eligible Dependent Children, who are traveling with the Employee
at the direction and expense of the Policyholder.
Estimated
Ver. 8-19
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
Prepare. Protect. Prevail:
THE
HARTFORD
Business Insurance
Employee Benefits
Auto
Horne
DESCRIPTION
FORM NUMBER
POLICY
BTA-1000
SCHEDULE
BTA-1100
Hazards/Benefits/Principal Sum:
CLASS
HAZARD
BENEFIT
PRINCIPAL SUM
Option 1:
PRINCIPAL SUM
Option 2
Class 1:
H-3, H-8,
H-15,
B-4, B-7, B-13, B-21, B-32,
B-39, B-49, B-50, B-51, B-55
$200,000
$250,000
Class 2:
H-7, H-21
B-4, B-7, B-13, B-32, B-39,
B-49, B-50, B-51, B-55
$25,000
$25,000
Class 3:
H-7, H-21
B-4, B-7, B-13, B-32, B-39,
B-49, B-50, B-51, B-55
$10,000
$10,000
Hazards Applicable:
HAZARD
HAZARD DESCRIPTION
FORM NUMBER
H-3
24-Hour Accident Protection While on Business
BTA PA-10053
H-7
24-Hour Family Relocation Trip
BTA PA-10050
H-8
24-Hour Hijacking Skyjacking Business
BTA PA-10055
H-15
Commutation
BTA PA-10062
H-21
Family Travel
BTA PA-10068
Benefits Applicable:
BENEFIT
BENEFIT DESCRIPTION
FORM NUMBER
AD&D
Accidental Death & Dismemberment
BTA-1000
B-4
Adaptive Home & Vehicle
BTA PA-10115
B-7
Bereavement Counseling
BTA PA-10093
B-13
Coma
BTA PA-10099
B-21
Education Expense
BTA PA-10107
B-32
Medical Emergency Evacuation
BTA PA-10119
B-39
Paralysis
BTA PA-10124
B-49
Rehabilitation Expense
BTA PA-10133
B-50
Repatriation of Remains
I BTA PA-10134 (AZ)
B-51
Seat Belt and Airbag
BTA PA-10135
B-55
Therapeutic Counseling
BTA PA-10139
V e r 8 - 19
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
Prepare. Protect. Prevail.
THEti
HARTFORD
Business Insurance
Employee Benefits
Auto
Home
BENEFIT
MAXIMUM AMOUNT
Accidental Death & Dismemberment
See principal sums
Incurral Period:
365 days
Adaptive Home & Vehicle
$25,000
Incurral Period:
24 months
Bereavement Counseling
Commencement Period:
365 days
Incurral Period:
2 years
Max Amount per session:
$150
Max Number of sessions:
10
Coma
See principal sums
Commencement Period:
30 days
Waiting Period:
30 days, not retroactive
Monthly Benefit Amount:
1% of max
Monthly Benefit Period:
100 months
Education Expense
Spouse
5% to a max of $5,000
Child
5% to a max of $5,000
Felonious Assault
10% of the Principal Sum to $25,000
Medical Emergency Evacuation
Actual cost up to a max of $1,000,000
Family Travel
Lodging:
$100 per day
Meals:
$50 per day
Emergency Reunion
Lodging:
$100 per day
Meals:
$50 per day
Paralysis Benefit
See principal sums
Quadriplegia
100%
Triplegia
75%
Paraplegia
75%
Hemiplegia
50%
Uniplegia
25%
Rehabilitation Expense
$25,000
Incurral Period:
2 years
Ver. 8 -19
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
Prepare. Protect. Prevail:
THE
HARTFORD
Business Insurance
Employee Benefits
Auto
Home
Repatriation of Remains
Actual cost up to a max of $1,000,000
Family Travel
Lodging:
$100 per day
Meals:
$50 per day
Identification and Escort Expense
Lodging:
$100 per day
Meals:
$50 per day
Seat Belt and Air Bag
Seat Belt:
the lesser of: $25,000 or
Percentage of Princi al Sum:
10%
Air Bag:
the lesser of: $25,000 or
Percentage of Principal Sum:
10%
Therapeutic Counseling Benefit
Commencement Period:
365 days
Incurral Period:
2 years
Max Amount per session:
$150
Max Number of sessions:
10
Aggregate Limit of Indemnity: $2,000,000 per Accident
Ver. 8-19
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
Prepare. Protect. Prevail.
THE
HARTFORD
Business Insurance
Employee Benefits
Auto
Home
HAZARDS:
H-3: 24-Hour Accident Protection While on Business Hazard
We will pay the Policy benefits for the Hazard when an Insured Person suffers an Injury resulting from a
Covered Loss during a Trip and while on the Business of the Policyholder, not lasting for more than 365 days,
including an Injury while:
1)
operating or a Passenger on, boarding, alighting from, or being struck or run down by
any Conveyance being used as a means of land or water Transportation, except:
a) any such Conveyance the Insured Person has been hired to operate or for which
the Insured Person has been hired as a crew member and while the Insured Person is
performing as an operator or crew member on any such Conveyance; or
b) any such Conveyance the Insured Person is operating, or for which the Insured Person is
performing as a crew member, (including while on, boarding, alighting from, or being
struck or run down by ) for the Transportation of Passengers or property for hire, profit
or gain; or
2) a Passenger on, boarding, or alighting from a Civil Aircraft or Military Transport Aircraft; or
3) being struck or run down by an Aircraft.
The benefits also apply where the Sojourn or Personal Deviation involves one or more stops en route to
the destination, and extensions time spent at the destination, that do not last longer than a total of 14
days.
H-7: 24-Hour Family Relocation Trip Hazard
We will pay the Policy benefits for the Hazard when an Insured Person's Spouse or Dependent
Child(ren) suffer(s) an Injury as a result of a Covered Loss which occurs anywhere in the world during a
Relocation Trip.
A Relocation Trip will not include any period of time in excess of 14 days during which the Insured
Person takes a vacation, or a Sojourn or Personal Deviation from the Relocation Trip.
H-8 — 24-Hour Hijacking or Sky-jacking Business Hazard
We will pay the Policy benefits for the Hazard described in this Rider when an Insured Person suffers
an Injury resulting from a Covered Loss which occurs during a Hijacking or Sky-jacking anywhere in
the world while the Insured Person is on the Business of the Policyholder . Coverage under this Rider
shall continue while the Insured Person is subject to the control of the hijacker(s) and during travel directly
to his or her residence or original destination.
Ver. 8 - 19
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
Prepare. Protect. Prevail:
THE
HARTFORD
Business Insurance
Employee Benefits
Auto
Home
H-15: Commutation Hazard
Broad Commutation Coverage
We will pay the Policy benefits for the Hazard described in the Rider, for an Injury which occurs while the
Insured Person is commuting directly between his or her residence and place of regular employment
either:
1) as a pedestrian; or
2) as a bicyclist; or
3) while traveling in or on, boarding, or alighting from a Conveyance;
on a regularly scheduled workday.
H-21: Family Travel Hazard
We will pay the Policy benefits for the Hazard when the Spouse or Dependent Child(ren) of the Insured
Person suffer(s) an Injury resulting from a Covered Loss:
1) while accompanying the Insured Person or on his or her way to join the Insured Person on a Trip
while on the Business of the Policyholder, including a Sojourn or Personal Deviation taken during
the course of such Trip; and
2) when such Trip is authorized by and/or paid for in whole or in part by the Policyholder.
Ver. 8-19
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
Prepare. Protect. Prevail.
THE
HARTFORD
Business Insurance
Employee Benefits
Auto
Home
BENEFITS:
Accidental Death and Dismemberment
FOR LOSS OF:
Life .....
Both Hands or Both Feet or Sight of Both Eyes.........
One Hand and One Foot............................................
One Hand and Sight of One Eye ...............
One Foot and Sight of One Eye ................................
Speech and Hearing in Both Ears ............................
Speech and Hearing in One Ear ...............................
One Arm or One Leg.....
One Hand or One Foot ..............................................
Sight of One Eye .................................
Speech or Hearing in Both Ears ............
Thumb and Index Finger on the Same Hand...........
Hearing in One Ear ......................
One Thumb...............................................
BENEFIT:
100% of the Accidental Death Principal Sum
100% of the Accidental Dismemberment Principal Sum
100% of the Accidental Dismemberment Principal Sum
100% of the Accidental Dismemberment Principal Sum
100% of the Accidental Dismemberment Principal Sum
100% of the Accidental Dismemberment Principal Sum
75% of the Accidental Dismemberment Principal Sum
75% of the Accidental Dismemberment Principal Sum 50%
of the Accidental Dismemberment Principal Sum 50% of the
Accidental Dismemberment Principal Sum 50% of the
Accidental Dismemberment Principal Sum 25% of the
Accidental Dismemberment Principal Sum 25% of the
Accidental Dismemberment Principal Sum 10% of the
Accidental Dismemberment Principal Sum
Age Reduction Schedule
The reduced amount will be determined by multiplying the Principal Sum by the percentage shown below
for the Insured Person's attained age:
AGE ON DATE OF ACCIDENT
70-74
75-79
80-84
85 and older
These reductions also apply if:
1) You become covered under The Policy; or
2) Your coverage increases;
on or after the date You attain age 70.
P E R C E N T A G E O F
P R I N C I P AL
S U M 6 5 % 4 5 %
30%
15%
Premium for an Insured Person age 70 or older is based on 100% of the coverage that would be in effect
if the Insured Person were under age 70.
Age refers to the age of the Insured Person's most recent birthday, regardless of the actual time of birth.
Ver. 8 -19
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
Prepare. Protect. Prevail:
THE
HARTFORD
Business Insurance
A u t o
H o m e
B-4: Adaptive Home & Vehicle Benefit
If an Insured Person suffers an Injury, other than loss of life, that results in a loss payable under the
Accidental Dismemberment or Paralysis Benefit, We will pay an additional benefit that is the lesser of:
1) the Benefit Amount as indicated; or
2) the actual cost
for Home Alteration and Vehicle Modification Expenses that are incurred within 24 months of the date of
the Covered Accident that caused the Injury if an Insured Person:
1) did not require, prior to the date of the Covered Accident that caused the Injury, the use of a
wheelchair or other adaptive device to be ambulatory; and
2) as a direct result of such Injury, the use of a wheelchair or other adaptive device to be
ambulatory is now compulsory.
B-7: Bereavement Counseling Benefit
If the Insured Person suffers an accidental death or an accidental dismemberment or Paralysis for which
an Accidental Death, or Accidental Dismemberment or Paralysis Benefit is payable or if he or she goes
into a Coma for which a Coma Benefit is payable, We will pay the Bereavement Counseling Benefit if an
Insured Person or his or her Spouse and/or Dependent Child(ren) receives Bereavement Counseling.
B-13: Coma Benefit
If an Injury renders the Insured Person Comatose within 30 days of the date of the Covered Accident, and
if the Coma continues for a period of 30 consecutive days, We will pay a monthly benefit equal to the
Monthly Benefit Amount shown. No benefit is provided for the first 30 days of the Coma.
B-21: Education Expense
We will pay a benefit to or on behalf of any child of the Insured Person who meets the definition of
Dependent Child on the date of the Covered Accident causing the Insured Person's death and on the date
of the Insured Person's death and who, on the date of the Insured Person's death:
1) is a full-time student in any Institution of Higher Learning above grade 12; or
2) is in grade 12 and subsequently enrolls as a full-time student in an Institution of Higher Learning
within 365 days after the date of the Insured Person's death.
We will pay a benefit to or on behalf of the Spouse of the Insured Person who meets the definition of
Spouse on the date of the Covered Accident causing the Insured Person's death and on the date of the
Insured Person's death and who, for the purpose of obtaining an independent source of support or to
enrich his or her ability to earn a living:
1) is enrolled in any Institution of Higher Learning or professional or trade training program on the
date of the Insured Person's death; or
2) subsequently enrolls in an Institution of Higher Learning or professional or trade training program
within 30 months after the date of the Insured Person's death.
Ver. 8 -19
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
Prepare. Protect. Prevail.
THE
HARTFORD
Business Insurance
Employee Benefits
Auto
Home
B-32: Medical Emergency Evacuation Benefit
We will pay for Covered Medical Emergency Evacuation Expenses reasonably incurred if the Insured
Person suffers an Injury or Emergency Sickness that warrants his or her Medical Emergency Evacuation
while he or she is outside a 100 mile radius from his or her current place of primary residence, up to the
Maximum Benefit Amount for all Medical Emergency Evacuations due to all Injuries from the same
Covered Accident or all Emergency Sicknesses from the same or related causes.
B-39: Paralysis Benefit
We will pay the percentage of the Maximum Benefit Amount shown below if Injury to the Insured Person
results in any one of the types of loss(es) specified below within 365 days of the date of the Accident that
caused the Injury, provided that the Paralysis is diagnosed by a Physician as reasonably expected to
continue for the duration of his or her lifetime.
If an Insured Person dies within 365 days of the Covered Accident, then We will pay a lump sum equal to
the Insured Person's Maximum Benefit Amount, less any Benefit Amount for Paralysis already paid.
Loss
Quadriplegia
100% of the Maximum Benefit Amount
Triplegia
75% of the Maximum Benefit Amount
Paraplegia
75% of the Maximum Benefit Amount
Hem iplegia
50% of the Maximum Benefit Amount
Uniplegia
25% of the Maximum Benefit Amount
B-49: Rehabilitation Benefit
If the Insured Person is participating in a Covered Hazard and suffers a Covered Accident for which an
Accidental Dismemberment or Paralysis benefit is payable under the Policy, We will reimburse the
Insured Person for Covered Rehabilitative Expenses that result from the Injury causing the
dismemberment or Paralysis up to the Maximum Benefit Amount shown for all Injuries caused by the
same Covered Accident. The Covered Rehabilitative Expenses must be incurred within 2 years after the
date of the Covered Accident causing the Injury.
B-50: Repatriation of Remains Benefit
If an Insured Person suffers an Injury or Emergency Sickness that results in loss of life while covered
under the Policy, We will pay for certain expenses incurred as a result of such death including, but not
limited to, the following:
1) the expense incurred for the preparation of the deceased's body for burial or cremation;
2) the most economical coffin or receptacle adequate for transporting the remains; and
3) transportation of the deceased's body to the place of burial or cremation;
up to the Maximum Benefit Amount shown in the Rider Schedule below, provided that the death of the
Insured Person occurred outside a 100 mile radius from his or her current place of primary residence.
Ver. 8 - 19
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
Prepare. Protect. Prevail:
THE
HARTFORD
I3usiness
Insurance
Employee
B6mIefits
Auto
B-51: Seat Belt and Airbag Benefit
Seat Belt Benefit
If an Insured Person suffers a loss of life for which the Accidental Death Benefit is payable under the
Policy and the Covered Accident causing death occurs while the Insured Person is operating, or riding as
a Passenger in, an Automobile and wearing a properly fastened Seat Belt, We will pay the Seat Belt
Benefit. The Seat Belt Benefit is equal to the lesser of:
1) the Percentage of Principal Sum; or
2) the Maximum Benefit Amount.
Airbag Benefit
If the Insured Person is wearing a Seat Belt and received a payment as indicated above, We will pay the
Airbag Benefit if:
1) the Insured Person was positioned in a seat equipped with a factory installed Airbag;
2) the Insured Person was properly strapped in the Seat Belt when the Airbag inflated; and
3) the police report establishes that the Airbag inflated properly upon impact.
The Airbag Benefit is equal to the lesser of:
1) the Percentage of Principal Sum; or
2) the Maximum Benefit Amount.
B-55: Therapeutic Counseling Benefit
We will pay for expenses incurred by the Insured Person for Therapeutic Counseling sessions up to the
Therapeutic Counseling Benefit Amount per session for the Maximum Number of Sessions, if:
1) an Insured Person incurs a Covered Loss, other than a loss of life, for which a benefit is payable
under the Accidental Dismemberment or Paralysis the Policy; and
2) the Insured Person initially requires Therapeutic Counseling within 365 days due to the Covered
Loss.
Benefits for any Therapeutic Counseling session must be incurred within 2 year(s) after the date of
the Covered Accident causing the Injury.
Ver. 8-19
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
Prepare. Protect. Prevail.
( C )
THE
HARTFORD
Business insurance
Employee Benefits
Auto
Home
TRAVEL ASSISTANCE AND ID THEFT PROTECTION SERVICES
The following assistance services may not include an insurance benefit unless stated in the above quote letter
and on your issued policy.
The Hartford partners with Generali Global Assistance USA, a leading global assistance provider. Help is only
a phone call away to give you 24/7 access to medical and travel assistance services anywhere in the world.
EMERGENCY
MEDICAL
ASSISTANCE
Emergency medical
evacuations
• Medical monitoring
• Repatriation of mortal
remains
• Traveling companion
assistance
• Dependent children
assistance
• Emergency medical
payments
PRE-TRIP INFORMATION
• Visa and passport
requirements
• Inoculation and
immunization requirements
• Foreign exchange rates
• Embassy and consular
referrals
EMERGENCY PERSONAL 1
SERVICES
• Medication and eyeglass
prescription assistance
• Emergency travel
arrangements
• Emergency cash
• Emergency pet
housing/return
• Bail advancement
IDENTITY THEFT — I
ASSISTANCE
• Prevention Services
Education
- Identity Theft Resolution Kit
• Detection Services
- Fraud alert to three credit
bureaus
• Resolution Guidance and
Assistance
- Credit information review
- ID Theft Affidavit Assistance
- Card replacement
• Personal Services
- Translation
...
BENEFICIARY ASSIST
Beneficiary Assist provides eligible beneficiaries and immediate family members with 24/7 phone access for
help related to the death of an insured person. Services are provided by Com Psych, the largest provider of
employee assistance programs, managed behavioral health, work/life, and crisis intervention services.
•
Legal advice, financial planning and emotional counseling for up to one year from the date the claim is
filed.
•
All counselors hold a master's or PhD degree in counseling and are licensed in the states in which
they practice.
•
Attorneys are licensed in their respective states.
•
Financial consultants are certified through the Institute of Certified Financial Planners.
Ver. 8-19
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
Prepare. Protect. Prevail,.
THE
HARTFORD
B u s i n e s s I n s u r a n c e
L i c • I t i : e r i B e n e f i t s
A r a ,
Exclusions
Unless otherwise specified in the Policy, including any attached Riders, the Policy does not cover loss
resulting from or for:
1) suicide or attempted suicide, whether sane or insane, or intentionally self-inflicted Injury;
2) war or act of war, whether declared or undeclared;
3) Injury sustained while on active duty service in the military, naval or air force of any country or
international organization. Upon Our receipt of proof of service, We will refund any premium paid
for this time. Reserve or National Guard Service is not excluded, unless it extends beyond 31
days;
4) Injury sustained while on any Aircraft except a Civil Aircraft, or Military Transport Aircraft, unless
specifically covered by a Hazard Rider;
5) except when specifically covered by a Hazard Rider, Injury sustained while on any Aircraft:
a)
as a pilot, crewmember or student pilot;
b)
as a flight instructor or examiner;
c)
if it is owned, operated or leased by or on behalf of the Policyholder, or any employer or
organization covering any Eligible Class under the Policy; or
d)
being used for tests, experimental purposes, stunt flying, racing or endurance tests;
6) Injury sustained as a result of the Insured Person's voluntary intoxication through the use of
poison, gas or fumes, whether by ingestion, injection, inhalation or absorption;
7) Injury sustained by an Insured Person during or as a result of his or her commission of a felony or
while incarcerated for a felony, except that this exclusion will not be applicable upon acquittal or
dismissal of the felony charges;
8) stroke or cerebrovascular accident or event; cardiovascular accident or event; myocardial
infarction or heart attack; coronary thrombosis; aneurysm;
9) Sickness, disease, or bacterial or viral infection, or medical or surgical treatment thereof unless
and only to the extent covered by Rider, except for any bacterial infection resulting from an
accidental external cut or wound or accidental ingestion of contaminated food;
10) Mental and Nervous Disorders;
11) services for which no charge is normally made.
Ver. 8-19
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2
EXHIBIT C
Prepare. Protect. Prevail:
THE
HARTFORD
Business lrusumnee
Employee Benefits
Auto
Home
City of Glendale
March 17, 2021
Premiums:
Option 1: Annual Premium:
3 Year Annual Installment Premium:
3 Year Prepaid Premium:
$16,490.00
$15,666.00 Per year
$44,523.00
Option 2: Annual Premium:
$20,520.00
3 Year Annual Installment Premium:
$19,494.00 Per year
3 Year Prepaid Premium:
$55,404.00
Commission:
Schedule E Flat 0%
Thank you for allowing The Hartford to offer this Business Travel Accident quotation. If you would like to
discuss further or have any questions, please feel free to contact me directly.
Sincerely,
Tom Keets, Executive Underwriter, 678-566-4491
Accident & Health, The Hartford
The Hartford® is The Hartford Financial Services Group, Inc. and its subsidiaries, including issuing companies Hartford
Life Insurance Company, Hartford Life and Accident Insurance Company and Hartford Fire Insurance Company. Home
Office is Hartford, CT. Blanket Travel Accident Form Series includes BTA-1000, or state equivalent. This quote letter
explains the general purpose of the insurance described, but in no way changes or affects the policy as actually issued.
Benefits are subject to state availability and any changes in state /federal laws, and assumption that there are less than
50 employees in the State of California. In the event of a discrepancy between this letter and the policy, the terms of the
policy will govern in all cases. Acceptance of this quote is contingent upon and subject to actual terms of the policy as
issued.
Please note: This quote is valid for 90 days.
To bind coverage, please complete, sign and return or advise via email: Thomas.KeetseTheHartford.com. Upon
receipt of this signed document, it will serve as your coverage binder. All bind orders are contingent on the
broker agency and agent of record being appropriately licensed and appointed with Hartford Fire
Insurance Company.
Please note: BILLING will be DIRECT unless otherwise requested via email.
Selected Option:
— 3y r 4,044 leulallmext pre",uylk
Signature
Effective Date of Coverage
For additional information regarding eligibility for Commissions and Other Payments and terms and conditions relating thereto,
please review our website htto://thehartford.com/arouo-benefits-producer-compensation or contact your Hartford representative.
Ver. 8-19
DocuSign Envelope ID: FC69346D-98AA-4625-912D-8FF7A44F75C2