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17
City of Pleasanton
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CITY CLERK
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AGENDA PACKETS
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2015
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072115
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17
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8/18/2015 11:46:55 AM
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7/14/2015 4:09:15 PM
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CITY CLERK
CITY CLERK - TYPE
AGENDA REPORT
DOCUMENT DATE
7/21/2015
DESTRUCT DATE
15Y
DOCUMENT NO
17
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2. Report to CLIENT, quarterly loss analysis of claims filed by frequency and <br />severity. <br />3. Assist in the preparation of all reports required by the State of California or other <br />Governmental agencies relating to Workers' Compensation claims. <br />4. ICS will prepare the federal information return (Form 1099) by the statutory <br />deadline for all payments subject to 1099 reporting made by ICS on behalf of the <br />CLIENT during the term of this Agreement. <br />5. Additional ad -hoc reports will be provided to CLIENT at their request at no <br />additional cost. Special report requests that require programming time will be <br />charged to CLIENT at $150 per hour, which is our direct cost. Our system is <br />capable of generating standardized reports as follows: <br />Claim Logs <br />Claim Activity <br />Claim Cost Detail <br />Claim Cost Summary <br />Claim Cost Summary by Year <br />Examiner Activity <br />Examiner Case Log <br />Frequency Reports <br />Location Summary <br />Management Summary <br />Multiple Claims Listing <br />Occurrence Cost <br />OSHA <br />Payment Type Totals <br />Vendor Payments Summary <br />State Annual Report <br />6. Ad -hoc reports queries, which require no specific programming will be provided <br />at no cost to CLIENT. <br />G. Banking Services. ICS will adhere to the following services standards, as <br />directed by the clients: <br />1. The CLIENT agrees to establish, fund and replenish an account at a financial <br />institution agreed upon by the CLIENT and ICS for the purpose of paying <br />benefits to workers or care providers and to pay Allocated Loss Adjustment <br />Expenses. <br />2. All funds in the CLIENT Account belong to the CLIENT. ICS shall have <br />authority to write checks on the CLIENT Account, however, two signatures may <br />be required at client's requested level. <br />
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