RFP-2024-0115 Insurance Broker and Related Services

expired opportunity(Expired)
From: Atlanta(City)
2024-0115

Basic Details

started - 04 Apr, 2024 (26 days ago)

Start Date

04 Apr, 2024 (26 days ago)
due - 19 Apr, 2024 (11 days ago)

Due Date

19 Apr, 2024 (11 days ago)
Bid Notification

Type

Bid Notification
2024-0115

Identifier

2024-0115
City of Atlanta

Customer / Agency

City of Atlanta
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Albert Murillo, Senior Vice President Contracts & Procurement Request for Proposals #2024-0115 Insurance Broker and Related Services March 22, 2024 Request for Proposals #2024-0115 Insurance Broker and Related Services PART 1 – GENERAL INFORMATION 1.1 About Atlanta Housing The Housing Authority of the City of Atlanta, Georgia (“Atlanta Housing” or “AH”) is the largest housing authority in Georgia and one of the largest in the nation. AH provides and facilitates affordable housing resources for over 23,000 low-income households. These affordable housing resources include AH- owned residential communities, AH-sponsored mixed-income, mixed-finance residential communities, tenant-based vouchers, HomeFlex Program (formerly Project Based Rental Assistance Program), supportive housing arrangements, and homeownership opportunities. Atlanta Housing has broad corporate powers including, but not limited to, the power to acquire, manage, own, operate, develop and revitalize affordable housing.
AH’s programs are funded and regulated by the U.S. Department of Housing and Urban Development (“HUD”). Using its Moving to Work flexibility, AH has implemented a variety of innovations that benefit low-income families and expand housing choice. AH’s approach to providing quality affordable housing and human development services is based on the belief that people can do better when given access to quality living environments and the tools they need to become self-sufficient. To learn more about AH and its history, mission and business plan, Respondents are encouraged to visit AH’s website www.atlantahousing.org. 1.2 Solicitation Purpose The Housing Authority of the City of Atlanta, Georgia (Atlanta Housing or AH) is seeking proposals from qualified, independent insurance broker to provide brokerage services for AH’s risk management program, to include: i. Commercial Property Insurance ii. Excess Workers’ Compensation Insurance iii. Management Liability Insurance (including fiduciary, crime, directors and officers liability, and employed lawyers coverage) iv. Cyber Liability Insurance v. Exploration of other insurance products as requested by AH Please note that AH is not seeking insurance for General Liability, Automobile Liability, or Automobile Physical Damage. Optional services relating to the above-referenced services may be periodically required (i.e., consulting services, training, etc.). Please refer to the Submittals paragraph 3.2, bullet number for more details on what information the Respondent shall submit under Optional Services. http://www.atlantahousing.org/ Request for Proposals #2024-0115 Insurance Broker and Related Services 2 | P a g e 1.3 Contract Term Contracts awarded from proposals received in answer to this solicitation will be for an initial term of one (1) year with the option to extend the contract, at Atlanta Housing’s sole discretion, for four (4) additional one (1) year option terms for a potential total maximum term of five (5) years. 1.4 Schedule of Events The following is the Schedule of Events and is AH’s estimate of the timetable for this solicitation: EVENTS DATE AND/OR TIME RFP Released Friday, March 22, 2024 Go to www.atlantahousing.org to download - https://www.atlantahousing.org/doing-business-with-ah/vendors/ Pre- Proposal Conference Wednesday, April 03, 2024 at 11:00 A.M., EDT Via ZOOM: (short registration is required to attend this zoom conference; please register prior to the beginning of the meeting) https://atlantahousing.zoom.us/meeting/register/tZwvcOCprD8pGda0mYUE- lRFWRa_cSaCCpVf After registering, you will receive a confirmation email containing information about joining the meeting. Deadline for Questions and/or Comments Wednesday, April 10, 2024 by 12:00 P.M., EDT Proposal Due Date and Time Friday, April 19, 2024 by 5:00 P.M., EDT NOTE: AH reserves the right, at its sole discretion, to adjust this Schedule of Events as it deems necessary. If necessary, AH will communicate adjustments to any event in the Schedule of Events in the form of an addendum to this RFP. Addenda to this RFP will only be issued and posted on AH’s website at https://www.atlantahousing.org/doing-business-with-ah/vendors/ and Business Management Portal. Addenda will not be mailed to potential Respondents. It is the responsibility of the Respondent to monitor AH’s website and electronic sourcing tool, Jaggaer, for any addenda issued. Each Respondent must acknowledge all addenda issued so as to ensure that addenda are considered in their proposal response by completing: Addenda Acknowledgement Form. This Form must be submitted with the Respondent’s response to this Request for Proposals. Failure to include the Form in the proposal response may subject your Firm to disqualification. http://www.atlantahousing.org/ https://www.atlantahousing.org/doing-business-with-ah/vendors/ https://atlantahousing.zoom.us/meeting/register/tZwvcOCprD8pGda0mYUE-lRFWRa_cSaCCpVf https://atlantahousing.zoom.us/meeting/register/tZwvcOCprD8pGda0mYUE-lRFWRa_cSaCCpVf https://www.atlantahousing.org/doing-business-with-ah/vendors/ Request for Proposals #2024-0115 Insurance Broker and Related Services 3 | P a g e 1.5 Communications In order to maintain a fair and impartial competitive process, AH and any outside consultants assisting AH with this solicitation, shall avoid private communication concerning this procurement with prospective Respondents during the entire procurement process. From the issue date of this RFP until the final award is announced, Respondents are not allowed to communicate about this RFP for any reason with any AH staff and/or outside consultants assisting AH with this solicitation except: • through the RFP Point of Contact named below; • as otherwise specified in this RFP; and / or • as provided by existing work agreement(s) (if any) Prohibited communication includes all contact, including but not limited to, telephonic communications, emails, faxes, letters, or personal meetings, such as lunch, entertainment, or otherwise. AH reserves the right to reject the quote of any Respondent violating this provision. A. Questions must be submitted via the Q&A Board on AH’s Business Management Portal. AH will receive requests for additional information and/or clarification relative to this solicitation no later than Wednesday, April 10, 2024 12:00 P.M. EDT B. Responses to these questions will be addressed in writing via the AH’s electronic procurement system. AH will not respond to requests for information after the date stated above. It is the responsibility of the Respondent to monitor AH’s website for any addenda issued. All Respondents are encouraged to frequently check AH’s website/portal for additional information. All requests for information or clarification pertaining to this solicitation must be addressed in writing. RFP Point of Contact Latasha Cole – Purchasing Analyst latasha.cole@atlantahousing.org The Housing Authority of the City of Atlanta, Georgia Contracts & Procurement Department 230 John Wesley Dobbs Avenue, NE 5th Floor Atlanta, Georgia 30303-2421 mailto:latasha.cole@atlantahousing.org Request for Proposals #2024-0115 Insurance Broker and Related Services 4 | P a g e PART 2 – SCOPE OF WORK 2.1 Current Contract The Housing Authority of the City of Atlanta, Georgia (“AH”) has been under contract with Arthur J. Gallagher Risk Management Services, Inc. from 2019 to present. AH is satisfied with the service provided by this firm; however, as the contract approaches expiration AH is required to enter the marketplace by issuing a new RFP for a provider. The attached Exhibit A is a list of current insurance coverages – including the carrier and expiration dates. Exhibit B is AH’s loss runs for various types of coverages. 2.2. Scope of Work and Specific Requirements Consultant will provide insurance brokerage, administration and other related services (“the Services”) as set forth below for AH’s risk financing program, which shall include the following coverages. The program will include, but is not limited to, financing the following: 1. Commercial Property Insurance 2. Excess Workers’ Compensation Insurance 3. Management Liability Insurance (including fiduciary, crime, directors and officers liability, and employed lawyers coverage) 4. Cyber Liability Insurance 5. Exploration of other insurance products as requested by AH The selected broker must possess all necessary insurance and business licenses to conduct business in the State of Georgia. The broker must be licensed by the State of Georgia and shall submit a copy of the broker license with the proposal response to be indicated as Attachment 1. The broker will provide a full service insurance program including sourcing, procuring, recommending and negotiating the financing for the various assigned risk exposures. Consultant shall: 1. Review AH’s current risk financing and self-insured program and develop an appropriate schedule for the design and implementation of the different facets of the risk financing program based upon relevant factors, such as current risk financing expirations, market conditions, etc. 2. Prepare recommendations that include: a. Methods available to AH for handling risk, including, but not limited to complete self- insurance, re-insurance, excess insurance, or any combination thereof; b. Appropriate risk retention levels, and related attachment points and limits for risk transfer, taking into account AH claims, reserves and loss history; AH’s responsibilities as a city-chartered public benefit corporation; and the availability and cost of various financing options, including premium proposals, legal fees, and incurred losses; Request for Proposals #2024-0115 Insurance Broker and Related Services 5 | P a g e c. Coverage enhancements that are consistent with agreed upon program goals, balancing AH’s loss experience with prevailing market conditions; d. Design of highly cost-effective financing strategies which will provide protection against catastrophic loss, taking advantage of AH’s financial ability to retain risk; and e. Coverage specifications, including issues related to business and coverage continuity. 3. Develop underwriting submissions for various categories of risk financing in accordance with an agreed-upon schedule, coverage specifications and recommendations. 4. Provide ongoing insurance brokerage and risk management consulting services (“Ongoing Consulting Services”) to assist AH in implementing and maintaining an approved risk financing design. Ongoing Consulting Services shall comprise the following categories: Continued Market Access Consulting Services; Periodic Reporting Consulting Services; and Account Management Consulting Services. a. Continued Market Access Consulting Services shall include: i. Accessing and effectively negotiating with any or all risk financing markets (including, but not limited to conventional and alternative risk insurance markets) that are potential sources of coverage for AH; and effectively participating in negotiations with underwriters for favorable coverage and pricing terms at policy inception and renewals, as well as during the resolution of any outstanding claims and binding coverage as approved by AH; and ii. Recommending underwriters to cover AH exposures, according to their (a) past underwriting effectiveness with comparable exposures; (b) financial strength; (c) ability to offer needed coverage and services; (d) prompt claim payment; and (e) include any other factors that may be applicable. b. Periodic Reporting Consulting Services shall include providing AH with comprehensive reviews of insurance industry annual results and changing market conditions, including long-range forecasts when possible. c. Account Management Consulting Services shall include: i. Refining and implementing the mutually agreed upon strategy for developing AH’s long term risk financing program; ii. Providing ongoing analysis of, and recommendations for, improved procedures for handling loss control, incurred losses, open claims and corresponding reserve positions in the applicable lines of coverage; and iii. Providing written and/or oral responses to AH inquiries. Request for Proposals #2024-0115 Insurance Broker and Related Services 6 | P a g e 5. Work effectively with AH, external consultants and/or service providers retained by AH, as may be required, when AH deems it necessary to expedite the achievement of a given related underwriting and financial objective. 6. Provide certificates of insurance, as requested, based upon contractual review and related obligations, as well as other standard financing program activities as needed. 7. Advise and assist AH in reviewing contracts, plan documents, insurance policies and other documents for applicability, accuracy, and consistency, and prepare any necessary reports. 8. Meet with AH and other applicable individuals or groups, as required, and provide a backup service person that is knowledgeable about AH’s program. 9. Participate in appropriate audits of vendors, as requested by AH. 10. Provide liaison services between AH and other program contractors. Consultant will provide other optional services (“Optional Services”) as requested by AH. Optional Services include, but are not limited to, (i) claim audits, (ii) best practices reviews, (iii) claim data and loss run preparation, (iv) benchmarking data and analysis, (v) consulting and training, as requested by Atlanta Housing, and (vi) other tasks as applicable. AH reserves the right to prepare underwriting submissions and bind coverage without the involvement or assistance of the Consultant/Broker. If this occurs, the Consultant will not be paid an annual fee. Payment will instead be withheld by AH, as appropriate. However, in the event Consultant makes recommendations, provides specifications, develops underwriting submissions, conducts negotiations with insurers and otherwise completes the majority of the work required under the coverage renewal, except for binding coverage, the Consultant will be paid up to 90% of its annual fee as if the coverage was bound and placed through the Consultant. 2.2 Current AH Fee Structure The fees associated with the current contract are paid to the firm based upon various coverage lines and the process associated with each. Payments are made only after the appropriate phase of risk financing is completed (i.e., insurance policy or financing contract issued) for the relevant exposure area. Request for Proposals #2024-0115 Insurance Broker and Related Services 7 | P a g e PART 3 – PROPOSAL EVALUATION 3.1 Clean Hands Policy Procurement actions shall be conducted only with responsible contractors who have the technical and financial competence to perform, who have the fiscal responsibility in business dealings, and who have a satisfactory record of integrity. Before awarding a contract, AH shall review the proposed contractor’s ability to perform the contract successfully, considering factors such as the contractor’s integrity, compliance with public policy, record of past performance on AH and other jobs (including contacting previous clients of the contractor), and financial and technical resources. AH shall not award a new contract or conduct new business with a bidding contractor, vendor or applicant who (i) has past due financial obligations or indebtedness to AH pursuant to a contract or other transaction and has not fulfilled the obligation prior to submission of a bid, proposal or application for a contract, (ii) has an existing claim, demand, litigation action, investigation, hearing, or other legal, administrative, arbitral or similar proceeding or dispute against AH, whether civil or criminal (including any appeal or review of any of the foregoing) or (iii) in AH’s reasonable discretion, has taken action that may give rise to or threatened to assert a claim, demand, litigation action, investigation, hearing, or other legal, administrative, arbitral or similar proceeding or dispute against AH, whether civil or criminal (including any appeal or review of any of the foregoing) or other dispute against AH. The President and Chief Executive Officer may waive the requirements of this paragraph for good cause shown as determined by the President and Chief Executive Officer and if it is otherwise in AH’s best interests. 3.2 Submittals Proposals shall be submitted via AH electronic sourcing platform - Jaggaer. AH will not accept any proposal in part or in whole through any other means. The sections are as follows: • Letter of Interest (submit on the Prerequisites Page) The Letter shall include the following: i. Statement of Firm’s interest in working with AH; ii. Details of Firm’s workload and ability to be responsive to AH requirements; iii. Provide an overview of your company including a brief description of your firm’s history, ownership structure and financial stability; and iv. Identify the name and signature of an authorized representative of the Firm authorized to negotiate services and cost with AH. Please include the authorized representative’s name and title, telephone (or mobile) number and email address. • Response to All Evaluation Questions A through E (submit on the Questions Page) • Compensation Structure (submit on the Prerequisites Page) • Optional Services, if available (submit on the Prerequisites Page on the same document with your Compensation Structure) - Please provide AHA with a description of additional products and optional services that will enhance the services requested and their ability to enhance our business operations. To that end, the Respondent may envision additional services that will aid AHA in achieving this goal. Please identify optional services provided by your organization and the associated fees for those services. AHA may wish to consider these optional services based on the Request for Proposals #2024-0115 Insurance Broker and Related Services 8 | P a g e availability, associated costs and value add to the overall increased functionality optional services may provide. 3.3. Evaluation Factors and Award The proposal evaluating process is designed to award the contract, not necessarily to the Respondent(s) of least cost, but rather to the Respondent(s) whose proposal represents the best overall value as determined by an evaluation of the best technical score (a combination of qualifications and experience) and price/costs. Evaluations are based upon the evaluation factors and weights specifically established within this RFP. Respondent(s) must provide all information outlined in the Evaluation Factors (as defined below) for the Respondent’s proposal to be considered responsive. Proposals will be evaluated based on the responsiveness of the Respondent’s information to the Evaluation Factors which will demonstrate the Respondent’s understanding of the Evaluation Factors and capacity to perform the required services of the Request for Proposals. The quality of answers rather than length of responses to this RFP is important. The maximum points that shall be awarded for each of the Evaluation Factors are detailed and described below. Evaluation Factor (Question) Items Submitted Yes / No Points A Professional Competence Required 25 Points B Staffing and Qualifications Required 30 Points C Firm’s Experience Required 30 Points D Ethical Behavior Required 10 Points E Commitment to Diversity Required 05 Points Maximum Point Value 100 Points The establishment, application and interpretation of the above Evaluation Factors (Questions) shall be solely within the discretion of AH. AH reserves the right to determine the suitability of proposals on the basis of all of these factors. EVALUATION FACTORS / QUESTIONS DESCRIPTIONS The maximum points that shall be awarded for each of the Evaluation Factors are detailed and described below. Evaluation Question A Professional Competence ........................................................................................................ 25 Points Please provide a detailed narrative of the firm’s methodology and/or approach for designing and implementing a comprehensive property/casualty risk financing program. Include details about how these lines of risk can be incorporated into a captive program. Additionally, provide detailed narrative of your firm’s program of transparency related to relationships with insurers, wholesale brokers, captive Request for Proposals #2024-0115 Insurance Broker and Related Services 9 | P a g e management firms, affiliates and others related to the marketing and placement of coverage as part of this RFP and the resulting contract. (15 Points) Respondent must provide information regarding your firm’s proficiency in providing services in the specialized areas. Respondent must also show ability to effectively manage and tracking efforts, and the progress and status for services. (10 Points) Evaluation Question B Staffing and Qualifications ................................................................................................... 30 Points Include an organizational chart identifying the names, job titles, specifications of task responsibilities and participation levels of staff that will be assigned to the resulting contract. Include specialties and/or certifications. Resumes must also be included for those staff persons along with any other relevant information. Evaluation Question C Firm Experience ...................................................................................................................... 30 Points Provide a minimum of four (4) current and/or former (for the purpose of this evaluation question, “former” is defined as within the past three years) clients to whom your firm has provided these services and include the client names, point of contact, telephone number and e-mail address. Please note that AH cannot be used as a reference; all references much be provided by companies other than AH. Points will not be given for any firm providing AH as a reference. AH may contact these references as part of its due diligence; Respondent can reach out to its past clients to confirm that they may be contacted to provide a reference. (10 points) Provide evidence of firm’s ability to complete the work described in the RFP in each of the required programs (Property/Casualty, Cyber Liability, Worker’s Comp, Automobile, and Management Liability). Detail general experience in providing services to other agencies similar in size to AHA as well as multi- family, affordable housing, and/or private sector entities. (20 Points) Evaluation Question D Ethical Behavior ................................................................................................................ 10 Points Please address how ethical behavior is integrated into your organization’s business practices and how it informs the service provided to your clients. Evaluation Question E Commitment to Diversity.................................................................................................5 Points AH shall, to the greatest extent feasible, make every effort to ensure that small businesses, minority owned and women-owned businesses, and labor surplus area businesses, and other individuals or firms located in or owned in substantial part by persons residing in the area of AH-owned communities are used when possible in AH’s contracting opportunities. Request for Proposals #2024-0115 Insurance Broker and Related Services 10 | P a g e Respondent is encouraged to provide a contracting/employment opportunity plan, noting the potential jobs and subcontracting opportunities that will be made available by Respondent for the services to be provided. MAXIMUM TOTAL POSSIBLE POINTS....................................................................................100 3.4 Responsibility Determination The responsibility determination includes consideration of a Respondent’s record of integrity and business ethics, compliance with public policy, past performance with AH (if any) and other entities, financial capacity, and eligibility to perform government work (e.g., debarment/suspension from any Federal, State, or local government). AH reserves the right to perform whatever research it deems appropriate in order to assess the merits of any Respondent’s proposal and utilize the information gathered in the final evaluation of those firms in competitive range. a) Financial Capacity Determination AH shall make an assessment of the Respondent’s financial capacity, that is, whether in the sole opinion of AH, the Respondent is capable of undertaking and completing the RFP scope of work delineated within this RFP in a satisfactory manner. AH will award a contract only to the responsible Respondent who, in AH’s sole opinion, has the financial ability to successfully perform under the terms of this RFP. AH’s determination will include an assessment of the Respondent’s financial resources/ability to perform the scope of work in accordance with the RFP requirements. Respondents who make the competitive range may be asked to submit financial information. Failure by the Respondent to provide such information within the allotted time will render the Respondent ineligible for award. b) Technical Capacity Determination AH will conduct a survey relating to the Respondent’s record of performance on past and present projects that are similar to the scope of work identified in this RFP, which may include services/projects not identified by the Respondent. AH reserves the right to perform whatever research it deems appropriate in order to assess the merits of any Respondent’s proposal. Such research may include, but not necessarily be limited to, discussions with outside Respondents, interviews and site visits with the Respondent’s existing clients and analysis of industry reports. AH will make a finding of the Respondent’s Technical Resources/Ability to perform the RFP scope of work based upon the results of the survey. A Respondent will be determined responsible if AH determines that the results of the Technical Resources/Ability survey reflect that the Respondent is capable of undertaking and completing the RFP scope of work in a satisfactory manner. Request for Proposals #2024-0115 Insurance Broker and Related Services 11 | P a g e PART 4 – TERMS SHEET 4.1 Compliance with E-Verify In compliance with O.C.G.A. §§ 13-10-90 and 13-10-91, effective July 1, 2013, before AH can consider Respondent’s proposal for the services requested, Respondent must register and participate in the federal work authorization program operated by the United States Department of Homeland Security, commonly known as E-Verify, to verify employment eligibility information of newly hired employees and must continue to participate in E-Verify during the term of the contract. Such participation is evidenced by submitting to AH a signed affidavit in the form of the affidavit either provided by Georgia Department of Audits and Accounts or approved by AH (“E-Verify Affidavit”) – see Prerequisites – State of Georgia Contractor E-Verify Affidavit. The E-Verify Affidavit is Respondent’s certification that it has registered with, is authorized to use and uses the federal work authorization program. Respondent further certifies that all tiers of contractors and subcontractors hired by Respondent to perform the services under the agreement are compliant with E-Verify; that Respondent will continue to use E-Verify throughout the term of the contract; that Respondent and all tiers of its contractors and subcontractors will only contract with other contractors and subcontractors who present an E-Verify Affidavit, or the appropriate documentation in lieu of the E-Verify Affidavit; and that Respondent will submit the appropriate affidavits and other documents to AH from it and all tiers of contractors and subcontractors, as required. 4.2 Licenses, Permits and Certifications Before a contract pursuant to this RFP is executed, the apparent successful Respondent(s) must hold all necessary, applicable professional licenses required by the State of Georgia and all other regulatory agencies necessary to complete the Services. The Respondent shall obtain, at the Service Provider’s expense, any permits, certificates and licenses as may be required in the performance of the work specified. All required licenses shall remain active and valid during the entire duration of the subsequent contract. AH may require any or all Respondents to submit evidence of proper licensure. 4.3 Atlanta Housing Opportunity Inclusion Policy (OIP) It is the policy of Atlanta Housing that Minority, Women and Small Business Enterprises (MBE/WBE/SBE) as defined in regulations developed by the Secretary of the Department of Housing and Urban Development (HUD) and promulgated in 2 CFR 200, the National Affordable Housing Act 42 U.S.C 12703, and HUD Procurement Handbook for Public Housing Agencies No. 7460.8 Rev.2, the United States Small Business Administration and other governmental and professional industry association certifying agencies) shall have the maximum opportunity to participate in the performance of contracts financed in whole or in part with federal funds and that bidders, proposers or contractors and their subcontractors or suppliers shall take all necessary and reasonable steps to ensure that MBE/WBE/SBEs shall have the maximum opportunity to compete for and perform contracts financed in whole or in part by federal funds. Request for Proposals #2024-0115 Insurance Broker and Related Services 12 | P a g e MBE/WBE/SBE economic participation shall be implemented through Atlanta Housing’s Opportunity Inclusion Policy via an MBE/WBE/SBE Utilization Plan that is submitted by entities seeking to do business with Atlanta Housing or its partners who utilize federal funding in whole or in part. Accordingly, businesses intending to respond to this RFP shall be a certified MBE/WBE/SBE or agree to expend no less than 35% of the total contract price, inclusive of all modifications and amendments through work with certified MBEs and WBEs. AH business partners that are certified not-for-profit/non- profit entities shall agree to expand not less than 20% of their contract value via MBE/WBE/SBE. Respondents who, as a result of a robust, timely and documented process of solicitation to the marketplace to meet this requirement, find that it is not possible to secure that level of participation, may augment their MBE/WBE/SBE participation goal with a comprehensive detail of good faith efforts. Documented good faith efforts will be considered on their merits and in light of other respondents and their plans regarding impracticability of meeting the published goals. In RFQ submissions of qualifications, an affidavit of future compliance will evidence intended compliance. For proposals submitted as a response to RFP’s a written plan to achieve the published aspirational goal will be required with initial proposal or subsequent task orders. RFP respondents may submit partial plans to comply with aspirational goals so long as they are accompanied with a detail of best efforts that support the impracticability of the aspirational goal with a request for partial waiver. 4.4 Atlanta Housing Section 3 Policy Section 3 of the Housing and Urban Development Act of 1968, as amended (12 U.S.C. 1701 u) requires that AH ensure that employment and other economic and business opportunities generated by HUD financial assistance, to the greatest extent feasible, are directed to public housing residents and other low-income persons, particularly recipients of government housing assistance, and business concerns that provide economic opportunities to low and very-low income persons. AH is committed to utilizing residents and other Section 3 eligible persons and businesses in contracts partially or wholly funded with funds from HUD. It is the responsibility of contractors, vendors and suppliers to implement progressive efforts to attain Section 3 compliance. The Respondent will be required to submit with their proposal either a Contract Compliance Affidavit (Schedule A) or a measurable Section 3 Action Plan via MWBE & Section 3 Business Utilization Plan (Schedule B) to include training, employment, contracting and other economic opportunities throughout all phases of the development work. The Action Plan should include a brief description of the job opportunities, business opportunities and/or training for Section 3 eligible participants. Some examples of opportunities include word processing, payroll, research, accounting, landscaping, painting, carpentry, and catering, to name a few. As contractors, Respondents will be expected to report on the progress of its Section 3 Action Plan on a quarterly basis, or as otherwise requested by AH. All Respondents to this RFP are required to comply with the requirements of Section 3, (Schedule A) - Contract Compliance Affidavit, as applicable. 4.5 Certification Regarding Debarment The Respondent certifies by submission of its offer, that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in Request for Proposals #2024-0115 Insurance Broker and Related Services 13 | P a g e this transaction by a Federal department or agency. All Respondents are required to submit a Disclosure Statement if this is not the case. 4.6 Respondents’ Status The Respondent and its agents will be held to be an independent contractor, and will not be an employee of AH. 4.7 Funding Limitations This procurement may be funded, in whole or in part, by grant funds provided by the U. S. Department of Housing and Urban Development. AH will not be bound to any contract if funding has been disallowed by HUD. 4.8 Government Restrictions In the event any governmental restrictions may be imposed which would necessitate alteration of the material, quality, workmanship or performance of the goods or the material, quality, workmanship or performance of the goods or services offered, it shall be the responsibility of the successful Respondent to immediately notify AH in writing specifying the regulation which requires an alteration. AH reserves the right to accept any such alteration, including any reasonable price adjustments occasioned thereby, or to terminate the contract at no expense to AH. 4.9 Insurance Contractor will be required to obtain and maintain the following insurance coverages during the entire contract period: A. Minimum Limits and Coverage I. Worker’s Compensation and Employer’s Liability with the following minimum limits and coverage: a. Workers Compensation- Statutory Limit in accordance with the laws of the State of Georgia b. Employer’s Liability: $500,000 bodily injury for each accident $500,000 bodily injury by disease for each employee $500,000 bodily injury disease aggregate II. Commercial General Liability with the following minimum limits and coverage: a. $1,000,000 combined single limit for each occurrence for bodily injury/property damage b. AH must be listed as an additional insured III. Automobile Liability with the following minimum limit and coverage: Request for Proposals #2024-0115 Insurance Broker and Related Services 14 | P a g e a. $1,000,000 combined single limit each accident. b. Coverage shall be for any auto (including owned, hired, and non-owned autos) c. AH must be listed as an additional insured IV. Professional Liability / Errors & Omissions (if required) a. Professional Liability / Errors & Omissions insurance in the amount of not less than $1,000,000 per claim, unless otherwise required by AH. V. Cyber-Liability Insurance Requirements In addition to having favorable cyber-risk controls and processes in place, Consultant shall have Cyber Liability Insurance with coverage to protect Atlanta Housing, including both first and third party coverage, with limits not less than $2,000,000 per occurrence or claim and $3,000,000 aggregate. Coverage shall be sufficiently broad to respond to the duties and obligations as are undertaken by Consultant in this agreement and shall address network security wrongful acts; privacy wrongful acts; crisis/breach management expenses; regulatory proceedings expenses; media/content liability expenses; digital asset expenses; business interruption costs; and cyber extortion and reward payments. The policy shall cover, but not be limited to, claims involving infringement of intellectual property, infringement of copyright, invasion of privacy or breach of privacy violations, release of private or personally identifiable information, breach of data, cost of data recovery, unauthorized access to data or systems, information theft, damage to or destruction of electronic information, alteration of electronic information, electronic theft, telecommunications fraud, computer fraud, social engineering fraud, cyber deception, fraudulently induced transfers, ransomware, malware, extortion, and network security. The policy shall provide coverage for breach response costs, regulatory fines and penalties, and credit monitoring expenses, with limits sufficient to respond to these obligations. Contractor shall provide certificates of insurance to AH prior to execution of the contract and at the beginning of each option term. B. Additional Requirements AH reserves the right to require the Contractor to provide certified copies of such policy or policies. Each such policy will not be canceled or materially changed or altered without first giving 30 days' written notice thereof to AH’s Director, Contracts & Procurement, 230 John Wesley Dobbs Avenue, NE, 5th Floor, Atlanta, Georgia 30303-2421, sent by certified mail, return receipt requested. Certificate(s) of Insurance shall be provided to AH evidencing that all coverage, limits and endorsements required herein are maintained and in full force. AH shall be listed on the Certificate as an additional insured as noted in the above coverage requirements. The insurance carrier shall be licensed to transact business in the State of Georgia and shall carry a current A.M. Best’s rating of no less than B+ VI. Request for Proposals #2024-0115 Insurance Broker and Related Services 15 | P a g e Contractor agrees, and hereby authorizes its insurer, to notify AH of any substantial change in such insurance coverage described herein. Substantial change includes, but is not limited to, events such as cancellation, non-renewal, reduction in coverage, or receipt of a claim against such coverage with a potential recovery in excess of 20% of available coverage. The premium cost of all insurance purchased by the Contractor for protection against risks assumed by virtue of the contract shall be borne by the Contractor and is not reimbursable by AH. AH reserves the right, but not the obligation, to review and revise any insurance requirements, including limits, coverages and endorsements, based upon insurance market conditions affecting the availability and affordability of coverage. Additionally, AH reserves the right, but not the obligation, to review and reject any insurance policies, certificates of insurance or insurer failing to meet the criteria stated herein. 4.10 Indemnification AH is defined in this section to include AH Commissioners, employees, agents and/or assigns. Contractor agrees to indemnify AH and hold it harmless from and against any and all claims, liabilities, damages, losses, costs or expenses, including, without limitation, reasonable attorney fees arising out of or related to (a) a breach of the contract by Contractor or (b) the performance of the Services, whether by Contractor, a subcontractor, or anyone directly or indirectly employed by them or anyone for whose acts they may be liable, regardless of whether or not such claim, liability, damage, loss, cost or expense is caused by the gross negligence or willful misconduct of a party indemnified hereunder. Contractor’s indemnification obligation shall not be limited by a limitation on amount or type of damages, compensation or benefits payable by or for Contractor or subcontractor under any insurance required by the contract, including workers’ compensation acts, disability benefit acts, other employee benefit acts, or any other insurance. Contractor shall not settle or compromise any indemnifiable claims hereunder without the prior written consent of AH. AH cannot and does not agree to indemnify, hold harmless, exonerate or assume the defense of Contractor or any other person or entity whatsoever, for any purpose whatsoever. 4.11 Compliance with Laws a) AH is legally obligated, as applicable, to require these provisions in its contract. Contractor and its employees, agents, and subcontractors shall comply with all applicable Federal, State, and local laws, rules, ordinances, regulations and orders applicable to the work described herein, including, but not limited to, those applicable laws, regulations and requirements governing equal employment opportunity strategies, subcontracting with small and minority firms, women's business enterprise, and labor surplus area firms, equal opportunity for businesses and unemployed and underemployed persons (as referenced in Section 3 of The Housing and Urban Development Act of 1968, as amended, 12 U.S.C. 1701u (“Section 3”), the Americans with Disabilities Act, Section 504 of the Rehabilitation Act of 1973, the Davis-Bacon Act, and those laws and regulations concerning the abatement and remediation of asbestos and lead-based paint, and shall provide for such compliance in the contract documents. To the extent the work required under this contract is related to development, Contractor shall further comply with the applicable Annual Contributions Contract (“ACC”) related to Request for Proposals #2024-0115 Insurance Broker and Related Services 16 | P a g e such development. To the extent such work is related to a mixed finance development, Contractor shall comply with the provisions of 24 CFR § 941.208. b) HUD Section 3 Compliance: 1) The services to be performed under the contract are subject to the requirements of Section 3 of the Housing and Urban Development Act of 1968, as amended, 12 U.S.C. 1701u (“HUD Section 3”). The purpose of HUD Section 3 is to ensure that employment and other economic opportunities generated by HUD assistance or HUD-assisted projects covered by HUD Section 3, shall, to the greatest extent feasible, be directed to low and very low-income persons, particularly persons who are recipients of HUD assistance for housing. 2) The Parties hereby agree to comply with HUD's regulations in 24 CFR Part 135, which implement HUD Section 3 (the “Implementing Regulations”). As evidenced by their execution of this contract, the parties to the contract certify that they are under no contractual or other impediment that would prevent them from complying with the implementing Regulations. 3) Contractor agrees to send to each labor organization or representative of workers with which Contractor has a collective bargaining agreement or other understanding, if any, a notice advising the labor organization or workers' representative of Contractor's commitments under this HUD Section 3 clause, and will post copies of the notice in conspicuous places at the work site where both employees and applicants for training and employment positions can see the notice. The notice shall describe the HUD Section 3 preference, shall set forth minimum number and job titles subject to hire, availability of apprenticeship and training positions, the qualifications for each; and the name and location of the person(s) taking applications for each of the positions; and the anticipated date the Services shall begin. 4) Contractor will certify that any vacant employment positions, including training positions, that are filled one (1) after Contractor is selected but before the contract is signed, and (2) with persons other than those to whom the Implementing Regulations require employment opportunities to be directed, were not filled to circumvent the contractor's obligations under the Implementing Regulations. 5) Noncompliance with HUD's regulations in 24 CFR part 135 may result in sanctions, termination of this contract for default, and debarment or suspension from future HUD assisted contracts. 6) With respect to work performed in connection with Section 3 covered Indian housing assistance, section 7(b) of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450e) also applies to the work to be performed under this contract. Section 7(b) requires that to the greatest extent feasible (i) preference and opportunities for training and employment shall be given to Indians, and (ii) preference in the award of contracts and subcontracts shall be given to Indian organizations and Indian- owned Economic Enterprises. Parties to this contract that are subject to the provisions of Section 3 and section 7(b) agree to comply with Section 3 to the maximum extent feasible, but not in derogation of compliance with section 7(b). Request for Proposals #2024-0115 Insurance Broker and Related Services 17 | P a g e c) Energy Efficiency Contractor will comply with all standards and policies relating to energy efficiency which are contained in the energy conservation plan issued in compliance with the Energy Policy and Conservation Act (Pub.L. 94-163) for the State in which the Services are performed. d) Clean Air and Clean Water For contracts in excess of $100,000, Contractor must comply with all applicable standards, orders, or requirements issued under section 306 of the Clean Air Act (42 USC 1857 (h)), section 508 of the Clean Water Act (33 USC 1368), Executive Order 11738, and Environmental Protection Agency regulations 40 CFR part 15. e) Equal Employment Opportunity Contractor, during the performance of the contract, shall not discriminate against any employee or applicant for employment because of race, color, religion, sex, or national origin. Contractor shall comply with applicable federal and state non-discrimination and equal opportunity laws, rules, regulations and executive orders. f) Anti-Lobbying 1) Contractor will not use federally- appropriated funds that have been paid or will be paid, by or on behalf of Contractor, for the purpose of influencing or attempting to influence any officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, or the extension, continuation, renewal, amendment or modification of any Federal contract, grant, loan or cooperative agreement. 2) Contractor agrees to disclose any conflict as soon as such conflict becomes known or should have become known. 3) Contractor agrees to include the language of this subsection in the award documents for sub-awards at all tiers (including subcontracts, sub-grants, and contracts under grants, loans and cooperative agreements) and that all sub recipients and subcontractors shall acknowledge and disclose accordingly. 4.12 Termination for Convenience and Default a) AH may terminate the contract, in whole or in part, for AH's convenience by delivering to Contractor a written notice of termination specifying the nature, extent, and effective date of the termination. Upon receipt of the notice, Contractor shall: (i) immediately discontinue all Services affected (unless the notice directs otherwise); and (ii) deliver to AH all information, reports, papers, and other materials accumulated or generated in performing the Services, whether completed or in process. Request for Proposals #2024-0115 Insurance Broker and Related Services 18 | P a g e b) Either Party may terminate the contract upon the material breach of the contract by the other Party, which breach is not cured within 30 calendar days following written notice thereof; provided, however, that if such breach is not susceptible to cure the non-breaching Party may terminate the contract immediately upon written notice thereof to the breaching Party. For avoidance of doubt, any materially false, deceptive, incorrect or incomplete statement, representation or certification by Contractor in connection with the contract or in the RFP process shall constitute a material breach that is not susceptible to cure by Contractor. Upon the termination of the contract by AH pursuant to this subsection, Contractor shall: (i) immediately discontinue all Services affected (unless the notice directs otherwise); and (ii) deliver to AH all information, reports, papers, and other materials accumulated or generated in performing the Services, whether completed or in process. c) If the termination is for the convenience of AH, then AH shall be liable only for payment for Services rendered before the effective date of the termination. In arriving at the amount due Contractor for a termination for convenience, in no event shall the payment to Contractor exceed the aggregate price set forth in the contract and there shall be deducted: (i) all progress payments to Contractor under the terminated portion of the contract, and (ii) any claim which AH has against Contractor under the contract. d) If the termination is due to breach by Contractor, AH may (i) require Contractor to deliver to it, in the manner and to the extent directed by AH, any work as described in subparagraph (b) above; (ii) take over the work and prosecute the same to completion by contract or otherwise, and Contractor shall be liable for any additional cost incurred by AH; and (iii) withhold any payments to Contractor, for the purpose of off-set or partial payment, as the case may be, of amounts owed to AH by Contractor. e) If, after termination for breach by Contractor, it is determined that Contractor had not in fact breached the contract, the termination shall be deemed to have been effected for the convenience of AH, and Contractor shall be entitled to payment as described in subparagraph (c) above. f) Contractor agrees that upon termination of the contract for any reason, it shall provide sufficient efforts and cooperation to ensure an orderly and efficient transition of the Services to AH or another contractor. Contractor shall provide full disclosure to AH and the third-party contractor about the equipment, software, or services required to perform the Services for AH. 4.13 Disputes a) The Parties agree to attempt to resolve all disputes and misunderstandings that may arise under or relating to the contract by agreement of the Parties or through amicable negotiations. b) All claims by Contractor shall be made in writing and submitted to AH. AH shall, with reasonable promptness, but in no more than 30 calendar days, render a decision concerning any claim hereunder. Unless Contractor, within 20 calendar days after receipt of AH's decision, shall notify AH in writing that it takes exception to such decision, the decision shall be final and conclusive. Contractor shall proceed diligently with performance of the contract, pending decision from AH concerning any claim hereunder. Request for Proposals #2024-0115 Insurance Broker and Related Services 19 | P a g e c) If Contractor does not agree with the decision of AH, Contractor may pursue other legal means to resolve such claim. The venue of any action brought under the contract shall be in the Superior Court of Fulton County, Georgia. 4.14 Examination and Retention of Contractor’s Records a) Contractor shall maintain, during the performance of the contract, and for a period of at least three years following the date of final payment under the contract, all of Contractor’s books, documents, papers and other records, including electronic records, involving transactions related to the contract for the purpose of making audit, examination, excerpts, and transcriptions. AH, the United States Department of Housing and Urban Development (“HUD”), or Comptroller General of the United States, or any of their duly authorized representatives, shall, until three years after final payment under the contract, have access to and the right to examine all such books, documents, papers and other records, including electronic records. b) Contractor agrees to include in first-tier subcontracts under the contract a clause substantially the same as subsection (a) above. “Subcontract,” as used in this section, excludes contracts not exceeding $10,000. c) Notwithstanding anything to the contrary set forth in this section, the periods of access and examination in subsection (a) above shall continue until final disposition of any appeals, litigation, claims or exceptions related thereto that were commenced prior to the expiration of such three-year period. 4.15 Ownership Rights in Works All data, materials, documentation, computer programs, inventions (whether or not patentable) and works of authorship created or developed in whole or in part by Contractor during the contract period in connection with the performance of the Services hereunder (collectively, “Works”) shall be considered work made for hire by Contractor and owned by AH. Works shall not be reproduced or used by Contractor without the express written consent of AH. Contractor shall execute all documents and take all actions necessary to vest ownership of the Works in AH. 4.16 Intellectual Property Contractor agrees it will not use the name or any intellectual property of AH, including but not limited to, AH copyrights, trademarks or logo in any manner, including commercial advertising or use as a business reference, without the prior written consent of AH. 4.17 Confidential Information AH may provide Contractor with information owned by or relating to AH and its business, including, without limitation, its operations, business plans, personnel, or financial matters, all of which is hereby designated as confidential and proprietary by AH (“Confidential Information”). Contractor agrees to only use AH’s Confidential Information to the extent necessary to perform the Services as contemplated herein. During the Contract Period and for two years following the expiration or earlier termination thereof, Contractor shall keep confidential and shall not publish or otherwise disclose, or permit its Request for Proposals #2024-0115 Insurance Broker and Related Services 20 | P a g e employees, subcontractors and assigns to publish or otherwise disclose, any of AH’s Confidential Information without AH’s prior written approval; provided that to the extent such Confidential Information constitutes a trade secret under applicable law, such covenants shall continue for so long as such Confidential Information so constitutes a trade secret. At a minimum, Contractor shall carry out its obligations hereunder using the degree of care that it uses in protecting its own confidential and proprietary information of similar importance. All Confidential Information is and shall remain AH’s property and Contractor shall return such Confidential Information, and all embodiments thereof, to AH upon expiration or termination of the contract or upon the earlier request of AH. Contractor agrees that all of its employees and subcontractors will, upon AH’s request, sign a confidentiality statement, in a form approved by AH in its reasonable discretion, in which such employees and subcontractors agree to be bound by the restrictions set forth in this section. The following types of information shall not be subject to the requirements of this section: (a) information which is or becomes known to the public through no act or omission of Contractor; (b) information which Contractor can demonstrate was in its possession prior to the execution of the contract (and was provided by a source other than AH); (c) information which Contractor developed independently from any relationship with AH; and (d) information which Contractor acquired from a third party which did not violate any obligation of confidentiality or trust by disclosing such information. 4.18 Conflicts of Interest AH is contractually obligated to ensure compliance with this provision. Contractor agrees to notify AH if any of the following persons enter into an agreement with Contractor while such persons are in the roles listed below or within one year after termination of such roles and further certifies that Contractor is not: a) A member or officer of AH's Board of Commissioners or an *immediate family member of an officer of AH’s Board of Commissioners. This prohibition does not include any present or former resident commissioner who does not serve on the governing body of a resident corporation, and who otherwise does not occupy a policymaking position with the resident corporation, AH, or a business entity. b) Any AH employee who formulates policy or who influences decisions with respect to AH’s projects, or any member of the employee's *immediate family, or the employee's partner. c) Any public official, member of the local governing body, or State or local legislator (including members of the City of Atlanta City Council, Fulton County Board of Commissioners, DeKalb County Board of Commissioners, or Georgia legislator), or any member of such individuals' *immediate family, who exercises functions or responsibilities with respect to AH’s projects. d) A member of or delegate to the Congress of the United States of America or a resident commissioner (defined as an individual appointed to oversee a territory or possession of the United States of America, such as Guam). * "Immediate family member “means the spouse, mother, father, brother, sister, or child of a covered class member whether related as a full blood relative, or as a "half" or "step" relative (e.g., half-brother or stepchild). Request for Proposals #2024-0115 Insurance Broker and Related Services 21 | P a g e Contractor agrees to notify AH in writing if it has, during the course of the contract, any organizational conflict of interest, which is defined as a situation in which the nature of work under the contract and a Contractor's organizational, financial, contractual or other interests are such that award of the contract may result in an unfair competitive advantage or Contractor's objectivity in performing the Services may be impaired. The terms of this section shall be included in all subcontracts entered into by Contractor in connection with the contract. At all times while Contractor is conducting business with AH, it is required to disclose in writing, any direct or indirect conflicts of interest and any organizational conflicts of interest as soon as such conflict becomes known or should have become known. If Contractor has a conflict of interest, it must provide a full and complete disclosure, in writing, to AH’s Vice President, Acquisition & Management Services. The Disclosure Statement must be presented on Contractor’s letterhead, notarized and signed by the individual making the disclosure. 4.19 Prohibition against Gifts/Favors/Anything of Monetary Value No AH employee can accept or solicit for themselves or for others, anything of value from Contractor or any person, corporation, or other entity doing business with or attempting to do business with AH. The term “anything of value” includes, but is not limited to, gifts, money, property, meals, favors, personal benefit, entertainment, loans, or promises. Contractor shall report any violation of this prohibition immediately to the Director, Contracts and Procurement, 230 John Wesley Dobbs Avenue, 5th Floor, Atlanta, Georgia 30303-2421. 4.20 Assignment Contractor may not assign the contract or any part thereof, or assign any of the monies to be paid thereunder, or assign or delegate any of its rights, duties or obligations under the contract to any other party, whether by operation of law or otherwise, without the prior written consent of AH. In the event Contractor subcontracts the performance of any of the Services to a third party approved by AH in accordance with this section, Contractor and each subcontractor shall enter into a subcontracting agreement in such form as approved by AH in its sole discretion, which form shall include, without limitation, all required provisions set forth in the contract. Any purported assignment in violation of this section shall be null and void. In its sole discretion, AH reserves the right to refuse approval of any assignment. During the contract term, Contractor is obligated to notify AH if the name or corporate structure changes, including any merger, acquisition, sale, restructuring or other transaction that renders the legal entity name or federal employer identification number different. Contractor agrees to provide sufficient documentation to AH to document such change in the legal entity name or federal employer identification number. Request for Proposals #2024-0115 Insurance Broker and Related Services 22 | P a g e 4.21 Non-Exclusive Rights The resulting contract is not exclusive. AH reserves the right to select other contractors to provide services similar to the Services described in the contract during the contract period. 4.22 Contract Modification AH reserves the right to increase or delete any scheduled items, and/or increase or reduce the quantity of any scheduled item as deemed necessary, and to make other changes and modifications consistent with AH’s policies and applicable local, State and Federal laws. 4.23 Governing Law The contract will be governed by and construed in accordance with the laws of the State of Georgia, without giving effect to principles of conflict of laws. Request for Proposals #2024-0115 Insurance Broker and Related Services 23 | P a g e SECTION 5 – FORM OF CONTRACT 5.1 Exceptions to Contract Respondents’ proposed exceptions to the Form of Contract must be identified and submitted with the Respondents’ proposal. Proposed exceptions must not conflict with or attempt to preempt mandatory requirements and required HUD terms and conditions. Prior to award, and if necessary, the apparent winning Respondent will be required to enter into discussions with AH to resolve any contractual differences before an award is made. These discussions will be finalized and all exceptions resolved within the timeframe specified by AH after notification of potential award. Failure to resolve contractual differences, including failure to return signed documents within time frames specified by AH, will lead to rejection of the Service Provider’s proposal. 1.2 Contract Terms and Conditions The contract that AH expects to award as a result of this RFP will be based upon the RFP, the contract terms and conditions, the Proposal submitted by the successful Respondent and any subsequent revisions to the Respondent’s Proposal and the contract terms and conditions due to negotiations, written clarifications or changes made in accordance with the provisions of the RFP, and any other terms deemed necessary by AH, except that no objection or amendment by a Respondent to the RFP requirements or the contract terms and conditions shall be incorporated by reference into the contract unless AH has explicitly accepted the Service Provider’s objection or amendment in writing. EXCEPTIONS OR OBJECTIONS TO THE PROPOSED CONTRACT TERMS MUST BE IDENTIFIED AND SUBMITTED WITH THE RESPONDENT’S PROPOSAL. AH WILL NOT ACCEPT PROPOSED EXCEPTIONS OR OBJECTIONS THAT CONFLICT WITH OR ATTEMPT TO PREEMPT MANDATORY REQUIREMENTS. PRIOR TO AWARD, AND IF NECESSARY, THE APPARENT WINNING RESPONDENT MAY BE REQUIRED TO ENTER INTO DISCUSSIONS WITH AH TO RESOLVE ANY CONTRACTUAL DIFFERENCES BEFORE AN AWARD IS MADE. THESE DISCUSSIONS WILL BE FINALIZED AND ALL EXCEPTIONS RESOLVED WITHIN THE TIMEFRAME SPECIFIED BY AH AFTER NOTIFICATION OF POTENTIAL AWARD. FAILURE TO RESOLVE CONTRACTUAL DIFFERENCES WILL LEAD TO REJECTION OF THE RESPONDENT’S PROPOSAL. AH RESERVES THE RIGHT TO REJECT OFFERS OR END DISCUSSIONS WITH RESPONDENTS THAT ARE NOT FORTHCOMING WITH EXCEPTIONS IN THE PROPOSAL SUBMISSION. GENERALIZED EXCEPTIONS ARE NOT ACCEPTABLE (E.G., RESPONDENT IS AMENABLE TO REACHING NEGOTIATED TERMS WITH AH). Request for Proposals #2024-0115 Insurance Broker and Related Services 24 | P a g e Exhibit A AH’s Current Insurance Coverages Atlanta Housing’s Insurance Roster of Policies as of December 19, 2018 (http://ahateams.hq.atlantahousing.org/sites/execfs/Risk Management 2/Risk Mgmt/2019/Policies 2018-2019/Insurance Roster of Policies 2018-12-19.docx) HAI GP HAI GP HAI GP AJG AJG AJG AJG AJG AJG. *$20 million aggregate limit of liability for these five coverages* AJG AJG Automobile (Collision/Comp) Automobile (Liability) General Liability Gen. & Excess Liability for Wildwood Lake Property Cyber Liability Equipment Breakdown (“Boiler & Machinery”) Workers Comp Excess (Fiduciary) XS / Follow Form D&O, EP & EL Liability (Fiduciary) D&O Directors & Officers Liability (Fiduciary) EP Employment Practices Liability (Fiduciary) EL Employed Lawyers Liability (Fiduciary) Fiduciary Liability (Fiduciary) Crime Third-Party Administrator (TPA) Policy Number BA-6964C413-18-HPR HGAU-536- 184443-18 HARRG-536- 183638-2018 0100065546-0 (GL) LHT905219 ASG18F004052 FBP2219111 EWC006136 MMX01238-18 0304-7342 0304-7342 0304-7342 0304-7342 0304-7342 HOUSAUT-31 0100065561-0 (XSGL) Type of Coverage Physical damage: Collision & Comprehensive Bodily injury and property damage liability & auto medical payments Unintentional negligence and Intentional torts Wildwood Lake Property and Lake Unintentional negligence and Intentional torts Buildings damage & loss, incl. contents Security & Privacy; Multimedia & Intell. Prop; Netwk Interrupt & Recvry; Event Suppt Exp; Privacy Regulatory Defense & Penalties; Netwk Extortion; Electronic Theft, Cptr & Telecom Fraud; Social Engineering Fraud; Reputational Damage Equipment failure, incl. mold, terrorism, data compromise, & identity recovery Excess Workers Compensation (HUD waiver on file for self- insurance) XS Defense costs for alleged wrongful acts by D&O Defense costs for alleged wrongful acts by D&O Liability from wrongful acts by staff or org arising from employment process Liability from wrongful acts by AHA’s staff attorneys Liability from wrongful acts by staff or org managing assets Liability from employee dishonesty– theft of money, securities, or property Admin for GL & All Other Claims under AJG, esp. XS Wkrs Comp. (But NOT for Auto Collision / Auto Liability) Insurance Carrier or Company HIS (Housing Insurance Services, Inc., v0000865) via Travelers / The Charter Oak Fire Insurance Co. HARRG Housing Authority Risk Retention Group, Inc. v000863 HARRG Housing Authority Risk Retention Group, Inc. v000863 Kinsale Insurance Company RSUI- Landmark American Insurance Co. Lloyd’s of London / Ascent Underwriters. The Hartford Steam Boiler Inspection & Insurance Co. Midwest Employers Casualty Company Atlantic Specialty / One Beacon Darwin National Assurance Co. / Allied World Assurance Co. Darwin National Assurance Co. / Allied World Assurance Co. Darwin National Assurance Co. / Allied World Assurance Co. Darwin National Assurance Co. / Allied World Assurance Co. Darwin National Assurance Co. / Allied World Assurance Co. Gallagher Bassett Services Effective Date 8/1/2018 8/1/2018 8/1/2018 4/20/2018 8/1/2018 8/1/2018 8/1/2018 8/1/2018 8/1/2018 8/1/2018 8/1/2018 8/1/2018 8/1/2018 8/1/2018 10/1/2018 Expiration Date 8/1/2019 8/1/2019 8/1/2019 4/20/2019 8/1/2019 8/1/2019 8/1/2019 8/1/2019 8/1/2019 8/1/2019 8/1/2019 8/1/2019 8/1/2019 8/1/2019 10/1/2019 Limit Amount Actual cash value or cost to repair, minus deductible $1.9 million $5 million $2 million (GL) $189,757,122 $5 million $50 million Coverage A (WC): Statutory None Separate Limit Separate Limit Separate Limit Separate Limit $2 million N/A $1 million (XSGL) (plus $250K @ no cost fr. HAI Group) Coverage B: (Employers Liability): (follows D&O, EP, & EL) $5 million $5 million $5 million $5 million Each single loss $1 million Deductible / SIR Collision: $2,500 Comp.: $2,000 $100,000 $100,000 $1,000 (GL) $0.00 (XSGL) $50,000 (NO coverage for Civic Center) $25,000 ($25,000 HAI Group's bonus policy) $5,000 $400,000 All Claims $75,000 Retention All Claims $75,000 Retention All Claims $75,000 Retention All Claims $10,000 Retention All Claims $25,000 Retention $10,000 Deductible Each single loss N/A Premium incl. Fees $8,493 $21,201 $161,556 (Commercial L) $7,048.08 (GL) $141,210 plus $29,759.60 (main) $9,710 $103,192 $48,916 $31,100 $19,706 $25,625 $2,975 $7,053 $15,000 plus $16,129 (Law Enforcement L) $1,591.20 (XSGL) $5,648.40 Surplus Lines Tax (4%) plus Plus $5,000 (AJG broker fees) Fee: $1,523.58 Fee: $16,191.68 Fee: $7,675.32 Fee: $4,879.86 Fee: $3,092.03 Fee: $4,020.77 Fee: $466.80 Fee: $1,106.67 $6,750 AJG fee $250 (Employee Benefits Admin L) Total: $8,639.28 Fees: $22,157.01 + $886.28 Total: $34,759.60 Ttl: $11,233.58 Ttl: $119,383.68 Ttl: $56,591.32 Ttl: $35,979.86 Ttl: $22,798.03 Ttl: $29,645.77 Ttl: $3,441.80 Ttl: $8,159.67 Total: $21,750 $1,779 (Terrorism) Ttl: $169,901.69 Total: $179,714 Totals $8,493.00 $21,201.00 $179,714.00 $8,639.28 $169,901.69 $34,759.60 $11,233.58 $119,383.68 $56,591.32 $35,979.86 $22,798.03 $29,645.77 $3,441.80 $8,159.67 $21,750.00 Mid-Year Adjustments $353.00 $533.00 New Totals $8,846.00 $21,734.00 $179,714.00 $8,639.28 $169,901.69 $34,759.60 $11,233.58 $119,383.68 $56,591.32 $35,979.86 $22,798.03 $29,645.77 $3,441.80 $8,159.67 $21,750.00 Request for Proposals #2024-0115 Insurance Broker and Related Services 25 | P a g e Exhibit B AH’s Loss Runs for Various Coverages CLAIM_NUM Claim Type POLEF_DATE POLEX_DATE TRAN_DATE PAYEE_NAME TOTAL_AMT DESCRIPTION SERV_ST_DT SERV_EN_DT 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 12/15/2014 GB TPA $11.00 IDX INDEX BUREAU FEE 12/8/2014 12/8/2014 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 1/12/2015 OCCUPATIONAL HEALTH CENTERS $140.30 MEDICAL 11/10/2014 11/10/2014 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 1/13/2015 OCCUPATIONAL HEALTH CENTERS $105.54 MEDICAL 11/17/2014 11/17/2014 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 1/26/2015 OCCUPATIONAL HEALTH CENTERS $0.00 MEDICAL 11/10/2014 11/10/2014 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 1/27/2015 U S MEDGROUP P A CO $275.93 MEDICAL 12/12/2014 12/12/2014 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 1/28/2015 OCCUPATIONAL HEALTH CENTERS $344.46 MEDICAL 11/3/2014 11/3/2014 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 1/28/2015 MEDRISK, INC $160.73 MEDICAL 11/21/2014 11/21/2014 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 1/28/2015 MEDRISK, INC $160.73 MEDICAL 11/17/2014 11/17/2014 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 1/28/2015 MEDRISK, INC $278.54 MEDICAL 11/3/2014 11/3/2014 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 1/28/2015 OCCUPATIONAL HEALTH CENTERS $249.08 MEDICAL 11/3/2014 11/3/2014 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 1/30/2015 US MEDGROUP PA CO $0.00 MEDICAL 12/12/2014 12/12/2014 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 2/2/2015 OCCUPATIONAL HEALTH CENTERS $46.29 MEDICAL 11/3/2014 11/3/2014 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 2/2/2015 OCCUPATIONAL HEALTH CENTERS $0.00 MEDICAL 11/17/2014 11/17/2014 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 2/3/2015 MEDRISK, INC $0.00 MEDICAL 11/21/2014 11/21/2014 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 2/3/2015 MEDRISK, INC $0.00 MEDICAL 11/3/2014 11/3/2014 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 2/3/2015 MEDRISK, INC $160.73 MEDICAL 11/10/2014 11/10/2014 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 2/3/2015 MEDRISK, INC $160.73 MEDICAL 11/24/2014 11/24/2014 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 2/3/2015 MEDRISK, INC $0.00 MEDICAL 11/17/2014 11/17/2014 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 2/3/2015 MEDRISK, INC $0.00 MEDICAL 11/13/2014 11/13/2014 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 2/3/2015 MEDRISK, INC $160.73 MEDICAL 11/13/2014 11/13/2014 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 2/3/2015 OCCUPATIONAL HEALTH CENTERS $105.54 MEDICAL 11/24/2014 11/24/2014 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 2/4/2015 OCCUPATIONAL HEALTH CENTERS $0.00 MEDICAL 11/17/2014 11/17/2014 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 2/10/2015 U S MEDGROUP P A CO $0.00 MEDICAL 12/12/2014 12/12/2014 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 2/11/2015 MEDRISK, INC $0.00 MEDICAL 11/24/2014 11/24/2014 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 2/11/2015 MEDRISK, INC $0.00 MEDICAL 11/21/2014 11/21/2014 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 2/11/2015 MEDRISK, INC $0.00 MEDICAL 11/17/2014 11/17/2014 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 2/11/2015 MEDRISK, INC $0.00 MEDICAL 11/13/2014 11/13/2014 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 2/11/2015 MEDRISK, INC $0.00 MEDICAL 11/10/2014 11/10/2014 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 2/11/2015 MEDRISK, INC $0.00 MEDICAL 11/3/2014 11/3/2014 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 2/11/2015 OCCUPATIONAL HEALTH CENTERS $0.00 MEDICAL 11/3/2014 11/3/2014 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 2/12/2015 OCCUPATIONAL HEALTH CENTERS $0.00 MEDICAL 11/17/2014 11/17/2014 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 2/13/2015 OCCUPATIONAL HEALTH CENTERS $0.00 MEDICAL 11/24/2014 11/24/2014 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 2/25/2015 US MEDGROUP PA CO $0.00 MEDICAL 12/12/2014 12/12/2014 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 6/25/2015 -$344.46 REFUND 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 1/12/2015 GB TPA $10.30 BILL AUDITING FEE 11/10/2014 11/10/2014 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 1/13/2015 GB TPA $31.41 BILL AUDITING FEE 11/17/2014 11/17/2014 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 1/28/2015 GB TPA $13.74 BILL AUDITING FEE 11/3/2014 11/3/2014 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 1/28/2015 GB TPA $12.61 BILL AUDITING FEE 11/17/2014 11/17/2014 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 1/28/2015 GB TPA $12.61 BILL AUDITING FEE 11/21/2014 11/21/2014 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 1/27/2015 GB TPA $13.56 BILL AUDITING FEE 12/12/2014 12/12/2014 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 1/28/2015 GB TPA $34.87 BILL AUDITING FEE 11/3/2014 11/3/2014 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 2/3/2015 GB TPA $12.61 BILL AUDITING FEE 11/13/2014 11/13/2014 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 2/3/2015 GB TPA $9.50 BILL AUDITING FEE 11/13/2014 11/13/2014 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 2/3/2015 GB TPA $9.50 BILL AUDITING FEE 11/17/2014 11/17/2014 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 2/3/2015 GB TPA $12.61 BILL AUDITING FEE 11/24/2014 11/24/2014 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 2/3/2015 GB TPA $12.61 BILL AUDITING FEE 11/10/2014 11/10/2014 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 2/3/2015 GB TPA $9.50 BILL AUDITING FEE 11/3/2014 11/3/2014 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 2/3/2015 GB TPA $9.50 BILL AUDITING FEE 11/21/2014 11/21/2014 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 2/11/2015 GB TPA $9.50 BILL AUDITING FEE 11/3/2014 11/3/2014 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 2/11/2015 GB TPA $9.50 BILL AUDITING FEE 11/10/2014 11/10/2014 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 2/11/2015 GB TPA $9.50 BILL AUDITING FEE 11/13/2014 11/13/2014 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 2/11/2015 GB TPA $9.50 BILL AUDITING FEE 11/17/2014 11/17/2014 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 2/11/2015 GB TPA $9.50 BILL AUDITING FEE 11/21/2014 11/21/2014 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 2/11/2015 GB TPA $9.50 BILL AUDITING FEE 11/24/2014 11/24/2014 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 2/2/2015 GB TPA $9.76 BILL AUDITING FEE 11/3/2014 11/3/2014 006016-000002-WC-01 Workers' Comp 10/1/2014 8/1/2015 2/3/2015 GB TPA $24.44 BILL AUDITING FEE 11/24/2014 11/24/2014 $2,312.00 006016-000004-WC-01 Workers' Comp 10/1/2014 8/1/2015 5/7/2015 THE EMORY CLINIC INC $159.43 MEDICAL 3/17/2015 3/17/2015 006016-000004-WC-01 Workers' Comp 10/1/2014 8/1/2015 5/7/2015 EMORY PHYSICAL THERAPY LLC $157.25 MEDICAL 4/13/2015 4/13/2015 006016-000004-WC-01 Workers' Comp 10/1/2014 8/1/2015 5/7/2015 GB TPA $11.00 IDX INDEX BUREAU FEE 4/30/2015 4/30/2015 006016-000004-WC-01 Workers' Comp 10/1/2014 8/1/2015 5/11/2015 EMORY UNIVERSITY HOSPITAL $1,172.40 MEDICAL 3/12/2015 3/12/2015 006016-000004-WC-01 Workers' Comp 10/1/2014 8/1/2015 6/16/2015 EMORY UNIV HOSP MAIN $256.10 MEDICAL 3/27/2015 3/27/2015 006016-000004-WC-01 Workers' Comp 10/1/2014 8/1/2015 7/21/2015 THE EMORY CLINIC INC $125.14 MEDICAL 3/27/2015 3/27/2015 006016-000004-WC-01 Workers' Comp 10/1/2014 8/1/2015 9/16/2015 THE EMORY CLINIC INC $43.46 MEDICAL 3/12/2015 3/12/2015 006016-000004-WC-01 Workers' Comp 10/1/2014 8/1/2015 9/16/2015 THE EMORY CLINIC INC $174.21 MEDICAL 3/12/2015 3/12/2015 006016-000004-WC-01 Workers' Comp 10/1/2014 8/1/2015 9/28/2015 THE EMORY CLINIC INC $46.93 MEDICAL 3/12/2015 3/12/2015 006016-000004-WC-01 Workers' Comp 10/1/2014 8/1/2015 5/7/2015 GB TPA $9.50 BILL AUDITING FEE 4/13/2015 4/13/2015 006016-000004-WC-01 Workers' Comp 10/1/2014 8/1/2015 5/7/2015 GB TPA $33.45 BILL AUDITING FEE 3/17/2015 3/17/2015 006016-000004-WC-01 Workers' Comp 10/1/2014 8/1/2015 5/11/2015 GB TPA $46.75 BILL AUDITING FEE 3/12/2015 3/12/2015 006016-000004-WC-01 Workers' Comp 10/1/2014 8/1/2015 6/16/2015 GB TPA $17.47 BILL AUDITING FEE 3/27/2015 3/27/2015 006016-000004-WC-01 Workers' Comp 10/1/2014 8/1/2015 7/21/2015 GB TPA $9.50 BILL AUDITING FEE 3/27/2015 3/27/2015 006016-000004-WC-01 Workers' Comp 10/1/2014 8/1/2015 9/16/2015 GB TPA $9.50 BILL AUDITING FEE 3/12/2015 3/12/2015 006016-000004-WC-01 Workers' Comp 10/1/2014 8/1/2015 9/16/2015 GB TPA $9.50 BILL AUDITING FEE 3/12/2015 3/12/2015 006016-000004-WC-01 Workers' Comp 10/1/2014 8/1/2015 9/28/2015 GB TPA $9.50 BILL AUDITING FEE 3/12/2015 3/12/2015 $2,291.09 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 7/30/2015 GB TPA $11.00 IDX INDEX BUREAU FEE 7/23/2015 7/23/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 7/30/2015 ORTHOATLANTA LLC $267.36 MEDICAL 6/29/2015 6/29/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 8/20/2015 INC. ONE CALL MEDICAL $515.40 MEDICAL 7/31/2015 7/31/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 8/26/2015 ORTHOATLANTA LLC $98.10 MEDICAL 7/17/2015 7/17/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 10/1/2015 COVENTRY HEALTH CARE, INC. $73.16 MEDICAL 9/15/2015 9/15/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 10/13/2015 MedRisk, Inc $150.69 MEDICAL 9/8/2015 9/8/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 10/13/2015 MedRisk, Inc $150.69 MEDICAL 9/3/2015 9/3/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 10/13/2015 MedRisk, Inc $150.69 MEDICAL 9/1/2015 9/1/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 10/13/2015 MedRisk, Inc $228.42 MEDICAL 8/21/2015 8/21/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 10/13/2015 MedRisk, Inc $150.69 MEDICAL 8/27/2015 8/27/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 10/13/2015 MedRisk, Inc $221.07 MEDICAL 8/25/2015 8/25/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 10/13/2015 ORTHOATLANTA LLC $160.84 MEDICAL 8/12/2015 8/12/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 11/1/2015 ORTHOATLANTA LLC $1,967.88 MEDICAL 9/17/2015 9/17/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 11/4/2015 EMORY SPECIALTY ASSOCIAT $173.57 MEDICAL 9/17/2015 9/17/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 11/9/2015 EMORY SPECIALTY ASSOCIAT $173.57 MEDICAL 9/17/2015 9/17/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 11/1/2015 ATLANTA OUTPATIENT SURGERY $5,559.75 MEDICAL 9/17/2015 9/17/2015 Page 1 of 7 CLAIM_NUM Claim Type POLEF_DATE POLEX_DATE TRAN_DATE PAYEE_NAME TOTAL_AMT DESCRIPTION SERV_ST_DT SERV_EN_DT 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 11/14/2015 MedRisk, Inc $260.89 MEDICAL 10/20/2015 10/20/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 11/14/2015 MedRisk, Inc $116.32 MEDICAL 10/19/2015 10/19/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 11/23/2015 ORTHOATLANTA LLC $291.60 MEDICAL 9/18/2015 9/18/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 11/27/2015 MedRisk, Inc $188.60 MEDICAL 11/10/2015 11/10/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 11/27/2015 MedRisk, Inc $230.54 MEDICAL 11/3/2015 11/3/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 12/12/2015 MedRisk, Inc $230.54 MEDICAL 11/23/2015 11/23/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 12/12/2015 MedRisk, Inc $230.54 MEDICAL 11/18/2015 11/18/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 12/12/2015 MedRisk, Inc $230.54 MEDICAL 11/16/2015 11/16/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 12/12/2015 MedRisk, Inc $230.54 MEDICAL 11/13/2015 11/13/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 12/16/2015 ORTHOATLANTA LLC $71.10 MEDICAL 12/4/2015 12/4/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 12/21/2015 COVENTRY HEALTH CARE, INC. $83.89 MEDICAL 12/4/2015 12/4/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 1/5/2016 MedRisk, Inc $230.54 MEDICAL 12/7/2015 12/7/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 1/12/2016 MedRisk, Inc $230.54 MEDICAL 12/14/2015 12/14/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 1/12/2016 MedRisk, Inc $230.54 MEDICAL 12/11/2015 12/11/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 1/23/2016 MedRisk, Inc $188.60 MEDICAL 12/21/2015 12/21/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 1/27/2016 MedRisk, Inc $188.60 MEDICAL 12/31/2015 12/31/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 2/2/2016 ORTHOATLANTA LLC $151.95 MEDICAL 1/8/2016 1/8/2016 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 2/9/2016 MedRisk, Inc $188.60 MEDICAL 1/4/2016 1/4/2016 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 2/17/2016 MedRisk, Inc $188.61 MEDICAL 1/8/2016 1/8/2016 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 3/3/2016 ORTHOATLANTA LLC $102.31 MEDICAL 2/5/2016 2/5/2016 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 3/4/2016 MedRisk, Inc $188.61 MEDICAL 10/27/2015 10/27/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 3/4/2016 MedRisk, Inc $188.61 MEDICAL 10/29/2015 10/29/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 3/15/2016 INC. ONE CALL MEDICAL $513.49 MEDICAL 2/3/2016 2/3/2016 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 4/7/2016 COVENTRY HEALTH CARE, INC. $39.08 MEDICAL 3/23/2016 3/23/2016 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 4/25/2016 ATLANTA HEART ASSOCIATES PC $25.25 MEDICAL 3/24/2016 3/24/2016 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 4/25/2016 ATLANTA HEART ASSOCIATES PC $140.84 MEDICAL 3/24/2016 3/24/2016 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 5/2/2016 SOUTHERN ORTHOPAEDIC SURGERY $7,564.15 MEDICAL 3/28/2016 3/28/2016 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 5/13/2016 ORTHOATLANTA LLC $2,506.13 MEDICAL 3/28/2016 3/28/2016 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 5/16/2016 ORTHOLANTA LLC $250.62 MEDICAL 3/28/2016 3/28/2016 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 5/21/2016 MedRisk, Inc $116.32 MEDICAL 4/22/2016 4/22/2016 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 5/21/2016 MedRisk, Inc $188.60 MEDICAL 4/29/2016 4/29/2016 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 5/26/2016 PIEDMONT ANESTHESIA ASSOCIATES $154.28 MEDICAL 3/28/2016 3/28/2016 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 5/27/2016 MedRisk, Inc $188.60 MEDICAL 5/2/2016 5/2/2016 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 6/2/2016 PIEDMONT ANESTHESIA ASSOCIATES $154.28 MEDICAL 3/28/2016 3/28/2016 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 6/9/2016 MedRisk, Inc $188.61 MEDICAL 5/16/2016 5/16/2016 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 6/9/2016 MedRisk, Inc $188.61 MEDICAL 5/9/2016 5/9/2016 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 6/9/2016 MedRisk, Inc $188.61 MEDICAL 5/6/2016 5/6/2016 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 6/22/2016 MedRisk, Inc $188.61 MEDICAL 5/23/2016 5/23/2016 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 8/9/2016 INC TMHC $919.05 MEDICAL 3/28/2016 3/28/2016 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 10/7/2016 ORTHOATLANTA LLC $117.31 MEDICAL 9/13/2016 9/13/2016 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 10/21/2016 INC. ONE CALL MEDICAL $353.61 MEDICAL 9/27/2016 9/27/2016 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 7/30/2015 GB TPA $17.60 BILL AUDITING FEE 6/29/2015 6/29/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 8/20/2015 GB TPA $25.54 BILL AUDITING FEE 7/31/2015 7/31/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 8/26/2015 GB TPA $12.19 BILL AUDITING FEE 7/17/2015 7/17/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 10/13/2015 GB TPA $52.60 BILL AUDITING FEE 8/25/2015 8/25/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 10/13/2015 GB TPA $30.31 BILL AUDITING FEE 8/27/2015 8/27/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 10/13/2015 GB TPA $16.94 BILL AUDITING FEE 8/21/2015 8/21/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 10/13/2015 GB TPA $30.31 BILL AUDITING FEE 9/1/2015 9/1/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 10/13/2015 GB TPA $30.31 BILL AUDITING FEE 9/3/2015 9/3/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 10/13/2015 GB TPA $30.31 BILL AUDITING FEE 9/8/2015 9/8/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 10/13/2015 GB TPA $13.11 BILL AUDITING FEE 8/12/2015 8/12/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 11/14/2015 GB TPA $18.93 BILL AUDITING FEE 10/19/2015 10/19/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 11/14/2015 GB TPA $62.45 BILL AUDITING FEE 10/20/2015 10/20/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 11/1/2015 GB TPA $38.50 BILL AUDITING FEE 9/17/2015 9/17/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 11/1/2015 GB TPA $720.35 BILL AUDITING FEE 9/17/2015 9/17/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 11/4/2015 GB TPA $14.90 BILL AUDITING FEE 9/17/2015 9/17/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 11/9/2015 GB TPA $14.90 BILL AUDITING FEE 9/17/2015 9/17/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 11/27/2015 GB TPA $53.31 BILL AUDITING FEE 11/3/2015 11/3/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 11/27/2015 GB TPA $40.69 BILL AUDITING FEE 11/10/2015 11/10/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 11/23/2015 GB TPA $18.57 BILL AUDITING FEE 9/18/2015 9/18/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 12/12/2015 GB TPA $53.31 BILL AUDITING FEE 11/13/2015 11/13/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 12/12/2015 GB TPA $53.31 BILL AUDITING FEE 11/16/2015 11/16/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 12/12/2015 GB TPA $53.31 BILL AUDITING FEE 11/18/2015 11/18/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 12/12/2015 GB TPA $53.31 BILL AUDITING FEE 11/23/2015 11/23/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 12/16/2015 GB TPA $11.71 BILL AUDITING FEE 12/4/2015 12/4/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 1/5/2016 GB TPA $53.31 BILL AUDITING FEE 12/7/2015 12/7/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 1/12/2016 GB TPA $53.31 BILL AUDITING FEE 12/11/2015 12/11/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 1/12/2016 GB TPA $53.31 BILL AUDITING FEE 12/14/2015 12/14/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 1/23/2016 GB TPA $40.69 BILL AUDITING FEE 12/21/2015 12/21/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 1/27/2016 GB TPA $40.69 BILL AUDITING FEE 12/31/2015 12/31/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 2/9/2016 GB TPA $40.69 BILL AUDITING FEE 1/4/2016 1/4/2016 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 2/2/2016 GB TPA $11.74 BILL AUDITING FEE 1/8/2016 1/8/2016 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 2/17/2016 GB TPA $40.69 BILL AUDITING FEE 1/8/2016 1/8/2016 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 3/4/2016 GB TPA $40.69 BILL AUDITING FEE 10/29/2015 10/29/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 3/4/2016 GB TPA $40.69 BILL AUDITING FEE 10/27/2015 10/27/2015 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 3/3/2016 GB TPA $11.01 BILL AUDITING FEE 2/5/2016 2/5/2016 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 3/15/2016 GB TPA $27.89 BILL AUDITING FEE 2/3/2016 2/3/2016 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 4/25/2016 GB TPA $14.85 BILL AUDITING FEE 3/24/2016 3/24/2016 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 4/25/2016 GB TPA $10.28 BILL AUDITING FEE 3/24/2016 3/24/2016 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 5/2/2016 GB TPA $75.00 BILL AUDITING FEE 3/28/2016 3/28/2016 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 5/13/2016 GB TPA $46.44 BILL AUDITING FEE 3/28/2016 3/28/2016 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 5/21/2016 GB TPA $40.69 BILL AUDITING FEE 4/29/2016 4/29/2016 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 5/21/2016 GB TPA $18.93 BILL AUDITING FEE 4/22/2016 4/22/2016 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 5/27/2016 GB TPA $40.69 BILL AUDITING FEE 5/2/2016 5/2/2016 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 5/16/2016 GB TPA $13.19 BILL AUDITING FEE 3/28/2016 3/28/2016 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 5/26/2016 GB TPA $20.30 BILL AUDITING FEE 3/28/2016 3/28/2016 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 6/9/2016 GB TPA $40.69 BILL AUDITING FEE 5/6/2016 5/6/2016 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 6/9/2016 GB TPA $40.69 BILL AUDITING FEE 5/9/2016 5/9/2016 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 6/9/2016 GB TPA $40.69 BILL AUDITING FEE 5/16/2016 5/16/2016 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 6/2/2016 GB TPA $20.30 BILL AUDITING FEE 3/28/2016 3/28/2016 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 6/22/2016 GB TPA $40.69 BILL AUDITING FEE 5/23/2016 5/23/2016 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 8/9/2016 GB TPA $9.50 BILL AUDITING FEE 3/28/2016 3/28/2016 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 10/7/2016 GB TPA $9.50 BILL AUDITING FEE 9/13/2016 9/13/2016 006016-000006-WC-01 Workers' Comp 10/1/2014 8/1/2015 10/21/2016 GB TPA $20.50 BILL AUDITING FEE 9/27/2016 9/27/2016 $30,705.95 Page 2 of 7 CLAIM_NUM Claim Type POLEF_DATE POLEX_DATE TRAN_DATE PAYEE_NAME TOTAL_AMT DESCRIPTION SERV_ST_DT SERV_EN_DT 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 2/12/2016 GB TPA $10.00 IDX INDEX BUREAU FEE 2/5/2016 2/5/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 3/10/2016 MedRisk, Inc $215.46 MEDICAL 2/24/2016 2/24/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 3/14/2016 ORTHOATLANTA LLC $117.31 MEDICAL 2/22/2016 2/22/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 3/14/2016 ORTHOATLANTA LLC $117.31 MEDICAL 2/29/2016 2/29/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 3/14/2016 ORTHOATLANTA LLC $186.47 MEDICAL 2/8/2016 2/8/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 3/22/2016 MedRisk, Inc $101.75 MEDICAL 2/29/2016 2/29/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 3/23/2016 INC. ONE CALL MEDICAL $354.49 MEDICAL 2/17/2016 2/17/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 4/7/2016 MedRisk, Inc $131.94 MEDICAL 3/9/2016 3/9/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 4/7/2016 MedRisk, Inc $101.75 MEDICAL 3/2/2016 3/2/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 4/8/2016 PEACHTREE ORTHOPAEDIC CLINIC $225.30 MEDICAL 3/16/2016 3/16/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 4/19/2016 MedRisk, Inc $145.73 MEDICAL 3/21/2016 3/21/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 4/19/2016 MedRisk, Inc $131.94 MEDICAL 3/16/2016 3/16/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 4/19/2016 MedRisk, Inc $131.94 MEDICAL 3/14/2016 3/14/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 4/21/2016 MedRisk, Inc $145.73 MEDICAL 3/23/2016 3/23/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 4/29/2016 MedRisk, Inc $145.73 MEDICAL 4/6/2016 4/6/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 4/29/2016 MedRisk, Inc $131.94 MEDICAL 4/4/2016 4/4/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 4/29/2016 MedRisk, Inc $134.19 MEDICAL 3/30/2016 3/30/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 4/29/2016 MedRisk, Inc $145.73 MEDICAL 3/28/2016 3/28/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 5/4/2016 MedRisk, Inc $145.73 MEDICAL 4/13/2016 4/13/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 5/4/2016 MedRisk, Inc $145.73 MEDICAL 4/11/2016 4/11/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 5/10/2016 PEACHTREE ORTHOPAEDIC CLINIC $156.34 MEDICAL 4/20/2016 4/20/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 5/20/2016 MedRisk, Inc $145.73 MEDICAL 4/18/2016 4/18/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 5/25/2016 MedRisk, Inc $145.73 MEDICAL 4/20/2016 4/20/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 5/27/2016 MedRisk, Inc $134.19 MEDICAL 4/27/2016 4/27/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 6/9/2016 MedRisk, Inc $134.19 MEDICAL 5/9/2016 5/9/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 6/10/2016 MedRisk, Inc $134.19 MEDICAL 5/16/2016 5/16/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 8/9/2016 PEACHTREE ORTHOPAEDIC CLINIC $217.22 MEDICAL 7/20/2016 7/20/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 9/22/2016 MedRisk, Inc $0.00 MEDICAL 3/7/2016 3/7/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 9/26/2016 MedRisk, Inc $0.00 MEDICAL 4/25/2016 4/25/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 9/22/2017 MedRisk, Inc $149.08 MEDICAL 4/25/2016 4/25/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 9/22/2017 MedRisk, Inc $136.75 MEDICAL 5/25/2016 5/25/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 9/26/2017 MedRisk, Inc $110.35 MEDICAL 3/7/2016 3/7/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 3/10/2016 GB TPA $15.80 BILL AUDITING FEE 2/24/2016 2/24/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 3/22/2016 GB TPA $12.79 BILL AUDITING FEE 2/29/2016 2/29/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 3/14/2016 GB TPA $10.82 BILL AUDITING FEE 2/8/2016 2/8/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 3/14/2016 GB TPA $9.50 BILL AUDITING FEE 2/29/2016 2/29/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 3/14/2016 GB TPA $9.50 BILL AUDITING FEE 2/22/2016 2/22/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 3/23/2016 GB TPA $20.53 BILL AUDITING FEE 2/17/2016 2/17/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 4/7/2016 GB TPA $12.79 BILL AUDITING FEE 3/2/2016 3/2/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 4/7/2016 GB TPA $17.61 BILL AUDITING FEE 3/9/2016 3/9/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 4/8/2016 GB TPA $43.08 BILL AUDITING FEE 3/16/2016 3/16/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 4/19/2016 GB TPA $17.61 BILL AUDITING FEE 3/14/2016 3/14/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 4/19/2016 GB TPA $17.61 BILL AUDITING FEE 3/16/2016 3/16/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 4/19/2016 GB TPA $21.76 BILL AUDITING FEE 3/21/2016 3/21/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 4/21/2016 GB TPA $21.76 BILL AUDITING FEE 3/23/2016 3/23/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 4/29/2016 GB TPA $21.76 BILL AUDITING FEE 3/28/2016 3/28/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 4/29/2016 GB TPA $18.29 BILL AUDITING FEE 3/30/2016 3/30/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 4/29/2016 GB TPA $17.61 BILL AUDITING FEE 4/4/2016 4/4/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 4/29/2016 GB TPA $21.76 BILL AUDITING FEE 4/6/2016 4/6/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 5/4/2016 GB TPA $21.76 BILL AUDITING FEE 4/11/2016 4/11/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 5/4/2016 GB TPA $21.76 BILL AUDITING FEE 4/13/2016 4/13/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 5/10/2016 GB TPA $10.86 BILL AUDITING FEE 4/20/2016 4/20/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 5/20/2016 GB TPA $21.76 BILL AUDITING FEE 4/18/2016 4/18/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 5/25/2016 GB TPA $21.76 BILL AUDITING FEE 4/20/2016 4/20/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 5/27/2016 GB TPA $18.29 BILL AUDITING FEE 4/27/2016 4/27/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 6/9/2016 GB TPA $18.29 BILL AUDITING FEE 5/9/2016 5/9/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 6/10/2016 GB TPA $18.29 BILL AUDITING FEE 5/16/2016 5/16/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 8/9/2016 GB TPA $9.50 BILL AUDITING FEE 7/20/2016 7/20/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 9/22/2017 GB TPA $18.08 BILL AUDITING FEE 5/25/2016 5/25/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 9/22/2017 GB TPA $21.41 BILL AUDITING FEE 4/25/2016 4/25/2016 006016-000009-WC-01 Workers' Comp 8/1/2015 8/1/2016 9/26/2017 GB TPA $12.86 BILL AUDITING FEE 3/7/2016 3/7/2016 $4,955.14 006016-000011-WC-01 Workers' Comp 8/1/2015 8/1/2016 6/19/2016 GB TPA $11.00 IDX INDEX BUREAU FEE 6/11/2016 6/11/2016 006016-000013-WC-01 Workers' Comp 8/1/2015 8/1/2016 10/12/2016 GB TPA $11.00 IDX INDEX BUREAU FEE 10/5/2016 10/5/2016 006016-000013-WC-01 Workers' Comp 8/1/2015 8/1

230 John Wesley Dobbs Avenue Atlanta, GA 30303Location

Address: 230 John Wesley Dobbs Avenue Atlanta, GA 30303

Country : United StatesState : Georgia

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