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BROWN & BROWN INSURANCEBrown & Brown Page 1 w Letter of Interest ....... ............................... ...........................Page 3 0 Qualifications, Experience, Resumes & References ........................Pages 4 - 13 m Non- Collusion Affidavit, Certification, Certificate of Insurance ......... Pages 14 - 18 m Sworn Statement, No Conflict of Interest Certification & Cone of Silence Affidavit .................. ............................... ..........................Pages 19 — 23 m RFP Information Form . ............................... ..........................Pages 24 - 25 m Cost Proposal ............ ............................... ..........................Pages 26 - 32 1„'o 27 Brown & Brown Page 2 Thank you for allowing Brown & Brown Insurance — Miami the opportunity to develop and present to you a proposal for your company. Brown & Brown Insurance staff of insurance professionals is dedicated to both personalized client service and enhancing the agency's relationship with the most reputable insurance companies in the industry. Brown & Brown is ranked as the seventh largest independent insurance intermediary organization in both the U.S. and the world, with over 68 years of continuous service. Our real strength is in the great flexibility we provide at a local level making it possible to respond rapidly to our customers needs backed up by B &B's National specialty resources. The resources we envision providing Amadeus at no cost to you include: 1) Ongoing Health Care Reform Guidance 2) Monthly newsletters 3) Value added services such Health Advocate, HR Genius & Web Benefits Our commitment to meet your required timelines and expectations will be our main focus. The process will consist of. -Initial interview & information gathering — July 20t" through July 22 °d, 2011 -Uncovering needs through understanding & identifying goals — July 25111, 2011 -Final proposal — August I Or", 2011 -Plan selection review & set open enrollment dates — August IT", 2011 -Open Enrollment Meetings — Week of August 29t", 2011 Brown & Brown of Florida — Miami Division representatives: Robert P. Hollander, EVP — Tel. 305- 364 -7818 — Email rollander@bbmia.com Yuresly Menendez, Benefits Manager — Tel. 305- 714 -4506 — Email jmenendez @bbmia.com Brown & Brown Page 3 Brown & Brown Page 4 PROPOSER'S QUALIFICATION STATEMENT Insurance Brokerage Services PROPOSER shall furnish the following information. Failure to comply with this requirement will render the Bid non - responsive and shall cause its rejection. Additional sheets shall be attached by the Proposer as required. PROPOSER'S Name and Principal Address: Brown & Brown Insurance of Florida - Miami Division 14900 NW 79Ct. Suite #200 Miami, Florida 33016 Contact Person's Name and Title: PROPOSER'S Telephone and Fax Number: PROPOSER'S License Number: Robert P. Hollander /Yuresly Menendez Tel.(305)364 -7818 Fax.(305)714 -4510 A121581 (Please attach ce PROPOSER'S Federal Identification Number: of competency and /or state registration.) 59- 0691921 I. Number of years your organization has been in business, in this type of work: 68 Years 2. Names and titles of all officers, partners or individuals doing business under trade name: Brown & Brown - Miami Division: Colin E. Lowe - President Robert P. Hollander - Executive Vice President See 2010 Brown & Brown annual report for complete listing. The business is a: Sole Proprietorship Partnership 11 Corporation LLP [] LLC 3. Describe your experience and services related to health management. This would include health risk assessments, wellness, health coaching, disease management, etc. Brown & Brown and conducts health fairs,wellness and cessation programs for our clients as well as promoting employee awareness of discounted Rx and various utilization programs. Brown & Brown Page 5 Insurance Brokerage Services RFP No. SM- 2011 -09 -HR Page 14 of 25 4. Describe an example of a City for whom you have coordinated or provided these services. All of these programs have been implemented at the City of Isles Beach for man 5. Have you ever failed to complete work awarded to you. If so, when, where, and why? No 6. How will you maintain confidentiality of the City's records and data (include in your discussion any security procedures for accessing, sending, and storing data that are currently in place)? Brown & Brown is HIPAA compliant. All internal networks are secured. The benefits staff is a seqreqated division with a less system and in house shredder. 7. Discuss your service approach and how you respond to City requests. Include what you consider non - urgent/routine requests and urgent requests. Urgent requests consist of enrollment issues, outstanding coverage or claims matters, physician inquiries and pharmacy requests. All other non urgent issues are resolved within 24 to 48 hours. 8. How do you measure client satisfaction? A customized time line is created and adhered to along with employee surveys. We recommend quarterly meetings with City designated benefits insurance committee. 9. Confirm that you serve as a consultant or broker, independently, and are not affiliated with any insurance company, third party administrative agency or provider networl<. Brown & Brown Insurance Company of Florida is an independent insurance agency and not affiliated with any insurance carrier, TPA or provider network. Brown & Brown Page 6 Insurance Brokerage Services RFP No. SM- 2011 -09 -HR Page 15 of 25 10. Describe your experience in provider network development, recruitment and negotiation, and maintenance. Brown & Brown has developed the highest level of relationshi will all insurance providers allowing for strong negotiations, recommendations regarding cost and plan selection for our clients. 11. Outline your ability to provide expertise and experience in the areas of health benefit plan analysis and design. Brown & Brown is constantly reviewing carrier benefit plans with the coal of customizing plans to meet the specific utilization and economic benefit of employers and eligible participants. 12. Explain in detail the types of analyses you have conducted relative to benefits analysis and design for a health plan with at least 100 employees. Brown & Brown has prepared comparison plan analysis. rate history analysis and employer impact cost analysis, for numerous employers with 4100 - 4500 participants. 13. Provide examples of communication materials developed and prepared by your organization for use in City's health benefit communication campaigns. Brown & Brown has prepared brochures related to the following topics: Health Care Reform - What Employers Need to Know, Brown & Brown's Rx guide and detailed information on HMO, PPO, POS & H S A Options. 14. Are there any existing service provider relationships that may prevent you from acting independently and providing objective advice or guidance? (Examples, overrides, commission agreements, preferred contracts, pricing based on volume, etc.) No Brown & Brown Page 7 Insurance Brokerage Services UP No. SM- 2011 -09 -HR Page 16 of 25 15. List any subcontractors who will provide services under this Contract and the services they will provide. The foregoing list of subcontractor(s) may not be amended after award of the contract without the prior written approval of the Contract Administrator, to be designated by the City Manager, and whose approval shall not be unreasonably withheld. None 16. List and describe all bankruptcy petitions (voluntary or involuntary) which have been filed by or against the Proposer, its parent or subsidiaries or predecessor organizations during the past five (5) years. Include in the description the disposition of each such petition. None 17. Provide specific examples of a significant savings in the cost of benefits to the client that can be directly attributed to your past services. Brown & Brown has implemented High Deductible plans bundled with hospital indemnity plans to reduce monthly costs for both employees and employers. 18. List any companies your are affiliated with or have contractual arrangement with including insurance companies, third party administrators (claims or other administrative /record keeping services), provider networks, HR or benefits software vendors, etc. Health: Aetna,Avmed,BC /BS, Cigna ,Coventry,Humana,NHP /United Ancillary:Assurant, Guardian ,Lincoln,Reliance,Standard, Metlife Value Added:Health Advocate,HR Genius, Web Benefits 19. Describe your firm's ability to assist with Benefits Administration issues. All clients are assigned a designated Account Manager backed up by office staff. In addition, services such as Health Advocate, HR Genius and Web Benefits are offered comoliment_arv. 20. What distinguishes your firm from other consulting firms and why should the City select your firm for consulting needs? Being the largest independent insurance agency in Florida provides the leverage and resources capable to meet client needs. Our decentralized culture allows for greater flexibility to provide rapid local in epen ent service. Brown & Brown Page 8 Insurance Brokerage Services RFP No. SM- 2011 -09 -HR Page 17 of 25 21. What is the total number- of employees that you have assigned, currently, to employees benefits counseling? 5 22. What is your corporate mission, vision and values, as well as your organization's philosophy towards providing benefits consulting services? Our mission is to provide the most comprehensive and competitive employee benefit programs to our clients along with the highest level of service in the insurance industry. 23. Discuss your firm's quality assurance policies and procedures. How do you measure whether you are meeting these standards? What is the frequency of any such review? Brown & Brown has a quality control committee that performs ongoing audits and detailed written reports that are provided to management. Our employment guidelines and procedures are strickly enforced. 24. Detail your ability to monitor regulatory and legislative developments at both the state and federal level and how this will benefit the City and be communicated to the City. Brown & Brown has a national benefits committee and independent law firm to provide updates to all offices and respective clients. Monthly newsletters with HR alerts are provided. 25. List all claims, arbitrations, administrative hearings and lawsuits brought by or against the Proposer or its predecessor organizations(s) during the last (5) years. The list shall include case name, case, arbitration or hearing identification number, name of the court or tribunal, the name of the project over which the dispute arose; and a description of the subject matter of the dispute. None 26. Describe all proceeding concerning business related offenses in which the Proposer, its principals or officers or predecessor organization(s) were defendants. None Brown & Brown Page 9 Insurance Brokerage Services RFP No. SM- 2011- 09 -IIR Page IS of 25 27. Has the Proposer, its principals, officers or predecessor- organization(s) been CONVICTED of a Public Entity Crime, debarred or suspended from bidding by any government during the last five (5) year's? If so, provide details. No The PROPOSER acknowledges and understands that the information contained in response to this Qualification Statement shall be relied upon by CITY in awarding the contract and such information is warranted by PROPOSER to be true. The discovery of any omission or misstatement that materially affects the PROPOSER'S qualifications to perform under the contract shall cause the CITY to reject the Bid, and if after the award, to cancel and terminate the award and /or contract. VERIFICATION PURSUANT TO SECTION 92.525(2), FLORIDA STATUTES Under penalties of perjury, I declare that I have read the foregoing Response to Qualification Statement and that the facts stated in it are true. DATED this 7th day of du '2011. 2011. — ---- - - - - - Robert P. Hollande (Print Na - opos By I ign our NKme on Line Above) Robert P. Hollander (On Line Above, Print or Type Name of Person Signing) FAILURE TO COMPLETE SIGN. & RETURN THIS FORM MAY DISOUALIFY YOUR RESPONSE Brown & Brown Page 10 Inswance Brokerage Services RFP No. SM -201 I -09 -HR Page 19 of 25 14900 N . 79th Court Phone (305) 364 -7818 Suite 200 Fax (305) 913 -2518 Miami Lakes, FL 33016 F-mail rhollandenNbbmiacom Robert P. Hollander Professional Brown & Brown Insurance 1997 - Present experience Aventura, Florida Executive Vice President Dade Underwriters Insurance Agency 1968 -1997 Owner /President Professional Memberships Education Independent Insurance Agents of South Florida 1977 -1978 President Aventura Marketing Council 2005 -2008 Chairman of Board Aventura Hospital and Medical Center 1993 -2007 Board Member and Chairman University of Miami 1963 -1967 -Bachelor of Business Administration -New York College of Insurance 1967 -1968 Comprehensive Business Insurance Degree Yuresly "Judy" Menendez Address: 7764 SVd 57 Ter. South Miami, Fl. 33143 Telephone: 305 -994 -4916 E -mail: yureslymenendez @yahoo.corn Education: High School: Florida Dept of Financial Services Crestcom Inc. Work Experience: Graduated: 215 Licensed Insurance Agent, 1999 Management & Leadership Course 2007 2008 - Current: Brown & Brown Insurance Group: Agency Manager of the Employee Benefits Department, supervising all departmental functions, including three full time employees and the placement of all Life, Health and all other employee benefits for the agency Responsible for new sales development, customer relations, Agency Liaison with all Carriers, Client retention, systems integration, personnel management. 2004 —2008 HBA Insurance Group: EMS Department Manager, supervising all departmental functions, including three full time employees and 5 dedicated Benefits producers. Responsible for the departmental duties related to: Quoting, Claims resolutions, Billing issues, Client presentations, Inception of new clients to all carriers, mediation of all client carrier related issues, Departmental Liaison with HBA Agency Management staff. 2008 HBA Insurance Group was acquired by Brown & Brown Insurance Group. 1999 —2004 HBA Insurance Group: EMS Department Supervisor and Executive Assistant to HBA Executive V.P. Responsible for the Employee Benefits Department. Accountable for all duties related to: Quoting, Claims resolutions, Billing issues, Client presentations, Inception of new clients to all carriers, and personal agenda of Exec V.P. 1997-1999 Amerinsurance Life Inc. — Customer Service Representative — Responsible for: Quoting, Claims resolutions, Billing issues, Client presentations, Inception of new clients to all carriers, Client relations with assigned book of business. 1999 Amerinsurance Life merged with Head Beckham Insurance Agency forming HBA Insurance Group. 1994 -1997 Amstar Insurance — SubsidiaryofMAPFREinsuranceGroup — Started as general departmental clerk, later promoted to Claims Assistant Manager, responsible for: Clerical duties, Maintenance of claims registry, reporting of claims activity and accountable for assigned book of claims. Brown & Brown Page 12 REFERENCES Insurance Brol<erage Services Please list three (3) governmental agency, or comparable corporate client, contract references for which you have done business within the past three (3) years: Agency Name Address City, State & Zip Code Contact's Name Telephone Number Agency Name Address City, State & Zip Code Contacts Name Telephone Number Agency Name Address City, State & Zip Code Contacts Name Telephone Number City of Sunny Isles Beach 18070 Collins Ave. Sunny Isles Beach, Fl. 33160 Yael Londono, HR Director 305- 792 -1809 Larkin Community Hospital 7031 Southwest 62 Ave. South Miami, Fl. 33143 Carlos Garcia, HR Director 305 - 284 -7500 Beauty Schools of America 1176 Southwest 67 Ave. Miami, Florida 33144 Susana Lorie, HR Director 305- 297 -7419 Attach additional sheets if necessary, FAILURE TO COMPLETE SIGN. & RETURN THIS FORM MAY DISQUALIFY YOUR RESPONSE Brown & Brown Page 13 Insurance Brokerage Services RCP No. SM- 2011 -09 -HR Page 23 of25 Brown & Brown Page 14 NON - COLLUSION AFFIDAVIT Insurance Brokerage Services STATE OF FLORIDA ) COUNTY OF MIAMI -DADE Robert P. Hollander states that: being first duly sworn, deposes and (1) He /She /They is /are the Executive Vice President (Owner, Partner, Officer, Representative or Agent) of Brown & Brown of Florida - Miami the PROPOSER that has submitted the attached BID; (2) He /She /They is /are fully informed with respect to the preparation and contents of the attached BID and of all pertinent circumstances concerning such BID; (3) Such BID is genuine and is not a collusive or sham BID; (4) Neither- the said PROPOSER nor any of its officers, partners, owners, agents, representatives, employees or parties in interest, including this affiant, have in any way colluded, conspired, connived or agreed, directly or indirectly, with any other PROPOSER, firm, or person to submit a collusive or sham BID in connection with the Work for which the attached BID has been submitted; or to refrain from PROPOSING in connection with such Work; or have in any manner, directly or indirectly, sought by agreement or collusion, or communication, or conference with any PROPOSER, firm, or person to fix any overhead, profit, or cost elements of the BID or of any other PROPOSER, or to fix any overhead, profit, or cost elements of the BID Price or the BID Price of any other PROPOSER, or to secure through any collusion, conspiracy, connivance, or unlawful agreement any advantage against (Recipient), or any person interested in the proposed Work; (5) The price or prices quoted in the attached BID are fair and proper and are not tainted by any collusion, conspiracy, connivance, or unlawful agreement on the part of the PROPOSER or any other of its agents, representatives, owners, employees or parties of interest, including this affiant. Signed, sealed and delivered in the presence of: 0 Subscribed and sworn to before me this 7t Eric Shim* Notary PoW %* d %nda wK MP Camp E� S�. 27 2414 FAIL URCQdw=mz!-IG-_,& )2 ETU RN T Insurance Brokerage Services RPP No. SM -207 1 -09 -HR r - - -- - - - - - - - - -- S ature Robert P. Hollander, EVP Print Name and Title h day of Jul 20 11 Notary Public (Signature) My Commission Expires: j Z 7 20 Brown & Brown Page 15 Page 20 of 25 SIGNATURE PAGE Insurance Brokerage Services The undersigned attests to his (her, their) authority to submit this Submittal and to bind the firm(s) herein named to perform as per agreement. Further, by signature, the undersigned attests to the following: I. The Proposer is financially solvent and sufficiently experienced and competent to perform all of the work required of the Proposer in the Contract; 2. The facts stated in the Proposer's response pursuant to Request for Proposal, instructions to Proposer and Specifications are true and correct in all respects; 3. The Proposer has read and complied with, and submits its proposal agreeing to all of the requirements, terms and conditions as set forth in the Request for Proposals. 4. The Proposer warrants all materials supplied by it are delivered to the CITY of South Miami, Florida, free from any security interest, and other lien, and that the Proposer is a lawful owner having the right to supply the same and will defend the conveyance to the CITY of South Miami, Florida, against all persons claiming the whole or any part thereof. 5. Proposer understands that if a team is short listed and selected to make oral presentations to the selection committee and /or CITY, only the team members who were involved in the preparation of the written submissions may participate in the oral presentations. Any changes to the team at the oral presentations may, at the sole discretion of the City, result in that Proposer's Bid disqualification. 6. The undersigned certifies that if the firm is selected by the City the firm will negotiate in good faith to establish a Contract. T Proposer understands that all information listed above may be verified by the City of South Miami and Proposer authorizes all entities or persons listed above to answer any and all questions. Proposer hereby indemnifies the City of South Miami and the persons and entitles listed above and holds them harmless from any claim arising from such investigation and verification process, including the dissemination of information pursuant thereto. Submitted on this 7th day of July 20 11 (If an individua tner p, or non - incorporated organization) Witness Company: Brown own Fl. Miami Printed: Y esly enen e By: Title: Benefits Manager Print Name, Title: Colin E. L e, President (If a corporation, affix seal) Company: Brown & Brown of Fl. Miami By: Attested by Secretary /EVP Print Name, Title: Robert P. Hollander, EVP Incorporated under the laws of the State of Florida FAILURE TO COMPLETE. SIGN. & RETURN THIS FORM MAY DISQUALIFY YOUR RESPONSE Brown & Brown page 16 Insurance Brokerage Services RPP No. SM -201 t -09 -HR Page .21 of 25 CERTIFICATION OF AUTHORITY To be completed and signed by a legal en C tity only. This ertification is not applicable to an indn iduaI Pro poser xU��w Insurance Brokerage Set -vices STATE OF FLORIDA COUNTY OF MIAMI -DADE IIXCorporation or Partnership LLP Joint Venture LLC 11 11 11 I HEREBY CERTIFY that a meeting of the Board of Directors, Partners, and /or Principals (include DBA -Doing Business As, if applicable) of the following entity Brown & Brown Insurance of Florida - Miami Division an organization existing under the laws of the State of Florida , was held on the 7th day of July 20 11 and the following resolution was duly passed and adopted: "RESOLVED, that, Robert P. Hollander as EVP of the organization, be and is hereby authorized to execute the Proposal dated, 7th day of July 2011 , to the City of South Miami and this organization and that my execution thereof, attested by a Notary Public of the State, shall be the official, act and deed of this attestation" I further certify that said resolution is now in full force and effect. IN WITNESS WHEREOF, I have hereunto set my hand and affixed the official seal of the corporation this, 7th day of July 2011 Print Name Robert P. Hollander Signature NOTARY PUBLIC: Notary Signature SEAL X Personally known to me, or Personal identification: Type of Identification Produced FAILURE TO COMPLETE SIGN, & RETURN THIS FORM MAY DISQUALIFY YOUR RESPONSE Brown & Brown Page 17 Insurance Brokerage Sewices RFP No. SM- 2011 -09 -HR Page 22 of 25 OP ID: SR 111 " CERTIFICATE OF LIABILITY INSURANCE DATE (MMMDNM) TYPE OF INSURANCE 07/06/11 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS ATE POLICIES CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s)- PRODUCER 386 - 252.9601 Brown 8 Brown of Florida, Inc. Daytona Beach Office 386 - 239 -5729 P.O. Box 2412 Daytona Beach, FL 32115 -2412 CONTACT NAME' _ HONK Exn. ac No: E -MAIL - - — -- ADDRESS: CUSTOMER ID a- BROWN -3 _ INSURER(s)AFFOROING COVERAGE _ -- INSURERA:Travelers- Prop- 8Cas- of -Amer - - NAICR 25674 - INSUREO BROWN & BROWN OF FLORIDA INC PO BOX 2412 --- DAYTONA BEACH, FL 32115 _ INSURERB:National Surety Corporation 21881 _ ER C Charter Oak Fire Ins 25615 Specialty Ins CO 3]$$$ PREMISESSEa Pccunence LINSURERn!XL ER E: ExecutiveRisklndemnity 35181 MED EXP (Any one person) F: PERSONAL &ADV INJURY �crt llrwq I t rvLJmetK: REVISION NUMBER• THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE XSR pDBR WNT, POLICY NUMBER -POLICY SEE MMIDDM'YY ) POLICYEXP LIMMIDEV)(YWI -- LIMITS A GENERAL DABILITY COh1MERCIAL GENERAL LIABILITY CLAIMS -MADE O OCCUR TC2JGLSA9527BB74 -11 01/01/11 01/01112 EACH OCCURRENCE 5 1,0B0,000 X PREMISESSEa Pccunence $ 1,000,000 MED EXP (Any one person) S 5,B0 PERSONAL &ADV INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 GENE AGGREGATE LIMIT APPLIES PER X POLICY PRO- LOC JE PRODUCTS - COMP /O_P_AGG $ 2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO TC2JCAP9527B862 -11 01/01/11 01101112 COMBINED SINGLE LIMIT IEa auidenp $ 1,000,000 _ BODILY INJURY (Per Peren) $ ALL ONMED AUrOs BODILY INJURY (Per accident) S SCHEOULEDAUTOS _ X PROPERTY DAMAGE (Per accident) $ HIREDAUTOS X NON -0N4IEDAUTOS S S B UMBRELLA LIAB EXCESS LIAR I X OCCUR CLAIMS -MADE 50000031754039 01/01111 01101/12 EACH OCCURRENCE 5 10,000,00 AGGREGATE s 10,000,000 DEDUCTIBLE - $ RETENTION S WORKERS IC COMPENSATION NDEMPLOYERS'LIABIDTY NY PROPRIETOR/PARTNER/EXECUTIVEVIN FEICERIMEMBER EXCLUDED? in NH) yes, describe under SCRIPTION OF OPERATIONS below S AGENTS E80 NIA TC20UB9517658011 TRJUB9518B76111 ELU119910 -11 01/01/11 01101/11 01/01111 01101/12 01/01/12 01/01112 WC OTtI- %( TORY LU.II S ER [LEACH ACCIDENT ACCT $ 1,000,00 EL. DISEASE- EAEMPLOYE $ 1,000,00 EL pI$EASE- POLICY LIMIT $ 1,000,000 EACH LOSS 5,000,00 P DIS /FIDELITY 82220236 04/28/10 01/01/12 BLANKET 25,000,00 DESCRIPnONOFOPERABONS /LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule If mores ace is eequiretl) THE CERTIFICATE HOLDER IS LISTED AS AN ADDITIONAL INSURED TO THE 'GENE IPtAL LIABILTY COVERAGE IN RESPECTS TO THE NAMED INSUREDS OPERATIONS. CITY OF SOUTH MIAMI 6130 SUNSET DRIVE MIAMI, FL 33143 At VICU ce (Lwa/UVf CITYSI5 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHOREEDREPRESENTATNE I ne ACORD name and logo are registered marks of ACORD CORPORATION. All riohts reserved. Brown & Brown Page 18 Brown & Brown Page 19 SWORN STATEMENT UNDER SECTION 287.133(3)(a), FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES (To be signed in the presence of a notary public or other officer authorized to administer oaths.) Before me, the undersigned authority, personally appeared Robert Hol larnderA,ho, being by me bust duly sworn, made the following statements: 1. The business address of 14900 NW 79 Ct. Suiteff200 Miami, F1. 33_01.6 (name of bidder or contractor) is Brown & Brown Insurance of Florida - Miami Division 2. Mytelationshipto Brown & Brown Insurance of Florida - Miami (name of buffet or contractor) is Executive Vice President (relationship such as sole proprietor, partner, president, vice president, etc.) 3. I understand that a public entity, crime as defined in Section 287.133 of the Florida Statutes includes a violation of any state or federal law by a person with respect to and directly related to the transaction of business with any public entity in Florida or with an agency m political subdivision of any other state or with the United States, including, but not limited to, any bid or contract for goods or services to be provided to any public entity or such an agency or political subdivision and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation. 4. 1 understand that `convicted" or "conviction" is defined by the statute to mean a finding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in any federal or state hail court of record relating to charges brought by indictment or information after July I, 1989, as a result of a jury verdict, nonjury trial, or entry of a plea of guilty or nolo contendere. 5. I understand that "affiliate" is defined by the statute to mean (1) a predecessor or successor of a person or a corporation convicted of a public entity crime, or (2) an entity under the control of any natural person who is active in the management of the entity and who has been convicted of a public entity crime, or (3) those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in the management of an affiliate, or (4) a person or corporation who knowingly entered into a joint venture with a person who has been convicted of a public entity crime in Florida during the preceding 36 months. 6. Neither the bidder or contractor out any officer, director, executive, partner, shareholder, employee, member or agent who is active in the management of the bidder or contractor not any affiliate of the bidder or contractor has been convicted of a public entity crime subsequent to July 1, 1989. Sigryr€ /Dfte (undersigned authority) Sworn to and subscribed before me in the state of Florida and county of Dade on the 7th day July , ?o 11 .._..— —._ ....... -- --._ (atfis seal) ro[an� Pubic Eric o� / ru Y RIbpC, Sip! Of RM& �� 1, `� 010 ! <� IM'�tt�a� Eta. gam• i. W14 - _ _ No. EE 20BM M� conunision e�pues Brown & Brown Page 20 NO CONFLICT OF INTEREST CERTIFICATION Insurance Brokerage Set-vices The undersigned, as Bidder /Proposer, declares that the only persons interested in this RFP are named herein; that no other person has any interest in this RFP or in the Contract to which this RFP pertains; that this response is made without connection or arrangement with any other person; and that this response is in every respect fair and made in good faith, without collusion or fraud. The Bidder /Proposer agrees that if this response /submission is accepted, to execute an appropriate CITY document for the purpose of establishing a formal contractual relationship between the Bidder /Proposer and the CITY, for the performance of all requirements to which the response /submission pertains. The Bidder /Proposer states that this response is based upon the documents identified by the following number: Bid /RFP No. SM- 2011 -08 -HR The full -names and residences of persons and firms interested in the foregoing bid /proposal, as principals, are as follows: The Bidder /Proposer further certifies that this response /submission complies with Chapter 8(a) of the Code of Ordinance, City of South Miami, Florida, that, to the best of its knowledge and belief, no Commissioner, Mayor, or other officer or employee of the CITY has an interest directly or indirectly in the profits or emoluments of the Contract, job, work or service to which the response /submission pertains. Signed, sealed and delivered in the presence of: 2 Subscribed and sworn before me this 7th Eric Sheaft Notary Pubic, so of Roma MY Com r"M 4 SW 27.2M4 No. EE 20844 S' to e R bert P. Hollander, EVP Print Name and Title day f July 20 11 N tary Pub c (Signature) My Commission Expires:U� j( FAILURE TO COMPLETE. SIGN. & RETURN THIS FORM MAY DISQUALIFY..YOUR RESPONSE Insurance Brokerage Services RI=P No. SM- 2011 -09 -HR Brown & Brown Page 21 Page 25 of 25 CONE OF SILENCE AFFIDAVIT Insurance Brokerage Services The "Cone of Silence" specifically prohibits communication regarding RFP "S (bids) or any solicitation with the City of South Miami staff except by written means, with copy filed with the City Clerk. This takes effect upon advertisement for Request for Proposal and terminates when the City Manager makes his recommendation to the City Commission for the award. An exception is made for oral communication during pre - proposal conferences. In addition to any other penalties provided by law, violation of the Cone of Silence shall render any proposal disqualified. CITY OF SOUTH MIAMI DISCLOSURE AFFIDAVIT Robert P. Hollander being first duly sworn, state: Florida The full legal name and business address of the person or entity contracting or transacting business with the City of South Miami are: Brown & Brown Insurance of Florida Inc. - Miami Division 14900 NW 79 Ct. Suite #200 Miami, Florida 33016 If the contract or business transaction is with a corporation, the full legal name and business address` shall be provided for each officer and director and each stockholder who holds directly or indirectly five percent (5%) or more of the stock in the corporation. If the contract or business transaction is with a partnership, the full legal name and business address shall be provided for each partner. If the contract or business transaction is with a trust, the full legal name and address* shall be provided for each trustee and each beneficiary.. If the contract or business transaction is with an LLP or LLC, the full legal name and address* shall be provided for each member of the LLP or LLC. All such names and addresses are: Brown & Brown Insurance is a publicly owned entity. Please see enclosed 2010 annual report. The full legal names and business address* of any other individual (other) than subcontractors, material men, suppliers, laborers, or lenders who have, or will have, any interest (legal, equitable, beneficial or otherwise) in the contract or business transaction with the City of South Miami are: None Brown & Brown Page 22 Lrsurauce Brokerage Services RFP No. SM- 2011 -09 -I IR Page 26 of 25 Notary Public Signed, sealed and delivered in the presence of: Subscribed and sworn to before me this By: Sig zree/ Robert P. Hollander, EVP - Print Name -and --Title -------------- 7th day of July/ 20 11 — ----------- - Notalr gubli (Signature) re My Commission Expires: FAILURE TO COMPLETE, SIGN, & RETURN THIS FORM MAY DISOUALIFY YOUR RESPONSE Brown & Brown Page 23 histirame Brokerage Services RIT No. SM-2011-09-11R Page 27 of 25 MEM��� RFP INFORMATION FORM Insurance Brokerage Services I certify that any and all information contained in this RFP is true;' and I further certify 'that this RFP is made without prior understanding, agreement, or connections with any corporation, firm or person submitting a RFP for the same materials, supplies, equipment, or services and is in all respects fair and without collusion or fraud. I agree to abide by all terms and conditions of the RFP, and if the Proposer is a legal entity, I certify that I am authorized to sign for the Proposer. Please print the following and sign your name where indicated below: Firm's Name: Brown & Brown Insurance of Florida - Miami Division Principal Business Address: 14900 NW '/9 Ct. Suite #200 Miami, Florida 33016 Telephone: 305 - 714 -4400 E -mail address: Name rhollander Robert P. Hollander Title: Executive Vice President Signature of Authorized i Representative: Fax: 305 - 714 -4510 q@ bbmia. com FAILURE TO COMPLETE. SIGN. & RETURN THIS FORM MAY DISQUALIFY YOUR RESPONSE Brown & Brown Page 25 hismance Brokerage Services RFP No. SM- 2011- 09 -HIZ Page 24 of 25 Brown & Brown Page 26 PRELIMINARY BROKER SERVICES AGREEMENT THIS BROKER SERVICES AGREEMENT ((his "Agreement'), effective September Ist, 2011 (the "Effective Date "), is made by and between City of South Miami. ("Company"). and the Miami Lakes office of BROWN R BROWN OF FLORIDA, INC. Background Broker is a licensed insurance agency in the State of Florida. Company has selected Broker to provide certain risk management and insurance program administration services relating to the Lines of Insurance (as hereinafter defined) and, for good and adequate consideration, the receipt and sufficiency of which are hereby acknowledged, the parties agree as follows: 1. Term. The term of this Agreement shall continence on the Effective Date and continue for a period of one (1) year. unless sooner terainated as herein provided. 2. Relationship of Parties. Broker is an independent contractor and nothing in this Agreement is intended not shall be construed to create an employer /employee relationship, a joint venture relationship or partnership relationship. In consideration of the compensation from the Company to the Broker, Broker is providing services to the Company as an insurance broker. However, Broker, or its parent company, Brown & Brown, Inc., and related or affiliated companies, may provide services as an insurance agent on behalf of certain insurance carriers or risk- bearing entities. Company acknowledges and expressly consents to such relationship, if applicable, in the rendition of services by Broker under this Agreement. 3. Broker Services. Broker, subject to the terms of this Agreement, shall provide certain services set forth in the attached Schedule A ((he "Sery ices" ), but only in relation to the following lines of insurance (collectively referred to as "Lines of Insurance "): (a) group health coverage; (b) group dental coverage; (c) group life insurance coverage; (d) group voluntary life insurance coverage; (e) group short term disability coverage; and (f) group voluntary long term disability coverage. Nothing in this Agreement shall be construed to impose any obligations on Broker, or limitations on Broker's compensation, relative to any lines of insurance or coverages other than those specifically included in the Lines of Insurance delineated above. 4. Company Responsibilities. In consideration of the Services provided by Broker, Company agrees as follows: (a) Company shall cooperate fully with Broker and the insurance companies with whom Broker solicits in the performance of Broker's obligations in this Agreement. (b) Company shall timely produce complete and accurate information including, but not limited to, current financial information, statements of values, loss information and any other information, necessary for the effectuation of insurance coverage at the request of Broker. Company further agrees to provide Broker with notice of any material changes in Company's business operations, risk exposures or in any other material information provided under this Agreement In addition, Company shall confirm the accuracy and recommend any changes to insurance policies issued to Company. (c) This Agreement shall in no way obligate Company to procure any insurance or to use Broker for any insurance it wishes to procure. IF however. Company nonetheless chooses to procure its insurance through Broker: Brown & Brown Page 27 SchedUlc A R01 R01 Company shall timely pay all premiums and fees. �(d)1[001 Company shall provide Broker with at ]cast ninety (90) days notice in advance of any policy effective date in the event Company intends to allove competing agents or brokers to solicit or market insurance. 5. Compensation. In consideration of the Services, Company shall compensate Broker through a "Broker Scivices Fee" in the amount of TWENTY FIVE THOUSAND DOLLARS AND xx /100 ($25,000.00). The Broker Services Fee shall be fully earned and payable upon Company's execution and delivery of this Agreement. If Company chooses to procure insurance through Broker, with regard to the Broker Services Fee, Company and Broker acknowledge and agree as follows: (a) In the event that Broker receives commission payments in connection with the placement Procurement of the Lines of Insurance for Company, the amount of such payments will be credited against the balance of the Broker Services Fee owed to Broker pursuant to this Agreement, and any commission amount in excess of such balance shall be promptly paid to Company within 30 days after receipt of such commission by Broker. It is understood and agreed that 13roke, or Broker's corporate parent, subsidiaries or affiliated entities, may receive contingent payments or allowances from insurers based on factors which arc not client- specific, such as the performance and /or size of an overall book of business produced with an insurer. Such contingent payments or allowances are not subject to this Agreement, and will not be credited against the balance of the Broker Services Fee owed to Broker pursuant to this Agreement or paid to Company. (b) Broker may utilize insurance intermediaries (such as a wholesale insurance broker, managing general agent (NIGA), managing general underwriter or reinsurance broker) for the placement of Company's insurance. In addition to providing access to the insurance company, the intermediary may provide the following services: (i) risk placement: (ii) coverage review; (iii) claims liaison services with the insurance company, (iv) policy review; and (v) current market intelligence. The compensation received by the insurance intermediary for placements and, if applicable, the services above is typically in the range of 5% to 15% of policy premium. There may be an intermediary utilized in the placement of your insurance, which may or may not be a company owned by Brown & Brown Inc., the parent company of Broker. Any payments or allowances paid to the intermediary arc not subject to this Agreement, and will not be credited against the balance of the fee owed to Broker pursuant to this Agreement or paid to Company. (c) If Company chooses to finance its premiums, Broker may assist Company in the arrangement of such financing. Any payments or allowances paid to Broker for arranging premium financing are not subject to this section, and will not be credited against the balance of the fee owed to Broker pursuant to this Agreement or paid to Company. (d) Broker may. in the ordinary course of its business. receive and retain interest on premiums paid by the Company fronh the date received by Broker until the date the premiums are remitted to the insurance company or intermediary. Any interest income retained by Broker on these premiums are not subject to this section, and will not be credited against the balance of the fee owed to Broker pursuant to this Agreement or paid to Company. (e) Compensation for the Services specified under this Agreement arc exclusive of all federal, state and local sales, use, excise, receipts, gross income and other similar taxes and governmental charges and fees. Any such taxes, charges or fees for the Services under this Agreement_ now imposed or hereafte imposed during the term of this Agreement, shall be in addition to the compensation, premiums and chugcs set forth in this Agreement and shall be paid by Company upon request. Brown & Brown Page 28 Schedule A M Company acknowledges and agrees that the Broker Services Fee is reasonable in relation to the Services to be provided by Broker hereunder. (g) The following language is required in any written fee agieemeut between Broker and its customer. The language above shall control regarding any understanding of compensation notwithstanding the following: If we are being compensated based upon a fixed dollar amount orfixed percentage fee, meaning that the contract specifies our compensation and states anywhere in the document that additional compensation will not be paid to us or any other party, any additional compensation to us or any other party, including wholesale brokers or third party intenncdiaries, is strictly prohibited. Likewise, if our contract sets compensation based upon a fixed dollar amount or fixed percentage fee, and the contract specifies that additional compensation shall be credited to the inswed, any additional compensation to any party, including brokers, wholesale brokers or third party intermediaries, must be promptly returned to you. If our contract is not based upon such fixed fee terms, no owned or affiliated party, including brokers, wholesale brokers or third party intcnnediarics, may accept any type of compensation without full disclosure by the undersigned broker to you of the dollar amount or percentage of compensation prior to binding your coverage. 6. Termination. (a) Either party may terminate this Agreement, without cause and for any reason whatsoever, by giving written notice of termination to the other party at least ninety (90) days prior to the effective date of termination, which shall be specified in such written notice. (b) Notwithstanding the provisions in sub - paragraph (a) above, Company may ternunate this Agreement upon the happening of any one of the following causes: (i) Suspension or tennination of Broker's insurance license in the State of Florida is not cured by Broker within sixty (60) days following such suspension or termination; (ii) Broker's participation in any fraud; or (iii) Broker's material failure to property perform its duties and responsibilities hereunder because of Broker's gross neglect, proven dishonesty, or commission of a felony. (c) Notwithstanding the provisions in sub - paragraph (a) above, Broker may terminate this Agreement upon the happening of any one of the following causes: (i) Company's failure to pay any Broker Services Fee more than five (5) days after such payment is due; (ii) Company's participation in any fraud; or (iii) Company's material failure to properly perform its duties and responsibilities hereunder because of Company's gross neglect, proven dishonesty, or cormnission of a felony. Termination for any cause enumerated in sub - paragraphs (b) or (c) shall become effective upon the delivery of written notice of tennination to the breaching party or at such later time as may be specified in the written notice. (d) Termination of this Agreement shall not release Company from any accrued obligation to pay any sum to Broker (whether then or thereafter payable) or operate to discharge any liability incurred prior to the termination date. Schedule A Brown & Brown Page 25 7. Notices. Anv notices required cu to be given under this Aerccment shall be sufficient if in writing by Certified Mail to If to Compam- If to Broker: City of South Miami 6130 Sunset Di i% South Miami. Fl. 33143 Brown & Brown of Florida, Inc. 14900 NW 79 CT Miami Lakes. FL 33016 Attu: Colin E. Lorvc With a copy to: Brown R Brown, Inc. 220 S. Ridgewood Avenue Daytona Beach, Florida 32114 Attu: Robert W. Lloyd, General Counsel Email: rlloyd rr)bbins.conr or such other address as either shall give to the other in writing for this purpose. 8. Severability. The invalidity or unenforceability of any provision of this Agreement shall in no way affect the validity or enforceability of any other provision. 9. Florida Law Applies; Venue. This Agreement has been made and executed in the State of Florida and shall be governed by and construed and enforced in accordance with the laws of the State of Florida. without regard to its conflicts of laws principles. Exclusive venue is agreed to be in a state or federal court of competent jurisdiction in or for Dade County, Florida. 10. Waiver of Jur y Trial. THE PARTIES WAIVE ANY RIGHT TO A TRIAL BY JURY IN THE EVENT OF LITIGATION ARISING OUT OF THIS AGREEMENT. IL Assignment. Neither this Agreement nor any of the rights, interests or obligations hereunder shall be assigned by any of the parties hereto (whether by operation of law or otherwise) without the prior written consent of the other party, which consent shall not be unreasonably withheld, conditioned or delayed. This Agreement Neill be binding upon, inure to the benefit of, and be enforceable by the parties and their respective successors and permitted assigns. 12. Entire Agreement. This Agreement (including the documents and instruments referred to herein) constitutes the entire agreement and supersedes all prior agreements and understandings, both written and oral, among the parties with respect to the subject matter hereof. The Agreement shall not be modified except by a written agreement dated subsequent to the date of this Agreement and signed on behalf of Company and Broker by their respective duly authorized representatives. Schedule A Brown & Brown Page 3( IN FITNESS WHEREOF, the parties to this 13roker Sen ices Agtecmeut executed this Agreement as of the Fffective Date. COMPANY: Witnesses (2): City of South Miami I . By: Name: 2. Title: As to Company BROKER: Wihresscs (2): Brown & Brown of Florida, Ltc. a Florida corporation 1. By: Name: 2. Titic: As to Broker Schedule A Brown & Brown Page 31 SCHEDULE A BROKER SERVICES a. Evaluate Company's business practices with regard to risk and possible transfer of risk to third parties and conduct regular. scheduled meetings %with Company to review Company's risk management program. b. Review and analyze Company's existing insurance coverage and identifi potential lines of coverage or coverage enhancements to improve Company's insurance program. C. Analyze current insurance market conditions and advise Company of significant implications for Company's insurance program. d. Facilitate, market and procure quotations from caric". review and analyze quotations and provide proposals for review by Company. A Secure and bind all coverages accepted by Company. f Coordinate loss prevention services provided by any insurance company with those services provided by Broker. g. Analyze past and eunent claim and loss history information and advise Company of significant implications for Company's insurance program. Brown & Brown Page 32 Schedule A