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Deliverable Number
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Commodity/Service Type
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Major Deliverable
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Method of Payment
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1
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INSURANCE, WORKMEN'S COMPENSATION
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The Association shall review the application for authorization to self-insure and forward the applic...
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Fixed Fee / Unit Rate
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| Major Deliverable: The Association shall review the application for authorization to self-insure and forward the application to the Department no later than 45 days from the date of receipt. In accordance with Sections 440.38(1)(b) and 440.385(6)(b), FS and Rule 69L-5, FAC. Rate Agreement: $230,569 ($19,214.08/monthly).
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| Deliverable Price: $0.00 |
| Non Price Justification: Rate Agreement |
| Performance Metrics: The monthly activity report is submitted to the contract manager. This report is reviewed by Division staff for consistency and accuracy.
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| Financial Consequences: All payments for services are subject to the terms and conditions established by this agreement and billing procedures established by the Department.
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| Source Documentation Page Reference: 1 |
| Deliverable Number: 1 |
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10
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INSURANCE, WORKMEN'S COMPENSATION
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If the member does not maintain the qualifications to self-insure in accordance with rules and statu...
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Fixed Fee / Unit Rate
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| Major Deliverable: If the member does not maintain the qualifications to self-insure in accordance with rules and statutes, the Association will forward to the Department a letter of recommendation. In accordance with 440.38(1)(b) and 440.385(3)(b)7, FS and Rule 69L-5, FAC. Rate Agreement: $230,569 ($19,214.08/monthly).
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| Deliverable Price: $0.00 |
| Non Price Justification: Rate Agreement |
| Performance Metrics: The monthly activity report is submitted to the contract manager. This report is reviewed by Division staff for consistency and accuracy.
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| Financial Consequences: All payments for services are subject to the terms and conditions established by this agreement and billing procedures established by the Department.
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| Source Documentation Page Reference: 1 |
| Deliverable Number: 10 |
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2
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INSURANCE, WORKMEN'S COMPENSATION
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The Association shall review and analyze each financial statement submitted by its members and docum...
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Fixed Fee / Unit Rate
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| Major Deliverable: The Association shall review and analyze each financial statement submitted by its members and document its member’s file to reflect when the review was conducted. In accordance with 440.38(1)(b) and 440.385(3)(b)7, FS and Rule 69L-5, FAC. Rate Agreement: $230,569 ($19,214.08/monthly).
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| Deliverable Price: $0.00 |
| Non Price Justification: Rate Agreement |
| Performance Metrics: The monthly activity report is submitted to the contract manager. This report is reviewed by Division staff for consistency and accuracy.
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| Financial Consequences: All payments for services are subject to the terms and conditions established by this agreement and billing procedures established by the Department.
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| Source Documentation Page Reference: 1 |
| Deliverable Number: 2 |
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3
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INSURANCE, WORKMEN'S COMPENSATION
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The Association shall maintain security deposits and copies of excess insurance policies in a fiduci...
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Fixed Fee / Unit Rate
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| Major Deliverable: The Association shall maintain security deposits and copies of excess insurance policies in a fiduciary manner for the exclusive benefit of workers’ compensation claimants. In accordance with 440.38(1)(b)1. and 5., FS and Rule 69L-5.219, FAC. Rate Agreement: $230,569 ($19,214.08/monthly).
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| Deliverable Price: $0.00 |
| Non Price Justification: Rate Agreement |
| Performance Metrics: The monthly activity report is submitted to the contract manager. This report is reviewed by Division staff for consistency and accuracy.
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| Financial Consequences: All payments for services are subject to the terms and conditions established by this agreement and billing procedures established by the Department.
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| Source Documentation Page Reference: 1 |
| Deliverable Number: 3 |
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4
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INSURANCE, WORKMEN'S COMPENSATION
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The Association shall provide the Department with written notification of the following change of in...
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Fixed Fee / Unit Rate
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| Major Deliverable: The Association shall provide the Department with written notification of the following change of information on each member self-insurer, within 21 days of the date the Association is notified (name change, subsidiaries, federal employer identification number and name of service company). In accordance with 440.38, FS and Rule 69L-5, FAC. Rate Agreement: $230,569 ($19,214.08/monthly).
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| Deliverable Price: $0.00 |
| Non Price Justification: Rate Agreement |
| Performance Metrics: The monthly activity report is submitted to the contract manager. This report is reviewed by Division staff for consistency and accuracy.
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| Financial Consequences: All payments for services are subject to the terms and conditions established by this agreement and billing procedures established by the Department.
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| Source Documentation Page Reference: 1 |
| Deliverable Number: 4 |
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5
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INSURANCE, WORKMEN'S COMPENSATION
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The Association shall collect a completed Form DFS-F2-SI-5 (Self-Insurer Payroll Report) as required...
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Fixed Fee / Unit Rate
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| Major Deliverable: The Association shall collect a completed Form DFS-F2-SI-5 (Self-Insurer Payroll Report) as required from each Association member and submit such forms to the Department within 14 days of initial receipt. In accordance with Rule 69L-5.203, FAC. Rate Agreement: $230,569 ($19,214.08/monthly).
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| Deliverable Price: $0.00 |
| Non Price Justification: Rate Agreement |
| Performance Metrics: The monthly activity report is submitted to the contract manager. This report is reviewed by Division staff for consistency and accuracy.
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| Financial Consequences: All payments for services are subject to the terms and conditions established by this agreement and billing procedures established by the Department.
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| Source Documentation Page Reference: 1 |
| Deliverable Number: 5 |
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6
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INSURANCE, WORKMEN'S COMPENSATION
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The Association shall maintain in an organized and uniform manner, files for each member, withdrawn ...
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Fixed Fee / Unit Rate
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| Major Deliverable: The Association shall maintain in an organized and uniform manner, files for each member, withdrawn or former member and applicant consisting of all documents in a secure environment. In accordance with 440.38, FS and Rule 69L-5, FAC. Rate Agreement: $230,569 ($19,214.08 / monthly).
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| Deliverable Price: $0.00 |
| Non Price Justification: Rate Agreement |
| Performance Metrics: The monthly activity report is submitted to the contract manager. This report is reviewed by Division staff for consistency and accuracy.
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| Financial Consequences: All payments for services are subject to the terms and conditions established by this agreement and billing procedures established by the Department.
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| Source Documentation Page Reference: 1 |
| Deliverable Number: 6 |
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7
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INSURANCE, WORKMEN'S COMPENSATION
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The Association shall provide written notice to the members that the Association authorizes a reduct...
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Fixed Fee / Unit Rate
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| Major Deliverable: The Association shall provide written notice to the members that the Association authorizes a reduction of the Security Deposit to the amount required by Department Rules. In accordance with 440.38, FS and Rule 69L-5, FAC. Rate Agreement: $230,569 ($19,214.08/monthly).
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| Deliverable Price: $0.00 |
| Non Price Justification: Rate Agreement |
| Performance Metrics: The monthly activity report is submitted to the contract manager. This report is reviewed by Division staff for consistency and accuracy.
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| Financial Consequences: All payments for services are subject to the terms and conditions established by this agreement and billing procedures established by the Department.
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| Source Documentation Page Reference: 1 |
| Deliverable Number: 7 |
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8
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INSURANCE, WORKMEN'S COMPENSATION
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All applications shall result in a letter of recommendation to the Department recommending either ap...
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Fixed Fee / Unit Rate
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| Major Deliverable: All applications shall result in a letter of recommendation to the Department recommending either approval or disapproval. This letter of recommendation shall set forth the statutory and factual grounds upon which the recommendation is based and shall be accompanied by all supporting calculations, analysis; expert opinions and other information upon which the Association has relied in reaching its recommendation. The Association shall provide notification to the Department within 7 days of the date of the initial receipt of the completed application. In accordance with 440.38, FS and Rule 69L-5, FAC. Rate Agreement: $230,569 ($19,214.08/monthly).
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| Deliverable Price: $0.00 |
| Non Price Justification: Rate Agreement |
| Performance Metrics: The monthly activity report is submitted to the contract manager. This report is reviewed by Division staff for consistency and accuracy.
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| Financial Consequences: All payments for services are subject to the terms and conditions established by this agreement and billing procedures established by the Department.
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| Source Documentation Page Reference: 1 |
| Deliverable Number: 8 |
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9
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INSURANCE, WORKMEN'S COMPENSATION
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The Association shall review bond rating for each association member at reasonable intervals and mai...
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Fixed Fee / Unit Rate
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| Major Deliverable: The Association shall review bond rating for each association member at reasonable intervals and maintain written documentation of the review in the member’s files. In accordance with 440.38, FS and Rule 69L-5, FAC. Rate Agreement: $230,569 ($19,214.08/monthly).
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| Deliverable Price: $0.00 |
| Non Price Justification: Rate Agreement |
| Performance Metrics: The monthly activity report is submitted to the contract manager. This report is reviewed by Division staff for consistency and accuracy.
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| Financial Consequences: All payments for services are subject to the terms and conditions established by this agreement and billing procedures established by the Department.
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| Source Documentation Page Reference: 1 |
| Deliverable Number: 9 |
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