164-22 Exhibits to Agreement for Workers Compensation Third Party Administration - 2022.pdf

STOCKHOLDER DISCLOSURE CERTIFICATION, I certify that the list below contains the names and home addresses of all stockholders holding 10% or more of the issued and outstanding stock of the undersigned. I certify that no one stockholder owns 10% or more of the issued and outstanding stock of the undersigned. PLEASE, CHECK TYPE OF BUSINESS ORGANIZATION: Partnership Limited Partnership Limited Liability Corp i Corporation. Sole Proprietorship Limited Liability Partnership __ 7 Subchapter S Corp PLEASE CHECK APPROPRIATE BOXES AND SIGN BELOW ‘Name: Home Address: | | Stockholders ‘Name: Home Address: | Name. Home Address: Name: Home Address: Owner or Representative Signature Print Name & Title NOTORY PUBLIC Sworn before me this day of 20 Ho a pg

REQUIRED EVIDENCE AFFIRMATIVE ACTION REGULATIONS N.J. S.A. 10:5-31, et seq. (NLA. C. 17:27) If awarded a contract, the Bidder will be required to comply with the requirements of N.J.S.A. 10:531, et seg., and N.J.A.C__ 17:27. Within five (5) days after receipt of the notification of intent to award the contract, the Bidder shall present one of the following: 1, Appropriate evidence that the Contractor is operating under an existing federally approved or sanctioned affirmative action program; or 2. A Certificate of Employee Information Report Approval issued in accordance with N,J.A.C. 17:27-4; or 3, An initial Employee Information Report consisting of forms provided by the Affirmative Action Office and completed by Contractor in accordance with N.LA.C. 17:27-4. The Bidder must submit no later than three (3) days after the signing of the Contract an Initial Project Manning Table consisting of forms provided by the Affirmative Action Office and completed by Contractor in accordance with N.LA.C, 17:27-7. Bidders are referred to the Bidder's Information Section of the Bid Packet for a further description of the above requirements. NO BIDDER MAY BE ISSUED A CONTRACT UNLESS THEY COMPLY WITH THE AFFIRMATIVE ACTION REGULATIONS OF N.J.S.A. 10:5-31, et seq. The following questions must be answered by all Bidders: 1. Do you have a federally-approved or sanctioned Affirmative Action Program? Yes (If yes, submit a copy of such approval.) No 2. Do you have a State Certificate of Employee Information Report approval? Yes {If yes, submit a copy of such approval.) No The undersigned Bidder certifies that he is aware of the commitment to comply with the requirements of N.J.S.A. 10:5-31, ef seg., and agrees to furnish the requi‘ed documentation pursuant to the law. COMPANY: NAME: SIGNATURE: TITLE: NOTE: A bid must be rejected as non-responsive if a Bidder fails to comply with requirements of N.J.S.A. 10:5-31, et seq., within the time frame stipulated. pe

BIDDER’S CHECK LIST Mandatory Items ¢ Business Registration Certification \ ¢ Stockholders Disclosure : Statement « Affirmative Action Compliance Notice * Iranian Disclosure Form * Non Collusion Affidavit e Proposal Form e Political Disclosure Statement * Addendum a CS

Exhibit “B”

Claims Resolution Corporation, Inc. Proposal for TOWNSHIP OF WEST ORANGE WORKERS COMP 3xp PARTY ADMINISTRATION i. May 17, 2022 973.731.5700 323 S. Pitney Road, Suite 200 Galloway, NJ 08205 www.thebesttpa.com

Table of Contents Executive Summary Resumes References and Client List Scope of Services Required Forms Fees

xecutive Summary Claims Resolution Corporation, Ine. is a New Jersey domiciled corporation created with the sole purpose of providing superior claims management services to public entities in the region. As an independent Third Party Administrator, we are not owned by an insurance company, managed care company, ot other remote corporate entity whose interests may differ from that of our clients. In short, we answer to pou - the client. Claims Resolution Corporation, Inc. maintains SAS 70/ SOC 1, and SSAE18 accreditation and will provide a copy upon request. The SSAE 18 report is designated as the industry standard for service organizations. This certification is gained after a company has had an audit of internal controls at a service organization that may relate to their clients internal control over financial reporting. Claims Resolution Corporation, Inc. offers its clients a proprietary mosaic approach to bill review/PPO access, providing the industry’s greatest discounts at the lowest possibie costs. Our flat annual fee includes first report and multiple PPO access. Claims Resolution Corporation, Inc. operates one of the most sophisticated and technologically robust software systems in the marketplace today. Our RMIS software provides our clients total access to their claims data and the ability to quickly drive meaningful analytics to better understand their claims experience and the drivers behind their loss trends. Claims Resolution Corporation, Inc. has unparalleled experience in understanding and quantifying risk J exposures, aligning risk management objectives with budgetary constraints, and creating opportunities to lower risk, increase efficiency, and reduce costs for public entities. Our expert staff has contributed to the success of countless Counties, Municipalities, and School Districts including: County of Hudson City of East Orange City of Plainfield City of Trenton Claims Resolution Corporation, Inc provides our Clients with customized claim management and managed care solutions designed to reduce their total cost of risk. Our team assists with development of efficient and effective claim servicing guidelines and designs and implements managed care solutions targeting our Clients’ demographics to maximize cost savings and utilization. In addition, Claims Resolution Corporation assists with risk assessment, identification, and

ements managed care solutions targeting our Clients’ demographics to maximize cost savings and utilization. In addition, Claims Resolution Corporation assists with risk assessment, identification, and management to help create and implement effective cost reduction programs. Our client-focused solutions involve all relevant stakeholders to develop true partnered strategies while aligning potential internal and external resources. Through the use of proprietary analytics and metrics, our Clients are able to clearly trend and predict those aspects of its program which are succeeding and those that require additional risk management intervention. All of these services and programs are offered as part of our proposal.

Corporate Mission Claims Resolution Corporation's mission is simple ~ serve our clients with the highest level of integrity, dedication and commitment while utilizing our decades of experience to develop a shared long-term vision of their claims management and risk management needs. Ata time when words like integrity and transparency are used as merely a tag line or talking point, Claims Resolution Corporation bases every relationship and recommendation on these core principles. We recognize the trust our clients place in us and strive to earn and maintain that trust every day by delivering superior service, savings and results.

Unique Qualifications Claims Resolution Corporation is uniquely qualified to serve as the Third Party Claims Administrator for the Township of West Orange based upon our team's extensive experience handling New Jersey public entities’ self-insured programs over the past two decades. As you will see from the attached resumes, our dedicated staff have considerable industry-specific experience and are experts in their respective fields. This background not only helps us understand the administrative requirements of serving our clientele but also gives our team the historical perspective to help develop and maintain the relationships with those departments who can benefit the most from our expertise. We believe there is no substitute for this experience when it comes to delivering superior outcomes, Perhaps the greatest Sample Client opportunity to reducing our WC TCOR clients’. total cost of risk lies ( Syr average) in the self-funded workers’ Insurance, — TPA Fees, compensation program. $675,000, $150,000, 3% Based on industry-standard analytical information and $398,000, 8% our general knowledge of New Jersey workers’ compensation programs, we developed the Total Cost of Risk graphic to the right. This graph helps clearly illustrate where our clients can achieve potential cost savings. We strongly believe there are no "cookie cutter” solutions to the challenges of today's marketplace, and that is why every aspect of our claims programs is unique to the specific client. ‘This process begins with developing client specific claim handling protocols for our Clients that address their specific needs. in the end our goal is to design and implement a custom tailored claims administration program that reflects the Client's vision and culture while functioning as an extension of their risk management department. Claims Resolution Corporation has the experience in understanding and quantifying risk exposures, aligning risk management objectives with budgetary constraints and creating opportunities to Jower risk, increase efficiency and reduce costs for our Clients.