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oorauuaaarr <br /> STATE OF FLORIDA <br /> sso0 4 <br /> °• a+r INDIAN RIVER COUNTY <br /> a0° <br /> e°°°C��y ' • • • • • • S/� %%HIS IS TO CERTIFY THAT THIS IS <br /> r J �. • . <br /> O : , lJ %*tRUE AND CORRECT COPY OF <br /> �`((�� ORIGINAL ON FILE IN THIS <br /> D . Funding Frequency : Dai** S ICE. <br /> s <br /> e iJfFFREY R . ITH , CLERK <br /> jY $ U , � . D I c , D.C . <br /> E . Method of Funding : ACH,i ; ; 3 <br /> 2 Q <br /> / a l <br /> • <br /> MONSOON <br /> aa�g2R <br /> NFR COU °°°• <br /> IV, Administrative Fees : aaaasu as a <br /> A. Administrative fees during the term of the Agreement : <br /> $49 . 95 per enrolled employee per month from May 1 , 2013 through <br /> September 30 , 2015 . <br /> B . Administrative fees after the termination of the Agreement: 15 % of <br /> claims paid . <br /> C . If the Agreement is terminated before September 30 , 2015 , the <br /> Employer .will pay Florida Blue a termination fee of $ 125 , 000 paid <br /> sixty days of termination . If the Agreement is terminated after <br /> September 30 , 2015 , no termination fee will be paid to Florida Blue . <br /> V. Late Payment Penalty <br /> A. A daily charge of . 00038 times the amount of overdue administrative <br /> fees . <br /> VI . Expected Enrollment <br /> A. The administrative fees and reserve requirement referenced above <br /> are based on an expected enrollment of: 1 , 570 . <br /> B . If the " actual enrollment is materially different from this expected <br /> enrollment, Florida Blue reserves the right to adjust the <br /> administrative fees and the reserve requirement as set forth in the <br /> Agreement. Actual administrative fees will be charged based on <br /> actual enrollment. <br /> -2- <br />