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CONFIDENTIAL AND PROPRIETARY Chent Indian River County Amendment Number P201 7 100 1 36 26 (a) Ensure the accuracy of all cost report data pro%ided by Client to PST and provide written certification of the accuracy of such data to PST and all applicable governmental agencies. (b) Make its internal practices, books and records relating to all cost report data provided to PST by Client available to PST to ensure the accuracy of all such data; (c) Comply with PST policies and procedures for the documentation oral I cost report data as established and provided to Client by PST from time to time;and (d) Provide PST with the following as part of Client's request for Supplemental Payment: • An organizational chart of Client's agency; • An organizational chart of Client's ambulance department: • Identification of the specific geographic service area covered by Client's ambulance department: • Copies of job descriptions for all staff employed within Client's ambulance department and an estimated percentage of time spent working for Client's ambulance department and for other departments of Client's agency, • Primary contact person for Client's agency;and • A signed letter documenting the governmental provider's voluntary contribution of non-lederal tunds. 3 SERVICE FEES 3.1 For Supplemental Payment Recovery Assistance Services rendered under Section 2 in Schedule IA directly above. Client will pay PST a service lee equal to 6.8%* of the Supplemental Payments recovered by PST on behalf of Client during the previous month, in accordance with Section J of the Agreement,entitled "Monthly Fees." Supplemental Payments shall include any payments from Florida Medicaid to Client related to the Florida Ambulance Supplemental Payment Program. *In the event that charging a percentage of'payments recovered for the services described herein is determined to be out of compliance with lederal or state laves or regulations.either party may amend this Amendment to set forth a different payment arrangement. The parties acknowledge and agree that such amendment does not waive the obligation to pay determined fees. 3? In addition to the 6.8%service lee due by Client to PST under this Schedule Client%kill pay PST a one-time, upfront fee of$5.500.00 (*'Setup Fee") for completion of the pre-cost report submittal requirements necessary for Client's participation in the Florida Ambulance Supplemental Payment Program. The Setup Fee will be due upon Client's execution of this Agreement. 3.3 All service lees are exclusive of all lederal.state and local taxes. including sales taxes,assessed on or due in respect of any Services performed by PST under this Agreement, for "hick taxes Client shall be solely responsible. Client shall reimburse PST for all those costs and expenses of Client paid by PST or any subsidiary or affiliate of PST on bchall'of Client in connection with the provision of Services hereunder. 3.4 Client acknowledges and agrees that PST shall be entitled to receive service fees for Services prokided by PST under this Agreement even alter expiration or earlier termination of this Agreement provided that PST provided such services on or betore the date of expiration or termination of this Agreement.