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3 CONFIDENTIAL AND PROPRIETARV Client. Indian Rivtl County Amendment Number P201 7 1 001 3 6 26 (a) Ensure the accuracy of all cost report data provided 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 1'or the documentation of all 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 lbr 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 o1' job descriptions Ibr all staffemployed within Client's ambulance department and an estimated percentage of time spent working for Client's ambulance department and ibr 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 funds. 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 fie equal to 6.8%* of the Supplemental Payments recovered by PST on behalf of Client during the previous month. in accordance with Section 4 of the Agreement. entitled "Monthly Fees." Supplemental Payments shall include any payments fmm 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 federal or state laws or regulations. either party may amend this Amendment to set Ibrth a different payment arrangement. The parties acknowledge and agree that such amendment does not %alive the obliaation,to pay determined ices. 3.2 In addition to the 6.8% service flee due by Client to PST under this Schedule Client will pay PST a one-time, upfront fee of $5.500.00 ("Setup Fee") for completion of the pre -cast report submittal requirements necessary for Client's participation in the Florida Ambulance Supplemental Payment Program. The Setup Fee will be due upon Clicnt's execution of this Agreement. 3.3 All service fees are exclusive of all federal. state and local taxes. including sales taxes. assessed on or due in respect of any Services performed by PST under this Agreement, for which taxes Client shall be solely responsible. Client shall reimburse PST for ail those costs and expenses of Client paid by PST or any subsidiary or affiliate of PST on behalf of Client in connection with the provision of Services hereunder. 3.4 Client acknowledges and agrees that PST shal provided by PST under this Agreement even Agreement provided that PST provided such termination ofthis Agreement. prsr 3 of I I be entitled to rticeive service lies for Services alter expiration or earlier termination of this services on or before the date of expiration or P90