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HomeMy WebLinkAboutBlue & Co.,_LLC/CFD/$5,000/Professional Services - Medicaid Cost Reporting DocuSign Envelope ID: E5671049-8E1B-493D-8964-FFA5OFBBDABF Blue&Co.,LLC. Fire Department-2022 Appropriation#1120 101 43.404.00 Fund;P.O.#106506 -APPROVED all 4mr4Pll G;rare[tu(efelrK f t t:JG am,ARa,V"ICI,2(12T Contract Not To Exceed$5,000.00 AGREEMENT FOR PROFESSIONAL SERVICES THIS AGREEMENT FOR PROFESSIONAL SERVICES ("Agreement") is hereby made and entered into by and between the City of Carmel, Indiana, acting by and through its Board of Public Works and Safety (hereinafter "City"), and Blue &Co., LLC (hereinafter"Professional"). RECITALS WHEREAS City owns and is responsible for the operation and maintenance of its property, personnel, public works and infrastructure; and WHEREAS,from time to time, City needs professional assistance in fulfilling its foregoing responsibilities; and WHEREAS, Professional is experienced in providing and desires to provide to City the professional services ("Services") referenced herein; and WHEREAS, City desires to engage Professional as an independent contractor for the purpose of providing to City the Services referenced herein; NOW, THEREFORE, in consideration of the foregoing recitals and the covenants and conditions set forth herein, City and Professional mutually agree as follows: SECTION 1 INCORPORATION OF RECITALS The foregoing Recitals are hereby incorporated into this Agreement and made a part hereof. SECTION 2 SCOPE OF SERVICES 2.1 City desires to engage Professional as an independent contractor for the Services set forth in attached Exhibit A, incorporated herein by this reference. 2.2 Professional understands and agrees that City may, from time to time, request Professional to provide additional or modified Services to City. When City desires additional Services from Professional, the City shall notify Professional of such additional Services desired, as well as the time frame in which same are to be provided.Only after City has approved Professional's time and cost estimate for the provision of such additional Services, has encumbered sufficient monies to pay for same, and has authorized Professional, in writing, to provide such additional Services, shall such Services be provided by Professional to City.A copy of the City's authorization documents for the purchase of additional Services shall be numbered and attached hereto in the order in which they are approved by City. 2.3 Time is of the essence of this Agreement. SECTION 3 CITY'S RESPONSIBILITIES [C:\Users\clivingston\Downloads\B1ue&Co..LLC Professional Services.docx:5/4/2022 2:02 PM] 1 DocuSign Envelope ID: E5671049-8E1B-493D-8964-FFA5OFBBDABF Blue&Co.,LLC. Fire Department-2022 Appropriation#1120 101 43.404.00 Fund;P.O.#106506 Contract Not To Exceed$5,000.00 3.1 City shall provide such information as is reasonably necessary for Professional to understand the Services requested. 3.2 City shall provide all data required for provision of Services. Professional may assume that all data so provided is correct and complete. 3.3. City shall arrange for Professional to enter upon public and private property as reasonably required for Professional to perform the Services. 3.4 City shall designate payment of the Services from City budget appropriation number 1120 101 43-404.00 funds. 3.5 City shall designate the Mayor or his duly authorized representative to act on City's behalf on all matters regarding the Services. SECTION 4 PROFESSIONAL'S RESPONSIBILITIES 4.1 Professional shall perform the Services pursuant to the terms of this Agreement and within any applicable time and cost estimate. 4.2 Professional shall coordinate with City its performance of the Services. 4.3 Professional shall provide the Services by following and applying at all times reasonable and lawful standards as accepted in the industry. SECTION 5 COMPENSATION 5.1 Professional estimates that the total price for the Services to be provided to City hereunder shall be no more than Five Thousand Dollars ($5,000.00) (the "Estimate"). Professional shall submit an invoice to City no more than once every thirty (30) days for Services provided City during the time period encompassed by such invoice. Invoices shall be submitted on a form containing the same information as that contained on the Professional Services Invoice attached hereto as Exhibit B, incorporated herein by this reference. City shall pay Professional for all undisputed Services rendered and stated on such invoice within thirty five (35) days from the date of City's receipt of same. 5.2 Professional agrees not to provide any Services to City that would cause the total cost of same to exceed the Estimate,without City's prior written consent. SECTION 6 TERM [C:\Users\clivingston\Downloads\B1ue&Co..LLC Professional Services.docx:5/4/2022 2:02 PM] 2 DocuSign Envelope ID: E5671049-8E1B-493D-8964-FFA5OFBBDABF Blue&Co.,LLC. Fire Department-2022 Appropriation#1120 101 43.404.00 Fund;P.O.#106506 Contract Not To Exceed$5,000.00 Unless otherwise terminated in accordance with the termination provisions set forth in Section 7.1 hereinbelow, this Agreement shall be in effect from the Effective Date through December 31, 2022, and shall, on the first day of each January thereafter, automatically renew for a period of one (1) calendar year, unless otherwise agreed by the parties hereto. SECTION 7 MISCELLANEOUS 7.1 Termination 7.1.1 The obligation to provide all or any portion of the Services under this Agreement may be terminated by City or Professional,without cause, upon thirty (30)days' notice. 7.1.2 The obligation to provide all or any portion of the Services under this Agreement may be terminated by City,for cause, immediately upon Professional's receipt of City's "Notice to Cease Services." 7.1.3 In the event of full or partial Agreement termination, and as full and complete compensation hereunder, Professional shall be paid for all such Services rendered and expenses incurred as of the date of termination that are not in dispute, except that such payment amount shall not exceed the Estimate. Disputed compensation amounts shall be resolved as allowed by law. 7.2 Binding Effect City and Professional, and their respective officers, officials, agents, partners and successors in interest are bound to the other as to all Agreement terms, conditions and obligations. 7.3 No Third Party Beneficiaries Nothing contained herein shall be construed to give rights or benefits to anyone other than the parties hereto. 7.4 Relationship The relationship of the parties hereto shall be as provided for in this Agreement, and neither Professional nor any of its agents,employees or contractors are City employees. Professional shall have the sole responsibility to pay to or for its agents, employees and contractors all statutory, contractual and other benefits and/or obligations as they become due. Professional hereby warrants and indemnifies City for and from any and all costs,fees,expenses and/or damages incurred by City as a result of any claim for wages, benefits or otherwise by any agent, employee or contractor of Professional regarding or related to the subject matter of this Agreement. This indemnification obligation shall survive the termination of this Agreement. 7.5 Insurance 7.5.1 Professional shall, as a condition precedent to this Agreement, purchase and thereafter maintain such [C:\Users\clivingston\Downloads\B1ue&Co..LLC Professional Services.docx:5/4/2022 2:02 PM] 3 DocuSign Envelope ID: E5671049-8E1B-493D-8964-FFA5OFBBDABF Blue&Co.,LLC. Fire Department-2022 Appropriation#1120 101 43.404.00 Fund;P.O.#106506 Contract Not To Exceed$5,000.00 insurance as will protect it and City from the claims set forth below which may arise out of or result from Professional's operations under this Agreement, whether such operations be by Professional or by its subcontractors or by anyone directly or indirectly employed by any of them, or by anyone directly for whose acts any of them may be liable: 1) Claims under Worker's Compensation and Occupational Disease Acts, and any other employee benefits acts applicable to the performance of the work; 2) Claims for damages because of bodily injury and personal injury, including death, and; 3) Claims for damages to property. Professional's insurance shall be not less than the amounts shown below: A. Commercial General Liability (Occurrence Basis) Bodily Injury, personal injury, property damage, Contractual liability, product/completed operations Each Occurrence Limit $1,000,000.00 Damage to Rented Premises $100,000.00 (each occurrence) Medical Expense Limit $5,000.00 Personal and Advertising Injury Limit $500,000.00 General Aggregate Limit $2,000,000.00 (Other than Products Completed Operations) NOTE: GENERAL AGGREGATE TO APPLY PER PROJECT Products/Completed Operations $1,000,000.00 B. Auto Liability $1,000,000.00 (combined single limit) (owned, hired & non-owned) Bodily injury& property damage $1,000,000.00 each accident C. Excess/Umbrella Liability $2,000,000 (each occurrence and aggregate) D. Worker's Compensation & Disability Statutory [C:\Users\clivingston\Downloads\B1ue&Co..LLC Professional Services.docx:5/4/2022 2:02 PM] 4 DocuSign Envelope ID: E5671049-8E1B-493D-8964-FFA5OFBBDABF Blue&Co.,LLC. Fire Department-2022 Appropriation#1120 101 43.404.00 Fund;P.O.#106506 Contract Not To Exceed$5,000.00 E. Employer's Liability: Bodily Injury by Accident/Disease: $100,000 each employee Bodily Injury by Accident/Disease: $250,000 each accident Bodily Injury by Accident/Disease: $500,000 policy limit F. Professional Liability Insurance. The Professional shall carry and maintain during the continuance of this Agreement, professional liability insurance in the amount of $2,000,000 for single limit claims and$3,000,000 in the aggregate.The Professional's policy of insurance shall contain prior acts coverage sufficient to cover all Services performed by the Professional for this Project. Upon City's request, Professional shall give prompt written notice to City of any and all claims made against this policy during the period in which this policy is required to be maintained pursuant to this Agreement. If the insurance is written on a claims-made basis and coverage is cancelled at any time, the Professional will obtain, at its cost, an extended reporting endorsement which provides continuing coverage for claims based upon alleged acts or omissions during the term of the Agreement until all applicable statute of limitation periods have expired. 7.5.2 Professional shall provide the City with a certificate of insurance, naming the City as an "additional insured,"showing such coverage then in force (but not less than the amount shown above) shall be filed with City prior to commencement of any work.These certificates shall contain a provision that the policies and the coverage afforded will not be canceled until at least thirty (30) days after written notice has been given to City. 7.5.3 Professional may, with the prior approval of the City, substitute different types of coverage for those specified if the total amount of required protection is not reduced. Professional shall be responsible for all deductibles. 7.5.4 Nothing in the above provisions shall operate as or be construed as limiting the amount of liability of Professional to the above enumerated amounts. 7.6 Liens Professional shall not cause or permit the filing of any lien on any of City's property. In the event such a lien is filed and Professional fails to remove it within ten (10) days after the date of filing, City shall have the right to pay or bond over such lien at Professional's sole cost and expense. 7.7 Default In the event Professional: (a) repudiates, breaches or defaults under any of the terms or conditions of this [C:\Users\clivingston\Downloads\B1ue&Co.,LLC Professional Son ices.docx:5/4/2022 2:02 PM] 5 DocuSign Envelope ID: E5671049-8E1B-493D-8964-FFA5OFBBDABF Blue&Co.,LLC. Fire Department-2022 Appropriation#1120 101 43.404.00 Fund;P.O.#106506 Contract Not To Exceed$5,000.00 Agreement, including Professional's warranties; (b)fails to perform the Services as specified; (c)fails to make progress so as to endanger timely and proper completion of the Services and does not correct such failure or breach within five(5)business days after receipt of notice from City specifying same;or(d)becomes insolvent, files, or has filed against it, a petition for receivership, makes a general assignment for the benefit of creditors or dissolves, each such event constituting an event of default hereunder, City shall have the right to terminate all or any part of this Agreement, without liability to Professional and to exercise any other rights or remedies available to it at law or in equity. 7.8 Government Compliance Professional agrees to comply with all laws,executive orders, rules and regulations applicable to Professional's performance of its obligations under this Agreement,all relevant provisions of which being hereby incorporated herein by this reference,to keep all of Professionals' required professional licenses and certifications valid and current, and to indemnify and hold harmless City from any and all losses,damages, costs, liabilities,damages, costs and attorney fees resulting from any failure by Professional to do so.This indemnification obligation shall survive the termination of this Agreement. 7.9 Indemnification Professional shall indemnify and hold harmless City and its officers, officials, employees and agents from all losses, liabilities, claims,judgments and liens, including, but not limited to, all damages, costs, expenses and attorney fees arising out of any intentional or negligent act or omission of Professional and/or any of its employees, agents or contractors in the performance of this Agreement. This indemnification obligation shall survive the termination of this Agreement. 7.10 Discrimination Prohibition Professional represents and warrants that it and each of its employees, agents and contractors shall comply with all existing and future laws prohibiting discrimination against any employee, applicant for employment and/or other person in the subcontracting of work and/or in the performance of any Services contemplated by this Agreement with respect to hire,tenure,terms,conditions or privileges of employment or any matter directly or indirectly related to employment, subcontracting or work performance hereunder because of race, religion, color,sex, handicap, national origin,ancestry,age,disabled veteran status or Vietnam era veteran status.This indemnification obligation shall survive the termination of this Agreement. 7.11 E-Verify [C:\Users\clivingston\Downloads\B1ue&Co.,LLC Professional Son ices.docx:5/4/2022 2:02 PM] 6 DocuSign Envelope ID: E5671049-8E1B-493D-8964-FFA5OFBBDABF Blue&Co.,LLC. Fire Department-2022 Appropriation#1120 101 43.404.00 Fund;P.O.#106506 Contract Not To Exceed$5,000.00 Pursuant to I.C. § 22-5-1.7 et seq., Professional shall enroll in and verify the work eligibility status of all of its newly-hired employees using the E-Verify program, if it has not already done so as of the date of this Agreement. Professional is further required to execute the attached Affidavit, herein referred to as Exhibit C, which is an Affidavit affirming that: (i) Professional is enrolled and is participating in the E-Verify program, and (ii) Professional does not knowingly employ any unauthorized aliens. This Addendum incorporates by reference, and in its entirety, attached Exhibit C. In support of the Affidavit, Professional shall provide the City with documentation that it has enrolled and is participating in the E-Verify program. This Agreement shall not take effect until said Affidavit is signed by Professional and delivered to the City's authorized representative. Should Professional subcontract for the performance of any work under this Addendum, the Professional shall require any subcontractor(s) to certify by affidavit that: (i) the subcontractor does not knowingly employ or contract with any unauthorized aliens, and (ii) the subcontractor has enrolled and is participating in the E-Verify program. Professional shall maintain a copy of such certification for the duration of the term of any subcontract. Professional shall also deliver a copy of the certification to the City within seven (7)days of the effective date of the subcontract. If Professional, or any subcontractor of Professional, knowingly employs or contracts with any unauthorized aliens, or retains an employee or contract with a person that the Professional or subcontractor subsequently learns is an unauthorized alien, Professional shall terminate the employment of or contract with the unauthorized alien within thirty (30)days ("Cure Period"). Should the Professional or any subcontractor of Professional fail to cure within the Cure Period, the City has the right to terminate this Agreement without consequence. The E-Verify requirements of this Agreement will not apply, should the E-Verify program cease to exist. 7.12 Severability If any provision of this Agreement is held to be invalid, illegal or unenforceable by a court of competent jurisdiction, that provision shall be stricken, and all other provisions of this Agreement that can operate independently of same shall continue in full force and effect. 7.13 Notice Any notice, invoice, order or other correspondence required or allowed to be sent pursuant to this Agreement shall be written and either hand-delivered or sent by prepaid U.S. certified mail, return receipt requested, addressed to the parties as follows: CITY: City of Carmel City of Carmel Fire Department Office of Corporation Counsel 10701 N College Avenue, Suite A One Civic Square Carmel, Indiana 46032 Carmel, Indiana 46032 PROFESSIONAL: [C:\Users\clivingston\Downloads\B1ue&Co.,LLC Professional Son ices.docx:5/4/2022 2:02 PM] 7 DocuSign Envelope ID: E5671049-8E1B-493D-8964-FFA5OFBBDABF Blue&Co.,LLC. Fire Department-2022 Appropriation#1120 101 43.404.00 Fund;P.O.#106506 Contract Not To Exceed$5,000.00 Blue &Co., LLC 12800 N Meridian St, Suite 400 Carmel, Indiana 46032 Notwithstanding the above, City may orally provide to Professional any notice required or permitted by this Agreement, provided that such notice shall also then be sent as required by this paragraph within ten (10) business days from the date of such oral notice. 7.14 Effective Date The effective date ("Effective Date")of this Agreement shall be the date on which the last of the parties hereto executes same. 7.15 Governing Law; Lawsuits This Agreement shall be governed by and construed in accordance with the laws of the State of Indiana,except for its conflict of laws provisions, as well as by all ordinances and codes of the City of Carmel, Indiana. The parties agree that, in the event a lawsuit is filed hereunder, they waive any right to a jury trial they may have, agree to file such lawsuit in an appropriate court in Hamilton County, Indiana only, and agree that such court is the appropriate venue for and has jurisdiction over same. 7.16 Waiver Any delay or inaction on the part of either party in exercising or pursuing its rights and/or remedies hereunder or under law shall not operate to waive any such rights and/or remedies nor in any way affect the rights of such party to require such performance at any time thereafter. 7.17 Non-Assignment Professional shall not assign or pledge this Agreement nor delegate its obligations hereunder without City's prior written consent. 7.18 Entire Agreement This Agreement contains the entire agreement of and between the parties hereto with respect to the subject matter hereof, and no prior agreement, understanding or representation pertaining to such subject matter, written or oral, shall be effective for any purpose. No provision of this Agreement may be amended, added to or subtracted from except by an agreement in writing signed by both parties hereto and/or their respective successors in interest. To the extent any provision contained in this Agreement conflicts with any provision contained in any exhibit attached hereto, the provision contained in this Agreement shall prevail. 7.19 Representation and Warranties [C:\Users\clivingston\Downloads\B1ue&Co..LLC Professional Services.docx:5/4/2022 2:02 PM] 8 DocuSign Envelope ID: E5671049-8E1B-493D-8964-FFA5OFBBDABF Blue&Co.,LLC. Fire Department-2022 Appropriation#1120 101 43.404.00 Fund;P.O.#106506 Contract Not To Exceed$5,000.00 Each party hereto represents and warrants that it is authorized to enter into this Agreement and that any person or entity executing this Agreement on behalf of such party has the authority to bind such party or the party which they represent, as the case may be. 7.20 Headings All headings and sections of this Agreement are inserted for convenience only and do not form a part of this Agreement nor limit, expand or otherwise alter the meaning of any provision hereof. 7.21 Advice of Counsel The parties warrant that they have read this Agreement and fully understand it, have had an opportunity to obtain the advice and assistance of counsel throughout the negotiation of same, and enter into same freely, voluntarily, and without any duress, undue influence or coercion. 7.22 Copyright City acknowledges that various materials which may be used and/or generated by Professional in performance of Services, including forms,job description formats,comprehensive position questionnaire,compensation and classification plan and reports are copyrighted. City agrees that all ownership rights and copyrights thereto lie with Professional, and City will use them solely for and on behalf of its own operations. City agrees that it will take appropriate action with its employees to satisfy its obligations with respect to use, copying, protection and security of Professional's property. 7.23 Personnel Professional represents that it has, or will secure at its own expense, all personnel required in performing the services under this agreement. Such personnel shall not be employees of or have any contractual relationship with City.All of the services required hereunder will be performed by Professional or under his supervision and all personnel engaged in the work shall be fully qualified to perform such services. 7.24 Records and Inspections Professional shall maintain full and accurate records with respect to all matters covered under this agreement for three (3)years after the expiration or early termination of this Agreement. City shall have free access at all proper times to such records and the right to examine and audit the same and to make transcripts there from, and to inspect all program data, documents, proceedings and activities. 7.25 Accomplishment of Project [C:\Users\clivingston\Downloads\B1ue&Co..LLC Professional Services.docx:5/4/2022 2:02 PM] 9 DocuSign Envelope ID: E5671049-8E1B-493D-8964-FFA5OFBBDABF Blue&Co.,LLC. Fire Department-2022 Appropriation#1120 101 43.404.00 Fund;P.O.#106506 Contract Not To Exceed$5,000.00 Professional shall commence, carry on, and complete the project with all practicable dispatch, in a sound economical and efficient manner, in accordance with the provisions thereof and all applicable laws. In accomplishing the project, Professional shall take such steps as are appropriate to ensure that the work involved is properly coordinated with related work being carried on within City's organization. 7.26 Debarment And Suspension 7.26.1 The Professional certifies by entering into this Agreement that neither it nor its principals nor any of its subcontractors are presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from entering into this Agreement by any federal agency or by any department, agency or political subdivision of the State of Indiana. The term "principal" for purposes of this Agreement means an officer, director, owner, partner, key employee or other person with primary management or supervisory responsibilities, or a person who has a critical influence on or substantive control over the operations of the Professional. 7.26.2 The Professional certifies that it has verified the state and federal suspension and debarment status for all subcontractors receiving funds under this Agreement and shall be solely responsible for any recoupment, penalties or costs that might arise from use of a suspended or debarred subcontractor. The Professional shall immediately notify the City if any subcontractor becomes debarred or suspended, and shall, at the City's request, take all steps required by the City to terminate its contractual relationship with the subcontractor for work to be performed under this Agreement. 7.27 Access to Public Records Act Professional understands and agrees that any"public record", as that term is defined in Indiana Code 5-14-3- 2(m), as amended, that is related to the subject matter of this Agreement, whether the same is in the possession or control of the Professional or the City, shall be subject to release under and pursuant to the provisions of Indiana's Access to Public Records Act, as codified in Indiana Code 5-14-3-1, et seq., as amended. 7.28 Iran Certification Pursuant to I.C. § 5-22-16.5, the Professional shall certify that, in signing this Agreement, it does not engage in investment activities within the Country of Iran. IN WITNESS WHEREOF, the parties hereto have made and executed this Agreement as follows: [C:\Users\clivingston\Downloads\B1ue&Co..LLC Professional Services.docx:5/4/2022 2:02 PM] 10 DocuSign Envelope ID: E5671049-8E1B-493D-8964-FFA5OFBBDABF Blue&Co.,LLC. Fire Department-2022 Appropriation#1120 101 43.404.00 Fund;P.O.#106506 Contract Not To Exceed$5,000.00 CITY OF CARMEL, INDIANA Blue &Co., LLC by and through its Board of Public Works and Safety BY: BY: Not Present �' �- � �I _ James Brainard, Presiding Officer Authorized Signature Date: Printed Name: Michael Alessandrini DocuSigned by: Q�Inbutria. Title: Director affAiirlfnft, Member Date: 5/18/2022 FID/TIN: 35-1178661 DocuSigned by: thri (Pa SM A, 5/9/22 `—E4rilkinatvon, Member Date: Date: 5/18/2022 ATTEST: ,-DocuSigned by: Suc OJONel C83A05D7A 4 CE... Sue WoOTpgark Date: [C:\Users\clivingston\Downloads\B1ue&Co..LLC Professional Services.docx:5/4/2022 2:02 PM] 11 DocuSign Envelope ID: E5671049-8E1B-493D-8964-FFA5OFBBDABF Exhibit A CPAs/ADVISORS " blue Blue&Co., LLC/500 N.Meridian Street,Suite 200/Indianapolis,IN 46204 main 317.633.4705 fax 317.633.4889 email blue@blueandco.com April 26, 2022 Mr. David Haboush Fire Chief City of Carmel Fire Department 2 Civic Square Carmel, IN 46032 Dear David: The purpose of this letter is to confirm the cost report services we will perform and the scope of our engagement. This engagement is by and between Blue & Co., LLC (Blue) and the City of Carmel Fire Department. Our engagement will include the preparation of the following cost report from the information you supply to us. • Indiana Medicaid Freestanding Governmental Ambulance Provider Cost Report for the year ending December 31, 2021 Blue is responsible for preparing the cost report listed above in compliance with cost allocation principles found in OMB Circular A-87 and CMS Pub.15-1 and based on the instructions outlined in the Indiana Health Coverage Program June 4, 2013 Medicaid bulletin BT201316. The purpose is to determine the Medicaid program ambulance costs for potential additional Medicaid reimbursement.We will not audit or otherwise verify the data you submit, although we may ask for some clarification. We will provide the City of Carmel Fire Department with a planning guide to assist in compiling the necessary data required for completion of the above report.This engagement is limited solely to cost report preparation. This engagement will begin with our request for 2021 information and will end upon our delivery of the cost report to you. We will also work with the State's contractor and answer any questions related to the above cost report year. The Office of Medicaid Policy and Planning requires that you have adequate documentation to support the cost report filed. All statements, records, schedules, working papers, or memoranda prepared by us during our engagement shall remain the exclusive property of our accounting firm. CPAs, like all providers of personal financial services, are now required by law to inform their clients of their policies regarding privacy of client information. CPAs have been and continue to be bound by professional standards of confidentiality that are even more stringent than those required by law. Therefore, we have always protected your right to privacy. We retain records relating to professional services that we provide so that we are better able to assist you with your professional needs and, in some cases, to comply with professional guidelines. In order to guard your information, we maintain physical, electronic, and procedural safeguards that comply with our professional standards. DocuSign Envelope ID: E5671049-8E1 B-493D-8964-FFA5OFBBDABF City of Carmel Fire Department April 26, 2022 Page 2 In the interest of facilitating our services to the City of Carmel Fire Department, we may communicate by facsimile transmission or send electronic mail over the internet. Such communications may include information that is confidential to the City of Carmel Fire Department. While we will use our best efforts to keep such communications secure in accordance with our obligations under applicable laws and professional standards, you recognize and accept that we have no control over the unauthorized interception of these communications once they have been sent, and you consent to our use of these electronic devices. Our fees will be $5,000 for the cost report for 2021. You will be invoiced upon completion of the cost report. Our invoices are due and payable within 30 days. Interest will be charged at a rate of 1.5% per month on balances in excess of 30 days. Our engagement is contingent upon your obligation to furnish us with timely information necessary to complete the report prior to the filing due date which is May 31, 2022 however, we understand that an extension has been granted for the City of Carmel Fire Department to July 31, 2022. In the event our work is suspended or terminated as a result of non-payment, you agree that we will not be responsible for your failure to meet government and other filing deadlines, or for penalties or interest that may be assessed against you resulting from your failure to meet such deadlines. Our engagement does not include any services or advice with respect to the design, operations or maintenance of your computerized systems, or the processing and storage of your data. It is mutually agreed that our accounting firm is not responsible for any claims or damages related to your computerized systems. Management is responsible for the substantive outcome of our work and therefore has a responsibility to be in a position in fact and appearance to make an informed judgment on the results of our services. This includes establishing and monitoring the performance of our services to ensure it meets management's objectives and evaluating the adequacy of the services performed and any findings or results. You are responsible for making any decisions that involve management functions relating to our services and accept full responsibility for those decisions. It is our understanding that you are the designated level official responsible and accountable for overseeing our services. We believe the foregoing correctly sets forth our understanding, but if you have any questions, please let us know. If you find the arrangements acceptable, please acknowledge your agreement to the understanding by signing and returning the letter to us. We are pleased to have you as a client and look forward to a long and mutually satisfying relationship. Should you have any questions please contact Tina Severs at 317.713.7946. ACCEPTED BY: CITY OF CARMEL FIRE DEPARTMENT NAME: DATE: DocuSign Envelope ID: E5671049-8E1 B-493D-8964-FFA5OFBBDABF EXHIBIT B Invoice Date: Name of Company: Address &Zip: Telephone No.: Fax No.: Project Name: Invoice No. Purchase Order No: Goods Services Person Providing Date Goods/Services Provided Cost Per Hourly Total Goods/Services Goods/ (Describe each good/service Item Rate/ Service separately and in detail) Hours Provided Worked GRAND TOTAL Signature Printed Name DocuSign Envelope ID: E5671049-8E1B-493D-8964-FFA5OFBBDABF EXHIBIT C AFFIDAVIT Tina Severs , being first duly sworn, deposes and says that he/she is familiar with and has personal knowledge of the facts herein and, if called as a witness in this matter, could testify as follows: 1. I am over eighteen (18) years of age and am competent to testify to the facts contained herein. 2. I am now and at all times relevant herein have been employed by Blue &Co., LLC (the "Employer") in the position of Manager 3. I am familiar with the employment policies, practices, and procedures of the Employer and have the authority to act on behalf of the Employer. 4. The Employer is enrolled and participates in the federal E-Verify program and has provided documentation of such enrollment and participation to the City of Carmel, Indiana. 5. The Company does not knowingly employ any unauthorized aliens. FURTHER AFFIANT SAYETH NOT. EXECUTED on the 10th day of May , 20 22 . Printed: Tina Severs I certify under the penalties for perjury under the laws of the United States of America and the State of Indiana that the foregoing factual statements and representations are true and correct. Printed: Tina Severs DocuSign Envelope ID: E5671049-8E1B-493D-8964-FFA5OFBBDABF Page 1 of 1 INDIANA RETAIL TAX EXEMPT 9 City of CIirnnie1 CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER FEDERAL EXCISE TAX EXEMPT 1 II I/ .511 1/I ONE CIVIC SQUARE 35-6000972 THIS NUMBER MUST APPEAR ON INVOICES,A/P CARMEL, INDIANA 46032-2584 VOUCHER,DELIVERY MEMO,PACKING SLIPS, SHIPPING LABELS AND ANY CORRESPONDENCE FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL-1997 PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION 5/2/2022 376469 Medicaid Cost Reporting BLUE&CO LLC Carmel Fire Department VENDOR 12800 N MERIDIAN ST SHIP 10701 N. College Avenue, Ste A SUITE 400 TO Carmel, IN 46280- CARMEL, IN 46032- PURCHASE ID BLANKET CONTRACT PAYMENT TERMS FREIGHT 65458 QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION Department: 1120 Fund: 101 General Fund Account: 43-404.00 1 Each Medicaid Cost Reporting $5,000.00 $5,000.00 Sub Total $5,000.00 r H / rf, 1 a1 Send Invoice To: 10%'1„',/'%%, Carmel Fire Department / 2 Civic Square 11, Carmel, IN 46032- PLEASE INVOICE IN DUPLICATE DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT PAYMENT $5,000.00 SHIPPING INSTRUCTIONS PART A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND VOUCHER HAS THE PROPER SWORN *SHIP PREPAID. AFFIDAVIT ATTACHED. I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN *C.O.D.SHIPMENT CANNOT BE ACCEPTED. THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER. *PURCHASE ORDER NUMBER MUST APPEAR ON ALL SHIPPING LABEL \ +. _ems v.��.✓' *THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. ORDERED BY Denise Snyder TITLE Accreditation/Budget Administrator CONTROL NO. 1 06506 CONTROLLER