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ATTACHMENT <br /> <br />Systems Design West LLC shall provide via Public Consulting Group (“Subcontractor”) the following <br />additional services upon City of Everett’s notification of its required participation in the Medicare Cost <br />Data Collection Survey. Specifically, Systems Design West LLC will execute the following steps to <br />complete the survey on behalf of City of Everett: <br />• Develop a detailed data request for those items that will be collected and provided by City of <br />Everett (“Client Data”). <br />• Systems Design West LLC will prepare and audit the completed Medicare Cost Survey and its <br />supporting documentation. <br />• Using the Client Data ‘as is’, based on what City of Everett provided, prepare the Cost Survey in <br />accordance with the Medicare principles of reimbursement that include but are not limited to 2 <br />CFR 200 – Uniform Administrative Requirements, Cost Principles, and Audit Requirements for <br />Federal Awards, and other relevant documents which provide regulatory guidance on allowable <br />costs and provider charges. <br />• The parties agree and acknowledge that Systems Design West LLC is not responsible for any <br />errors or omissions in the (i) Client Data that it receives from City of Everett and (ii) Cost Survey <br />that it prepares based on the Client data. <br />• Systems Design West LLC will provide a report to City of Everett that will include the submission <br />of work papers and methodologies for the filing of the Medicare Cost Data Survey along with <br />the completed report. <br />• Systems Design West LLC will submit the final report and supporting documentation to CMS. <br />• Systems Design West LLC will support the department in the event of a state or federal audit. <br />PCG will develop responses to any inquiries from the Centers for Medicare and Medicaid <br />Services (CMS) related to City of Everett’s filed survey. <br />City of Everett shall compensate Systems Design West LLC $35,000.00 for the services in this <br />attachment. Systems Design West LLC will invoice City of Everett within thirty (30) days following the <br />submission of City of Everett’s Medicare Cost Report. City of Everett will remit payment to Systems <br />Design West LLC within thirty (30) days of invoice receipt.