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HomeMy WebLinkAboutItem 05 - Ambulance Fee Ordinance Amendment and Ambulance Service Billing ContractAmbulance Fee Ordinance Amendment and Contract for Ambulance Service Billing Intermedix, Inc. Non-residents of Grapevine will receive a statement that all charges have been assigned to their insurance carrier and that any unpaid portion will be the responsibility of the patient (except in the instance of a government health care program). Intermedix, Inc. specializes in patient account management for emergency medical service providers. They provide this service to a number of EMS agencies in our area and around Texas. In addition to the patient billing services, Intermedix will provide the following services to the City and Fire Department via the Internet: • Electronic Document Management — All patient medical records, correspondence, insurance records and other relevant records are digitally scanned and made available to EMS Staff via secure web servers to the Fire Department computers. • On -Line Medical Record Entry — Rather than using paper forms, medics will be able to run reports via portable laptop computers carried on -board ambulances with automatic delivery of completed run reports to any receiving facility in less than five minutes. • Trauma Registry Reporting — Required medical information is reported directly to proper agencies utilizing data from run records with no duplication of effort. This is done automatically by Intermedix computers. The Fire Department reporting burden in this regard is eliminated. • Statistics and Demographics — The Intermedix computer system provides up-to-date reports and statistics including, among other things, reports on patient location, response times, call types, financial data, statistics related to each individual paramedic performance, and certificates and licensing reports and many more data reports. Based upon historical records and typical costs for ambulance runs as compared to current fee rates, the City should see a substantial increase in revenues for ambulance services. Staff recommends approval of both the resolution authorizing the Intermedix contract and the ordinance implementing the new billing method. Enclosures December 28, 2005 (11:24AM) ORDINANCE NO. AN ORDINANCE OF THE CITY COUNCIL OF THE CITY OF GRAPEVINE, TEXAS, AMENDING THE GRAPEVINE CODE OF ORDINANCES, CHAPTER 5 AMBULANCE SERVICES RELATIVE TO EMERGENCY AMBULANCE SERVICE FEES; ADOPTING A SERVERABILITY CLAUSE; DECLARING AN EMERGENCY AND PROVIDING AN EFFECTIVE DATE NOW, THEREFORE, BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF GRAPEVINE, TEXAS: Section 1. That Chapter 5 Ambulance Service, Section 5-3 (b) and (c) of the Code of Ordinances be amended to read as follows: "(b) Fees for emergency ambulance service shall be established to conform with reasonable and customary charges as established by the City's contracted ambulance billing service as reviewed and approved by the City Manager on a periodic basis, but not less than annually. Once approved by the City Manager, the emergency ambulance service fees shall be in effect until such a time as the City Manager approves new emergency ambulance service fees. (c) Any person(s) receiving emergency ambulance services shall be responsible to remit payment to the City. In the case of emergency ambulance services being received by a minor, the parent or legal guardian shall be responsible to remit payment to the City. (1) Residents of the City. For emergency ambulance services rendered to a resident(s) of the City, the City shall bill the resident's insurance, which shall include any federal healthcare programs or insurers. A resident shall only be responsible for payment to the City for emergency ambulance services to the maximum extent covered by the resident's insurance, if any. (2) Non-residents of the City. For emergency ambulance services rendered to a non-resident(s) of the City, the City shall first bill the non-resident's(s') insurance, which shall include any federal healthcare programs or insurers. To the extent a non-resident's insurance does not cover payment for any or all of the emergency ambulance service, the non-resident shall be responsible for payment to the City." Section 2. All sections and provisions of Chapter 5, Section 5-3 of the Code of Ordinances of the City of Grapevine, Texas, not hereby amended shall remain in full force and effect. Section 3. If any section, article, paragraph, sentence, clause, phrase or word in this ordinance, or application thereto any person or circumstances is held invalid or unconstitutional by a Court of competent jurisdiction, such holding shall not affect the validity of the remaining portions of this ordinance; and the City Council hereby declares it would have passed such remaining portions of the ordinance despite such invalidity, which remaining portions shall remain in full force and effect. Section 4. The fact that the present ordinances and regulations of the City of Grapevine, Texas, are inadequate to properly safeguard the health, safety, morals, peace, and general welfare of the public creates an emergency which requires that this ordinance become effective from and after the date of its passage, and it is accordingly so ordained. PASSED AND APPROVED BY THE CITY COUNCIL OF THE CITY OF GRAPEVINE, TEXAS on this the 3rd day of January, 2006. ATTEST: ORD. NO. 2 RESOLUTION NO. A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF GRAPEVINE, TEXAS, APPROVING THE AMBULANCE SERVICE BILLING CONTRACT WITH INTERMEDIX, INC., FOR BILLING AND COLLECTION OF AMBULANCE SERVICES PROVIDED BY THE GRAPEVINE FIRE DEPARTMENT, FOR A ONE-YEAR TERM, BEGINNING JANUARY 3, 2006 AND ENDING JANUARY 3, 2007, FOR A FEE EQUIVALENT TO TWELVE (12%) PERCENT OF THE TOTAL AMOUNT COLLECTED ON EACH ACCOUNT, AND AN ADDITIONAL ONE AND EIGHT -TENTHS (1.8%) PERCENT, IF PAYMENT IS MADE BY A CREDIT CARD, TO AUTHORIZE INTERMEDIX, INC. TO PERIODICALLY MODIFY AND UPDATE PRICING FOR AMBULANCE SERVICES PROVIDED TO CONFORM WITH THE REASONABLE AND CUSTOMARY COSTS ASSOCIATED WITH THE PROVISION OF SUCH SERVICES, AS APPROVED BY THE CITY MANAGER; AND AUTHORIZING THE CITY MANAGER TO EXECUTE THE CONTRACT WITH INTERMEDIX, INC. AND ANY DOCUMENTS RELATED THERETO, ON BEHALF OF THE CITY OF GRAPEVINE, TEXAS AND PROVIDING AN EFFECTIVE DATE WHEREAS, the City of Grapevine provides emergency ambulance services and through the course of that service has the ability to offset operational expense through billing for services rendered, and has the need to generate patient care reports for the services rendered and to continuously improve service quality and to satisfy regulatory requirements for the State Trauma Registry Reporting System; and WHEREAS, Intermedix, Inc. has been identified to offer a billing method and collection service coupled with a web -based patient reporting system that will increase revenue; and WHEREAS, after review and consideration, is deemed in the best interest of the City of Grapevine, Texas, to contract with Intermedix, Inc. to provide the aforementioned emergency ambulance billing services. NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF GRAPEVINE, TEXAS: Section 1. That the above findings are hereby found to be true and correct and are incorporated herein in their entirety. Section 2. That the City Council of the City of Grapevine, Texas, hereby approves the ambulance service billing contract with Intermedix, Inc. relating to the professional services for providing for ambulance service billing, and further authorizing the City Manager to execute said contract and any and all related documents on behalf of the City of Grapevine, Texas. Section 3. That this resolution is effective from and after the date of its passage. PASSED AND APPROVED BY THE CITY COUNCIL OF THE CITY OF GRAPEVINE, TEXAS on this the 3rd day of January, 2006. I_1WWZ�]�l ATTEST: RES. NO. 2 SERVICE AGREEMENT This Service Agreement ("Agreement") entered into by and between Intermedix, Inc., a Texas corporation with offices at 16225 Park Ten Place. Drive, Suite 805, Houston, Texas 77084, Facsimile No. (866) 724-5995 (hereinafter referred to as "Intermedix"), and the provider of emergency medical and or ambulance transportation services as identified and with the address as set out on the signature page hereto (hereinafter referred to as "Provider"), is as follows: Recitals WHEREAS, Intermedix is a company in the business of administrating and collecting accounts receivables; and WHEREAS, Provider operates, as part or all of its overall activities, an ambulance service that provides emergency and/or non -emergency medical and ambulance services, including emergency medical responses, other patient encounters and/or patient ambulance transportation (the "Services"); NOW, THEREFORE, in consideration of the mutual promises herein contained, the parties hereto agree as follows: Article One Term and Termination 1.01 Term. The initial term of this Agreement shall be for a period of one year unless earlier terminated pursuant to Sections 1.02 or 1.03 (such initial term, together with all extensions thereof, shall be referred to herein as the "Term"). Unless notice is given before the end of the initial Term by either party that it does not wish to extend the relationship, at the end of the initial Term, this Agreement shall be automatically extended for additional, one-year periods. 1.02 Optional Termination. Notwithstanding any provision of this Agreement to the contrary, this Agreement may be terminated by either party, without cause and without liability (except for continuing obligations during such period), upon 90 days advance written notice to the other party. 1.03 Termination on Default. Either party may terminate this Agreement if (a) the other party is in default under the terms and conditions of this Agreement and (b) the default is not cured within 60 days of receipt of written notice specifying the default. 1.04 Obligations During Notice Period. During the 60- or 90 -day notice periods specified in Sections 1.02 and 1.03, Intermedix shall be entitled to receive compensation for all accounts billed and/or collected with respect to the Services and shall be entitled, after the end of the termination period to receive compensation for all amounts billed during the termination period but not collected until after the end of the termination period. -1- 1.05 Obligations on Termination. Upon termination of the Agreement, for whatever cause, Intermedix will immediately return all original medical records to Provider and may, at Intermedix's sole election, provide to Provider a digital copy on a CD-ROM of all paper records related to Provider. Article Two Billing, Remittances of Collections and Other Services 2.01 Exclusivity. During the Term, Intermedix shall be exclusively responsible for the billing and collection of all charges and fees relating to the Services provided by Provider, including but not limited to private insurance, Medicare, Medicaid, and other governmental programs. 2.02 Rate Schedule. Absent specific, written instructions by Provider to the contrary, Intermedix shall provide a rate schedule for the Services based on prevailing charges and/or Provider's demographic service area. Intennedix will use its reasonable best efforts to determine and use standard pricing for the Services. The rate schedule for the Services will be available via the Web Access System (as such term is defined below) in a format or accessible determined by Intermedix in its sole discretion. Provider may from time -to -time and at any time, upon 30 days written notice to Intermedix, instruct Intermedix to change one or more scheduled charges. 2.03 Place of Payment. Intermedix may accept payments at any location designated by it and may accept payments in the name of Intermedix f/b/a Provider or Provider. 2.04 Remittances of Collections. On each Wednesday (or the immediate following business day should any Wednesday not be a business day in the State of Texas) of each week during the Term, Intermedix shall forward to Provider checks received but not deposited during the previous week. 2.05 Copies of Records. From time to time, Intermedix may receive requests from patients or the representatives of patients for copies of treatment records. Intermedix may bill patients or their representatives $40.00 for preparation and release of records (or, whether greater or lesser, the highest amount as may be charged by Texas or Federal law, including, without limitation, the Texas Open Records Act), and the total amount billed and collected may be retained by Intermedix for its services rendered. Provider will not receive any portion of this payment and specifically waives any right, title or interest it may now or later claim in such payment. In return for the right to receive such payments, Intermedix will provide, at no charge to Provider, copies of patient treatment records and/or other records Intermedix maintains on behalf of Provider if Provider receives a subpoena, discovery, or public information request for such records. Article Three Settlements and Alternative Collection Arrangements 3.01 Payment Arrangement Authority. Provider hereby grants Intennedix authority F to enter into a payment arrangement on its behalf with patients charged for the Services if (a) the -2- payment is for the full amount of a bill and (b) the length of the payments does not exceed 12 months. Provider must approve payment arrangements made for any period exceeding 12 months. 3.02 Settlement Authority. Provider hereby grants Intermedix authority to compromise and settle an account on its behalf with a patient s charged for the Services if the amount of payment is at least 70 percent of the total amount billed. Provider must approve any payment amount for less than 70 percent of the total amount. 3.03 Termination of Collection Efforts. If active collection efforts with respect to any account have been unsuccessful for 120 days or more, Intermedix shall have the right to terminate collection efforts with respect to such account and close the account as an unpaid debt. In addition, Intermedix may terminate or suspend collection efforts if Provider has supplied Intermedix with incomplete or inaccurate billing and/or patient information. In either event, Intermedix shall upon termination or suspension, immediately forward to Provider all records of Intermedix collection efforts, at no charge to Provider, and cease all collection activity. Article Four Compensation 4.01 Compensation. With respect to accounts collected during the Term and all accounts billed during the Term and collected after the Term, Intermedix shall be compensated and paid in accordance with the following schedule: a. 12% of the total amount collected on each account. b. An additional 1.8% if payment is made by a credit card. 4.02 Obligation for Payment. Payment in accordance with Section 4.01 shall be due and owing to Intermedix by Provider for all accounts collected during the Term and collected after the term but billed during the term regardless of whether payment was made to Intermedix or to Provider and regardless of whether Intermedix is used as the billing agent. Intermedix and Provider agree that the purpose of this section is to guarantee that Intermedix is the sole person engaging in billing services on behalf of Provider. Article Five Records and Reporting 5.01 Secure Website Access. Intermedix shall maintain records regarding Provider's accounts, collections and patient encounters on a secure website (the "Web Database") accessible with the Web Access System (as such term is defined below). Provider understands and agrees that the medical information available on the Web Database is private and confidential medical data that is protected as PHI (as such term is defined in Section 11.01 hereof) under Federal Law. Provider further understands and agrees that the Web Database contains other proprietary and confidential information that Provider may not share with third parties. Provider agrees to maintain the confidentiality of such information. Further, Provider -3- shall limit access to the Web Database to its authorized personnel who have completed and signed an access form. Provider understands and agrees that Intermedix must receive and review each access form prior to activating any person's access to the Web Database. Provider understands and agrees that to maintain the confidentiality of the Web Database; Provider must provide Intermedix immediate, written notice of the termination of any person with access to the Web Database. Provider understands and agrees that Intermedix shall use its reasonable best efforts to maintain the security of the Web Access System, but that Intermedix shall not be responsible for negligence with respect to password security related to Provider's personnel or other breaches beyond Intermedix's reasonable control. 5.02 Records of Patient Encounters. Provider shall forward all original medical records of each patient encounter to Intermedix within 10 days of such patient encounter. Such records shall be deemed to be the property of Provider, but Intermedix shall have the right to duplicate and retain paper or electronic copies of the records. If the records exist only in electronic form, each electronic copy shall be deemed to be an original for the purposes of this Agreement. 5.03 Requests for Copies. Any and all requests for copies of medical records should be submitted directly to Intermedix. Either Intermedix or Provider may authorize release of the records such that the release is in accordance with the standards and time requirements established by State and Federal law. 5.04 Texas Department of State Health Services Reports. Intermedix will be responsible for reporting all required information regarding patient encounters and trauma to the Texas Department of State Health Services. 5.05 Monthly Activity Reports. No later than the l Oth day of each calendar month, Intermedix shall prepare and forward to Provider a report of the prior calendar month activity. Such report shall list all accounts on which payment has been received and indicate whether such payment was made directly to Provider. 5.06 Information Received by Provider. To the extent that Provider receives payments or original copies of documentation directly, Provider shall forward to Intermedix copies of checks, Explanations of Benefits and/or other documentation within ten (10) days of the date of receipt of payment by Provider. 5.07 Statistical Data. Provider understands and agrees that Intermedix's Web Database will maintain statistical data regarding collections and medical encounters reflecting data as it is entered in the Web Database by Intermedix or Provider. The format and content of the statistical data reports available in the Web Database will be established and defined by Intermedix, and Intermedix may add, delete or modify the content and types of reports available without notice to Provider. Notwithstanding its right to change the form of such reports the available data in the reports shall include, at a minimum, a list of the accounts open and closed, the statement amount due for each account, the amount paid for each account and the date each account was open and closed. Provider further understands and agrees that, to the extent that it enters information into the Web Database, such information will be used in calculating the statistical data. To the extent that the information provider enters is in error, the statistical data and calculations may, likewise, contain errors. Provider understands and agrees that Intermedix shall not be responsible for any such statistical errors and/or the correction of incorrectly entered data. Article Six Web Database Access and Data Management 6.01 Web Access System. Intermedix will grant to Provider electronic access to all records on file regarding Provider including, but not limited to, medical records, billing records, correspondence regarding accounts, and records on personnel including credentials and training records. It shall be the responsibility of Provider to provide its own necessary computer equipment, computer communication equipment capable of connecting to the Internet and accessing Intermedix's Internet server (hereinafter referred to as "Web Access System") and Internet access. Provider will be solely responsible for maintaining and upgrading its computer equipment as necessary to access the Web Access System. Provider acknowledges and agrees that it may have obligations under various state and federal laws to maintain patient privacy with respect to certain patient information, and any violation of such laws will be the sole responsibility of Provider. 6.02 Web Access System Training. Upon written request of Provider, Intermedix will provide an annual, on-site training class on the use of the Web Access System at a time determined to be mutually convenient to the parties. 6.03 Compliance with Texas State Records Retention Schedule. The information Intermedix maintains on behalf of Provider shall be retained and maintained in accordance with the provisions of Local Schedule PS of the Texas State Records Retention Schedule as may be promulgated by the Texas State Library and Archives Commission from time to time and as adopted by Provider. Notwithstanding the foregoing, Provider understands and agrees that Intermedix is agreeing to maintain and retain such records only during the Term of and pursuant to the provisions of this Agreement. Provider further understands and agrees that Intermedix will comply with the provisions of this section at the termination of this Agreement by providing written or electronic copies of such records to Provider. After such copy is provided, Intermedix shall have no further obligations under this section. Article Seven Support Services Intermedix will provide patients and personnel of Provider with telephone support services during normal business hours (Monday - Friday from 9:00 a.m. to 5:00 p.m.) except on public holidays or other holidays as established by Intermedix. Article Eight Indemnification and Fidelity Bond -5- 8.01 Intermedix's Indemnification. Intermedix shall indemnify and hold harmless Provider from and against claims, damages, losses and expenses, including but not limited to attorneys' fees, arising out of or resulting from Intermedix's performance, but only to the extent caused by the willful misconduct or the negligent acts or omissions of Intermedix. The indemnification provided for herein shall not be applicable to any claim of adjustment or request for reimbursement made by an insurance company or any servicing agency for Medicare or Medicaid that may be made as the result of an audit of claims made or governmental regulations or laws, including Intermedix's fees charged, except for any adjustments or claims for reimbursement made as a direct result of Intermedix's error. 8.02 Provider's Indemnification. Provider shall indemnify and hold harmless Intermedix from and against claims, damages, losses and expenses, including but not limited to attorneys' fees, arising out of or resulting from Provider's failure to control access to the Web Database and/or its Web Access Systems. 8.03 Fidelity Bond. Intermedix shall keep and maintain during the term of this Agreement a fidelity bond with a qualified insurer of no less than $50,000.00. 8.04 Insurance. Intermedix shall keep and maintain during the term of this Agreement general liability insurance with a qualified insurer of no less than $1,000,000.00. Article Nine Confidentiality 9.01 Confidentiality of this Agreement. The terms and conditions of this Agreement are confidential and neither party shall release any of the terms hereof to any third party without the prior written consent of the other party, except to the extent necessary to comply with law, including public information requests, the valid order of a court of competent jurisdiction, or the valid order or requirement of a governmental agency. 9.02 Web Database; Web Servers; Other Property of Intermedix. Provider agrees that the equipment, computer hardware and software, billing and collection processing, and other related systems and equipment are the property and trade secrets of Intermedix, and that Provider will not release any information regarding such trade secrets to any third party without the prior written consent of Intermedix. 9.03 Fact of Contractual Relationship May Be Disclosed. Notwithstanding the foregoing, either party may, without the prior written consent of the other party, disclose the existence of a contractual relationship between the parties. Article Ten Audit 10.01 Accurate Books and Records. During the Term and for a period of three (3) years thereafter, each party agrees to maintain accurate books and records associated with the billing and collections made the subject of this Agreement. W01 a 10.02 Right to Audit. Upon reasonable written notice, either party may audit the books and records of the other party insofar and only insofar as such books and records relate or pertain directly to this Agreement. Such audit shall be conducted at the office of the party being audited, shall be during normal business hours, and shall be at the sole cost and expense of the party conducting the audit. 10.03 Penalty for Underpayment. If an audit reveals that a party has failed to pay any amount or portion of any amount due or payable under this Agreement and such amount is in excess of $20,000, the party being audited shall pay to the auditing party the full cost of the audit and the full amount due or payable plus interest at the rate of ten percent (10%) per annum from the date(s) of nonpayment. Article Eleven Protected Health Information 11.01 HIPAA Compliance. Intermedix shall carry out obligations under this Agreement in compliance with the privacy regulations pursuant to Public Law 104-191 of August 21, 1996, known as the Health Insurance Portability and Accountability Act of 1996, Subtitle F — Administrative Simplification, Sections 261, et seq., as amended ("HIPAA"), to protect the privacy of any personally identifiable protected health information ("PHP') that is collected, processed or learned as a result of the services provided in this Agreement. In conformity therewith, Intermedix agrees that it will: a. Not use or further disclose PHI except as permitted under this Agreement or required by law; b. Use appropriate safeguards to prevent use or disclosure of PHI except as permitted by this Agreement. c. To mitigate, to the extent practicable, any harmful effect that is known to Intermedix of a use or disclosure of PHI by Intermedix in violation of this Agreement; d. Report to Provider any use or disclosure of PHI not provided for by this Agreement of which Intermedix becomes aware; e. Ensure that agents or subcontractors to whom Intermedix provides PHI, or who have access to PHI, agree to the same restrictions and conditions that apply to Intermedix with respect to such PHI; f. Make PHI available to Provider and to the individual who has a right of access as required under HIPAA within 30 days of the request by Provider on the individual; g. Incorporate any amendments to PHI when notified to do so by Provider; -7- h. Provide an accounting of all uses or disclosures of PHI made by Intermedix as required under the HIPAA privacy rule within 60 days; and i. Make its internal practices, books and records relating to the use and disclosure of PHI available to the Secretary of the Department of Health and Human Services for purposes of determining Intermedix's and Provider's compliance with HIPAA. 11.02 HIPAA Disclosures. The specific uses and disclosures of PHI that may be made by Intermedix on behalf of Provider include: a. The preparation of invoices to patients, carriers, insurers and others responsible for payment or reimbursement of the services provided by Provider to its patients; b. Preparation of reminder notices and documents pertaining to collections of overdue accounts; c. The submission of supporting documentation to carriers, insurers and other payers to substantiate the health care services provided by Provider to its patients or to appeal denials of payments for same; d. The preparation and release of medical records to patients or their legal representatives as permitted by HIPPA privacy rule; and e. Uses required for the proper management of Intermedix as a business associate; f. Other uses or disclosures of PHI as permitted by HIPAA privacy rule. Article Twelve Miscellaneous 12.01 No Waiver. The failure of either party to insist upon strict performance of any provision of this agreement shall not be construed as a waiver of any subsequent breach of the same or similar nature. 12.02 Provisions Construed Separately. The parties agree that each provision of this Agreement shall be construed as separable and divisible from every other provision and that the enforceability of any one provision shall not limit the enforceability, in whole or in part, of any other provision hereof. In the event that a court of competent jurisdiction determines that any term or provision herein shall be invalid or unenforceable, the remaining terms and provisions of this Agreement shall not be affected thereby, and shall be interpreted as if the invalid term or provision were not a part hereof. 12.03 Final Agreement. This Agreement sets forth the entire, final and complete understanding between the parties hereto relevant to the subject matter of this Agreement. No i waiver or modification of any of the terms or conditions of this Agreement shall be effective unless in writing signed on behalf of both parties. 12.04 Performance of Agreement, Venue; Choice of Law. Provider understands and agrees that Intermedix will be performing this contract in Harris County, Texas. The venue for any disputes or causes of action that may arise out of this Agreement is the state and county courts located in the geographically nearest of the following major metropolitan areas located in the State of Texas: Austin, Corpus Christi, Dallas, El Paso, Fort Worth, Houston, Lubbock, and San Antonio. The provisions of this Agreement shall be determined in accordance with the laws of the State of Texas excluding the choice of law provisions thereof. 12.05 Headings. The headings of this Agreement are for ease of reference only and are not intended to limit or restrict the terms hereof. 12.06 Binding Nature of Agreement. This Agreement is binding upon the heirs, legal representatives, successors and assigns of the parties hereto. 12.07 Compliance with Laws Generally. Intermedix shall comply with all applicable laws, orders, rules, or regulations of all governmental agencies bearing on its performance hereunder. If so requested by Provider, Intermedix shall submit appropriate evidence of such compliance. 12.08 Independent Contractor. It is understood and agreed that Intermedix is an independent contractor. Nothing herein contained shall be construed to create any partnership, joint venture, or joint enterprise between the parties. 12.09 Non -Profit Status Determination Letter. If Provider is a not-for-profit entity, Provider shall provide a duplicate of its letter determining its not-for-profit status with the Internal Revenue Service. In providing such letter, Provider further represents and warrants to Intermedix that it has done every act necessary to maintain its not-for-profit status with the Internal Revenue Service and is not aware of any pending, threatened or actual revocation of its not-for-profit status. 12.10 Appendices. Intermedix and Provider may enter into various appendices to this Agreement from time to time and at any time regarding additional services. Such appendices shall be considered part of this Agreement as if set forth herein at length unless such appendix provides otherwise. 12.11 Notices. Intermedix's address and facsimile number are as listed in the opening paragraph above. Provider's address and facsimile number are as listed below its signature. Should either party change addresses or facsimile numbers, such party will notify the other of its new information, in writing, within 30 days of such change of information. Notices required or permitted to be given hereunder shall be deemed to be given the day they are mailed or faxed and shall be deemed to be received the same day if by fax (provided the sender has a fax machine/fax database generated proof of receipt) and in three days if by mail. M [ONLY SIGNATURE PAGE TO FOLLOW] EXECUTED on the day of 200_, and EFFECTIVE as of the day of 200_. Intermedix, Inc. Jeremy Mattern, President WR-11TATITU., Name: City of Grapevine, Fire Department Type of Entity: Municipality For Profit X Not for Profit By: Name: Bruno Rumbelow Title: City Manager ADDRESS OF PROVIDER 200 S. Main St. Grapevine, Texas 76051 P.O. Box 95104, Grapevine Texas 76051 Facsimile No.: (817) 410-8106 MVIE