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REPLACEMENT <br />APPENDIX B <br />CLIENT ELECTIONS <br />As set forth in the Billing Services Agreement, Client hereby directs Life Force Management on the following <br />elections by having the official with contracting authority initial the elections selected, which elections may be <br />changed from time to time on advance written notice to Life Force Management. <br />1. AUTHORIZED COMMUNITY LIAISON OR COMMITTEE <br />Pursuant to Section 2(M, Client shall appoint a primary liaison to Life Force that at all times will have the <br />authority to direct Life Force on behalf of the Client the.Authorized Liaison"). If Client establishes a Liaison <br />Committee (i.e., comprised of inembers such as elected officials, community officials, Fire Deparhnent <br />officers, and residents), Client shall designate which Liaison Committee member shall act as the Authorized <br />Liaison to Life Force. The Authorized Liaison must review and monitor all billing disputes and procedures <br />and meet with Life Force on a regular basis concerning billing amounts and collecfion procedures and at all <br />times have the authority to direct Life Force as follows on behalf of the Client: <br />o Refer accounts to a collection agency, <br />a Adjust the amount of the bill, <br />o Establish a payment program for the invoice amount, <br />• Write off tYie account as "uncollectible" or, <br />• Totally waive the bill. <br />Client appoints the Fire Chief or his designee <br />2. BANgll?TG?AN? DEPOSIT ?THOD ELECTIONS <br />Pursuant to Section 2(B), Client elects one of the following banking rnethods: <br />(PLEASE INITIAL_ONE ELECTION): <br />Client will utilize a lockbox.procedure with a bank of its choice at the sole cost and <br />expense of the Client for the receipt of written billing inquiries, correspondence and <br />payments. <br />? Life Force will provide a P.O. Box at its sole cost and expense to be used as the <br />mailing address for all Patient and Payor written billing inquiries, correspondence <br />and payments. Life Force will deposit any payments it receives in an account in <br />Client's name if the Client's bank so allows. Otherwise, Life Force will forward <br />payments to Client for deposit. <br />Client will receive aIl paytnents and correspondence at Client's address and make <br />deposits. Client will notify Life Force of all collections and forw ll?support: <br />CUSTOMER <br />DA <br />220681513664-1