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FD Nordian Medicare Part B LetterApril 20, 2018 Noridian -Medicare Part B Attn: Provider Enrollment 900 42 nd St S Fargo, ND 58103 To whom it may concern: The City of San Rafael attests that it will be legally and financially responsible for Medicare payments received including any potential overpayments. The City of San Rafael further attests that it will be legally and financially responsible in the event that there is any outstanding debt owed to CMS. Very truly yours, ~HUTZ City Manager CITY OF SAN RAFAEL! 1400 FIFTH AVENUE, SAN RAFAEL, CALIFORNIA 94901 I CITYOFSANRAFAEL.ORG Gary 0 Phillips . Mayor· John Gamblin . Vice Mayor· Kate Colin , Councllmember • Maribeth Bushey, Councilmember • Andrew Cuyugan McCullough . Councilmember CONTRACT ROUTING FORM INSTRUCTIONS: Use this cover sheet to circulate all contracts for review and approval in the order shown below. TO BE COMPLETED BY INITIATING DEPARTMENT PROJECT MANAGER: Contracting Department: Fire Department Project Manager: David Catalinatto Extension: CIiGk here to enter text. Contractor Name: Medicare Contractors Contact: Click here to enter text. Contact's Email: Click here to enter text. o FPPC: Check if Contractor/Consultant must file Form 700 Step RESPONSIBLE DESCRIPTION DEPARTMENT 1 Project Manager a. Email PINS Introductory Notice to Contractor b. Email contract (in Word) & attachments to City Atty c/o Laraine.Gittens@cityofsanrafael.org 2 City Attorney a. Review, revise, and comment on draft agreement and return to Project Manager b. Confirm insurance requirements, create Job on PINS, send PINS insurance notice to contractor 3 Project Manager Forward three (3) originals of final agreement to contractor for their signature 4 Project Manager When necessary, * contractor-signed agreement agendized for Council approval *PSA > $20,000; or Purchase> $35,000; or Public Works Contract> $125,000 Date of Council approval PRINT CONTINUE ROUTING PROCESS WITH HARD COPY 5 Project Manager Forward signed original agreements to City Attorney with printed copy of this routing form 6 City Attorney Review and approve hard copy of signed agreement 7 City Attorney Review and approve insurance in PIN~) and bonds (for Public Works Contracts) II ~ 8 City Manager / Mayor Agreement executed by Council auth 6 rized official 9 City Clerk Attest signatures, retains original agreement and forwards copies to Project Manager COMPLETED DATE Click here to enter a date. 4/17/2018 4/19/2018 4/19/2018 Click here to enter a date 0 N/A Or Click here to enter a date. i {It( /11 q /l q/Jt8 ~-lLJ·-{Y REVIEWER Check/Initial 0 IZl IZl LG IZl LG N/A3309 0 0 ~ ~ hO ~J