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Di~.4F~" <br />EXHIBIT 1 C <br />DATA REQUIREMENTS <br />PARS will provide the Services under this Agreement contingent upon receiving the <br />following information: <br />1. Contribution Data - Completed Contribution Transmittal Form signed by Plan <br />Administrator (or authorized Designee) which contains the following information: <br />(A) Agency name <br />(B) Contribution amount <br />(C) Signed certification of reimbursement from the Plan Administrator, or authorized <br />Designee <br />2. Reimbursement Data -Completed Payment Reimbursement Form signed by the Plan <br />Administrator (or authorized Designee) which contains the following information: <br />(A) Agency name <br />(B) Payment reimbursement amount <br />(C) Applicable statement date <br />(D) Copy of applicable premium statement <br />(E) Signed certification of reimbursement from the Plan Administrator (or authorized <br />Designee) <br />3. Executed Legal Documents: <br />(A) Certified Resolution <br />(B) Adoption Agreement to the PARS Public Agencies Post-Retirement Health Care <br />Plan <br />(C) Trustee Investment Forms <br />4. Other information requested by PARS and Actuarial Provider <br />Page 7 <br />