HHS Provider Relief Fund - Estimated Expenses and Lost Revenue Tool

The rules, regulations and guidance related the creation of this form and are governed by federal regulations. Such federal regulations are subject to change, and therefore, may affect advice provided by us as part of this form. These effects may be material. You are responsible for understanding all Health and Human Services forgiveness requirements and restrictions applicable to your Provider Relief Funds.

You agree that you will not, and are not entitled to rely upon, any advice unless it is provided in writing. We cannot guarantee whether any amount of your Provider Relief Fund will be approved for forgiveness. You agree to hold us harmless from any and all claims arising from or related to the acceptance and approval of the forgiveness application due to Mueller Prost LC’s good faith completion of services described in this Agreement.

Indemnification

You agree to indemnify, defend, and hold harmless Mueller Prost, LC any of its partners, principals, shareholders, officers, directors, members, employees, agents or assigns with respect to any and all claims made by third parties arising from this engagement, regardless of the nature of the claim, and including the negligence of any party, excepting claims arising from the gross negligence or intentional acts of the Mueller Prost, LC.