PATIENT TRANSFER AGREEMENT BETWEEN AND

Size: px
Start display at page:

Download "PATIENT TRANSFER AGREEMENT BETWEEN AND"

Transcription

1 PATIENT TRANSFER AGREEMENT BETWEEN AND THIS PATIENT TRANSFER AGREEMENT ( Agreement ) dated ( Effective Date ) is entered into by and between ( ) and ( ). WITNESSETH WHEREAS, and share a mutual desire to ensure the continuity of care and treatment appropriate to the needs of each patient in their respective institutions; and WHEREAS, the purpose of this Agreement is to provide for the orderly transfer of acutely ill patients from the Transferring Facility to the Receiving Facility when the Receiving Facility provides services more appropriate for the patient level of medical need based on the Receiving Facility s more extensive medical resources, as well as the return or transfer of patients whose condition no longer requires an acute level of medical care to the Transferring Facility; NOW, THEREFORE, in consideration of the foregoing, the undersigned parties agree as follows: 1. TERM. The term of this Agreement shall be for a period of three (3) years from the Effective Date set forth above. This Agreement shall automatically renew for successive one (1) year terms. 2. TERMINATION. This Agreement may be terminated by either party at any time and for any reason upon at least sixty (60) days prior written notice and by ensuring the continuity of care to patients who already are involved in the transfer process. This Agreement shall automatically terminate upon the occurrence of any of the following: a. either institution has its license revoked or suspended; b. either institution loses its accreditation; c. either institution is destroyed to such an extent that the patient care provided by such institution cannot be carried out adequately; d. either institution no longer is able to provide the services for which this Agreement is sought; e. either institution is excluded from federal health care programs; f. either institution is in default under any of the terms of this Agreement. 3. TRANSFERRING VS. RECEIVING FACILITY. For purposes of this Agreement, the entity transferring the patients shall be called the Transferring Facility; the entity receiving the 1

2 patient shall be called the Receiving Facility. The definition of Transferring Facility includes the main hospital campus and all of its off-campus departments. 4. DUTIES OF THE TRANSFERRING FACILITY. The Transferring Facility shall: a. Ensure that the Receiving Facility is appropriately qualified, licensed and equipped, by way of bed capacity and resources, to accept, care for and meet the patient's medical needs. b. Ensure that all transfers are consistent with promotion of the health and safety of the patient as determined by the patient s physicians and health care professionals. The Transferring Facility shall obtain the consent of the patient or of a legally authorized individual prior to initiating transfer, except that in emergency situations efforts to obtain consent need to be documented by the physician responsible for the patient. c. Comply fully with all applicable laws, regulations and accreditation standards, including the requirements of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO); 10A NCAC 13B.3302; 10A NCAC 13B.4101; 10A NCAC 13B d. Prior to the transfer, coordinate the transfer with the Receiving Party to ensure a smooth transfer of the patient and his/her records. e. At the time of transfer, provide the Receiving Party with all pertinent medical information necessary to maintain a continuum of care. Typically, this will include the patient s name, address, a copy of the patient's history, physical examinations, name of the treating physician, physician progress notes, laboratory reports, x-ray reports, discharge summary and transfer form, among others. The Transferring Facility is responsible for obtaining all necessary medical releases for the release of pertinent medical information. f. Be responsible for all patient charges incurred until the transfer is completed, including transportation costs. g. When transferring patients with a known infectious condition, notify the Receiving Facility and take all reasonably necessary and medically appropriate precautions to prevent the spread of disease. h. Ensure that the patient is sufficiently stabilized for safe transfer. This means that no material deterioration of the patient's condition is likely, within reasonable medical probability, to result from or occur during the transfer of the patient. i. The Transferring Facility shall not transfer an unstabilized patient unless: 2

3 1. The patient or the patient's legally authorized agent, after being informed of the Transferring Facility s obligation to provide treatment and of the risks of transfer, in writing, requests a transfer to the Receiving Hospital; or 2. A physician or other qualified medical personnel at the Transferring Facility has signed a certification that, based upon the reasonable risks and benefits to the patient, and based upon the information available at the time of transfer, the medical benefits reasonably expected from treatment at the Receiving Hospital outweigh the increased risks to the patient. j. Provide the Receiving Facility with reasonable prior notice of the patient transfer. k. Use qualified personnel and transportation equipment including the use of necessary and medically appropriate life support measures to ensure the timely and safe transfer of patients. l. Arrange for the provision of security and accountability of patient s personal effects on transfer. m. If medically appropriate, accept patient back at the Transferring Facility for further care and treatment. n. Transfers shall be based upon the recommendation of the transferring physician who has assessed the patient and determined that the transfer is medically appropriate and the acceptance of the transfer by the receiving physician who concurs that transfer to a higher level of care is required, who concurs transfer is medically appropriate, and who reasonably believes that appropriate facilities and staff are not available at the Transferring Facility. o. To arrange for the transfer of the patient to the Receiving Facility, and to accept and arrange for the transfer of the patient back to the Transferring Facility, when the patient no longer requires the specialized capabilities of Receiving Facility. 5. DUTIES OF RECEIVING FACILITY. The Receiving Facility shall: a. Comply fully with all requirements of EMTALA. b. Comply with all applicable laws, regulations, and accreditation standards, including the requirements of the Joint. Commission on Accreditation of Healthcare Organizations (JCAHO). 6. INSURANCE. Each party shall maintain general and professional liability insurance with limits of at least $1,000,000 per occurrence and $3,000,000 in the aggregate. Each party shall make available to the other certificates of insurance upon request. 3

4 7. HOLD HARMLESS. To the extent permitted under North Carolina law, each party on its behalf, and on behalf of its employees and agents agrees to indemnify and hold harmless other party from any and all claims, demands, damages or any other financial demands (including without limitation attorneys fees and expenses) due to any actions or omissions of the other party, its employees or its agents pursuant to this Agreement. 8. INDEPENDENT CONTRACTORS. The parties are independent contractors who shall have no liability or obligation for the acts or omissions of the other. 9. NONEXCLUSIVE. Nothing in this Agreement shall be construed as limiting the rights of either party to affiliate or contract with any other hospital or health care provider while this Agreement is in effect. 10. PATIENT REFERRALS. This Agreement does not require either Transferring or Receiving Facility to refer patients or enter into any other arrangement for the provision of any item or service offered for which Medicare or Medicaid payments may be made. 11. NON-DISCRIMINATION REGARDING PATIENTS. Neither party shall differentiate or discriminate in the treatment of any patient because of the patient s race, color, national origin, ancestry, religion, health status, sex, marital status, age, the source or amount of payment available, or the ability of the patients to pay for medical services. 12. BILLING. The parties shall coordinate as necessary to insure that billing of third party or government payors pursuant to this Agreement is consistent with all applicable legal requirements. 13. ASSIGNMENT. This Agreement may not be assigned by either party without the prior written consent of the other party. 14. ENTIRE AGREEMENT. This Agreement contains the entire understanding between the undersigned parties and supersedes any and all prior agreements or understandings, whether oral or written, relating to the subject matter of this Agreement. This Agreement may not be amended, changed or modified except by written agreement executed by both parties hereto. 15. GOVERNING LAW. This Agreement shall be deemed to have been made under and shall be construed and interpreted in accordance with the laws of the State of North Carolina. 16. CHANGE IN LAW. It is the intention of the parties to comply with all Medicare/Medicaid laws and regulations and all other applicable laws and regulations, including, but not limited to, the Internal Revenue Code of 1986, as amended, the Medicare and Medicaid Anti-Kickback statute, and any regulations promulgated thereunder. The Parties acknowledge that legislation, regulations, an administrative ruling or other legally binding opinion may be adopted, amended, promulgated or issued which effectively renders this Agreement unlawful, could affect the taxexempt status of either party or any affiliates thereof, could impose liability or exclusion from participation in the Medicare or Medicaid program or otherwise have a negative impact on either party. In such event, either party may by written notice propose the termination, restructuring or 4

5 renegotiation of this Agreement in order to effect compliance. If such notice is given and the parties are unable within thirty (30) days thereafter to reach an agreement with respect to restructuring of the Agreement, then this Agreement shall automatically terminate. 17. THIRD PARTY BENEFICIARY. The parties do not intend to confer any rights, privileges or benefits upon any other individual(s) or entity(ies), not signatories to this Agreement, arising out of this Agreement. The parties agree that nothing in this Agreement shall be construed or interpreted to confer any such rights, privileges or benefits upon any individual or entity not a signatory to this Agreement. 18. FORCE MAJEURE. The parties understand and acknowledge that neither shall be liable for any loss, damage, detention, delay or failure to perform in whole or in part resulting from causes beyond their control including, but not limited to, act of God, fire, hurricanes, strikes, insurrections, riots, embargoes, shortages of motor vehicles, delays in transportation, and inability to obtain supplies of raw materials or requirements or regulations of the United States government or any other civil or military authority. 19. COUNTERPARTS. This Agreement may be executed simultaneously in two or more counterparts, each of which shall be deemed an original, but all of which together shall constitute one and the same instrument. 20. NOTICE. Any notice required or permitted to be given hereunder shall be in writing and shall be deemed to have been given when delivered personally or three (3) days after being mailed by certified mail, return receipt requested, postage prepaid to the following addresses, or at such other address as either party may designate in a manner in compliance with this Section: 21. ACCESS TO RECORDS. The parties agree that, until the expiration of four (4) years after the furnishing of services pursuant to this Agreement, the parties shall make available, upon written request, to the Secretary of the Department of Health and Human Services or the Comptroller General of the United States, or any of their duly authorized representatives, this Agreement and any books, documents and records that are necessary to certify the nature and extent of the cost of services provided pursuant to this Agreement. 22. FREE CHOICE AND MEDICAL JUDGMENT. This Agreement is not intended to influence the free choice of the patient in his or her ability to select facilities or services, nor is it intended to influence the independent judgment of the medical staff of either party. 23. HEADINGS. The headings and numbers of sections and paragraphs of this Agreement are for reference purposes only and shall not affect, in any way, the meaning or interpretation of this Agreement. Any gender-specific word or terms shall include both the masculine and the feminine gender unless otherwise indicated by the context. 5

6 24. DEFICIT REDUCTION ACT. To the extent it is required by 42 U.S.C. 1396a(a)(68), as it relates to the provision of services under this Agreement, each party adopts and acknowledges having received the other party's written policies regarding compliance with the federal False Claims Act, 31 U.S.C , administrative remedies for false claims and statements, 31 U.S.C. Chapter 38, state laws pertaining to civil or criminal penalties for false claims and statements, and whistleblower protections under such federal and state false claims laws, as well as detailed information regarding the other party's policies and procedures for detecting and preventing fraud, waste, and abuse. To the extent there is a conflict between any of the policies of either party or between either party's policies and any applicable law, the more restrictive provision in the relevant policy shall apply to allow compliance of both parties with the requirements as set forth under 42 U.S.C. Section 1396a(a)(68). IN WITNESS WHEREOF, the undersigned parties have caused this Agreement to be executed by their duly authorized officers as of the Effective Date set forth above. By: By: Name: Name: Title: Title: 6

BILLING SERVICES AGREEMENT WITNESSETH

BILLING SERVICES AGREEMENT WITNESSETH BILLING SERVICES AGREEMENT THIS BILLING SERVICES AGREEMENT is made this day of, between Medical Practice Management Services ( MPMS ) and ( Client ). WITNESSETH WHEREAS, MPMS provides billing services

More information

Agreement for Professional Emergency Services. professional emergency and related services provided at (hospital name) Hospital be

Agreement for Professional Emergency Services. professional emergency and related services provided at (hospital name) Hospital be Agreement for Professional Emergency Services This Agreement, made and effective on (effective date) by and between (name of hospital) Hospital, Inc., located at (address of hospital), (city, state and

More information

DRAFT ONLY SUBJECT TO CHANGE

DRAFT ONLY SUBJECT TO CHANGE DRAFT ONLY SUBJECT TO CHANGE AGREEMENT BETWEEN XXX LIBRARY AND CALIFA FOR THE PROVISION, INSTALLATION AND MAINTENANCE OF ADVANCED NETWORK (DATA) SERVICES This Agreement, hereinafter referred to as Agreement,

More information

PATIENT TRANSFER AGREEMENT

PATIENT TRANSFER AGREEMENT Appendix 2 SAMPLE PATIENT TRANSFER AGREEMENT THIS AGREEMENT is made effective as of by and between ( Children s Hospital) a nonprofit corporation, and ( Hospital ), a corporation. WHEREAS, operates a tertiary

More information

AFLAC LEVEL 2 DENTAL INSURANCE POLICY NETWORK PARTICIPATION AGREEMENT

AFLAC LEVEL 2 DENTAL INSURANCE POLICY NETWORK PARTICIPATION AGREEMENT 1. PURPOSE This agreement is between Health Care Networks of America, LLC ( HNA ), a Nevada corporation and the Dentist, Professional Corporation, or Group Practice ( Provider ). Provider agrees to participate

More information

LENDER PARTICIPATION AGREEMENT. By and Between. RAYMOND JAMES & ASSOCIATES, INC., as Program Administrator. and., as Participating Lender

LENDER PARTICIPATION AGREEMENT. By and Between. RAYMOND JAMES & ASSOCIATES, INC., as Program Administrator. and., as Participating Lender LENDER PARTICIPATION AGREEMENT By and Between RAYMOND JAMES & ASSOCIATES, INC., as Program Administrator and, as Participating Lender Made and entered into as of, 20 Table of Contents Page ARTICLE I DEFINITIONS

More information

SCHOOL AFFILIATION AGREEMENT

SCHOOL AFFILIATION AGREEMENT SCHOOL AFFILIATION AGREEMENT This SCHOOL AFFILIATION AGREEMENT (the Agreement ) is made and entered into as of the day of, 2015 (the Effective Date ), by and between Aurora Health Care, Inc. ( Aurora )

More information

Business Associate Agreement

Business Associate Agreement Business Associate Agreement This Agreement is entered into as of ("Effective Date"), between ( Covered Entity ), and ( Business Associate ). RECITALS WHEREAS, Business Associate provides services on behalf

More information

STUDENT TRAINING AGREEMENT

STUDENT TRAINING AGREEMENT STUDENT TRAINING AGREEMENT BETWEEN [1] (School) AND THE NEW YORK AND PRESBYTERIAN HOSPITAL (Hospital) THIS AGREEMENT made and entered into this day of, 200 [2] by and between [3], a corporation organized

More information

INSURANCE AGENT AGREEMENT

INSURANCE AGENT AGREEMENT INSURANCE AGENT AGREEMENT THIS INSURANCE AGENT AGREEMENT is made, 200_ by and between Athens Area Health Plan Select, Inc. ( AAHPS or the Plan ), and ( Agent ). RECITALS: WHEREAS, AAHPS is licensed to

More information

MEMORANDUM OF UNDERSTANDING ORANGE COUNTY DISTRICT ATTORNEY S OFFICE & SCHOOL OF LAW TO FACILITATE THE OCDA FELOWSHIP PROGRAM

MEMORANDUM OF UNDERSTANDING ORANGE COUNTY DISTRICT ATTORNEY S OFFICE & SCHOOL OF LAW TO FACILITATE THE OCDA FELOWSHIP PROGRAM Page 1 of 6 MEMORANDUM OF UNDERSTANDING ORANGE COUNTY DISTRICT ATTORNEY S OFFICE & SCHOOL OF LAW TO FACILITATE THE OCDA FELOWSHIP PROGRAM THIS AGREEMENT is made and entered into [DATE] in the State of

More information

LTC ELITE, LLC MEMBERSHIP AGREEMENT

LTC ELITE, LLC MEMBERSHIP AGREEMENT LTC ELITE, LLC MEMBERSHIP AGREEMENT This Membership Agreement (this Agreement ) is made and entered into effective, (the Effective Date ), by and between LTC Elite, LLC, a Texas limited liability company

More information

THE UNIVERSITY OF UTAH INDEPENDENT CONTRACTOR SERVICES AGREEMENT INSTRUCTIONS

THE UNIVERSITY OF UTAH INDEPENDENT CONTRACTOR SERVICES AGREEMENT INSTRUCTIONS THE UNIVERSITY OF UTAH INDEPENDENT CONTRACTOR SERVICES AGREEMENT INSTRUCTIONS Contracting for Independent Contractor services with the University of Utah may require completion of the following: Employee/Independent

More information

City of Piedmont COUNCIL AGENDA REPORT

City of Piedmont COUNCIL AGENDA REPORT City of Piedmont COUNCIL AGENDA REPORT DATE: September 6, 2011 FROM: Edward W. Tubbs, Fire Chief SUBJECT: Emergency Medical Services Billing Contract RECOMMENDATION Authorize the Fire Chief to enter into

More information

COMPREHENSIVE REMOTE ACCESS AGREEMENT FOR PRIVATE MEDICAL PRACTICES OR NURSING HOMES

COMPREHENSIVE REMOTE ACCESS AGREEMENT FOR PRIVATE MEDICAL PRACTICES OR NURSING HOMES COMPREHENSIVE REMOTE ACCESS AGREEMENT FOR PRIVATE MEDICAL PRACTICES OR NURSING HOMES THIS COMPREHENSIVE REMOTE ACCESS AGREEMENT ("Agreement") between MAIN LINE HEALTH, INC. ("MLH") in its own capacity

More information

SERVICES AGREEMENT. 2. Term. This Agreement will commence and expire. Medical Center Representative: Name and Title

SERVICES AGREEMENT. 2. Term. This Agreement will commence and expire. Medical Center Representative: Name and Title This Services Agreement ( Agreement ) dated is made by and between [INSERT CONTRACTOR S NAME AND ADDRESS] (hereinafter called "Contractor"), and UMass Memorial Medical Center, Inc., Worcester, MA (hereinafter

More information

To Whom It May Concern:

To Whom It May Concern: To Whom It May Concern: The Ohio Treasurer of State ( Treasurer ) may be eligible for an initial allocation of 100,000 student loan accounts to become a Not-For-Profit Direct Loan Servicer, as permitted

More information

Infinedi HIPAA Business Associate Agreement RECITALS SAMPLE

Infinedi HIPAA Business Associate Agreement RECITALS SAMPLE Infinedi HIPAA Business Associate Agreement This Business Associate Agreement ( Agreement ) is entered into this day of, 20 between ( Company ) and Infinedi, LLC, a Limited Liability Corporation, ( Contractor

More information

AFFILIATION AGREEMENT PACKET FOR DOCTOR OF NURSING PRACTICE PRACTICUM EXPERIENCE ADMINISTRATION AND ADVANCED PRACTICE NURSING STUDENTS.

AFFILIATION AGREEMENT PACKET FOR DOCTOR OF NURSING PRACTICE PRACTICUM EXPERIENCE ADMINISTRATION AND ADVANCED PRACTICE NURSING STUDENTS. AFFILIATION AGREEMENT PACKET FOR DOCTOR OF NURSING PRACTICE PRACTICUM EXPERIENCE ADMINISTRATION AND ADVANCED PRACTICE NURSING STUDENTS And MASTER OF SCIENCE IN NURSING- NURSE EDUCATOR STUDENTS The Ida

More information

STUDENT LOAN DEFAULT MANAGEMENT SERVICES AGREEMENT Between. and HARRISBURG AREA COMMUNITY COLLEGE

STUDENT LOAN DEFAULT MANAGEMENT SERVICES AGREEMENT Between. and HARRISBURG AREA COMMUNITY COLLEGE STUDENT LOAN DEFAULT MANAGEMENT SERVICES AGREEMENT Between and HARRISBURG AREA COMMUNITY COLLEGE This Agreement is made between Harrisburg Area Community College (HACC), whose primary address is One HACC

More information

Children's Medical Center Dallas exp. Apr 2015

Children's Medical Center Dallas exp. Apr 2015 Children's Medical Center Dallas exp. Apr 2015 CLINICAL AFFILIATION AGREEMENT BETWEEN CHILDREN'S MEDICAL CENTER OF DALLAS AND EMERGENCY MEDICAL TRAINING SERVICES This Clinical Affiliation Agreement is

More information

EDUCATIONAL AFFILIATION AGREEMENT (CAMPUS) and (FACILITY)

EDUCATIONAL AFFILIATION AGREEMENT (CAMPUS) and (FACILITY) EDUCATIONAL AFFILIATION AGREEMENT (CAMPUS) and (FACILITY) This Agreement made and effective this day of, 20 by and between (the Facility ), and the UNIVERSITY OF MAINE SYSTEM, acting by and through the

More information

MEDICAL TRANSPORTATION SERVICES AGREEMENT BETWEEN (Proposers Name) AND THE COUNTY OF SANTA CLARA RECITALS

MEDICAL TRANSPORTATION SERVICES AGREEMENT BETWEEN (Proposers Name) AND THE COUNTY OF SANTA CLARA RECITALS MEDICAL TRANSPORTATION SERVICES AGREEMENT BETWEEN (Proposers Name) AND THE COUNTY OF SANTA CLARA THIS AGREEMENT, effective the first day of, (XXXX) is entered into by and between the County of Santa Clara,

More information

CITY OF SHERWOOD Independent Contractor Agreement (for Personal Services or for Public Works under $25,000)

CITY OF SHERWOOD Independent Contractor Agreement (for Personal Services or for Public Works under $25,000) CITY OF SHERWOOD Independent Contractor Agreement (for Personal Services or for Public Works under $25,000) Dated: Parties: City of Sherwood ( CITY ) 20 NW Washington Street Sherwood, Oregon 97140 And

More information

BUSINESS ASSOCIATE AGREEMENT

BUSINESS ASSOCIATE AGREEMENT BUSINESS ASSOCIATE AGREEMENT Please complete the following and return signed via Fax: 919-785-1205 via Mail: Aesthetic & Reconstructive Plastic Surgery, PLLC 2304 Wesvill Court Suite 360 Raleigh, NC 27607

More information

NORTH CAROLINA STATE UNIVERSITY MASSAGE THERAPIST AGREEMENT

NORTH CAROLINA STATE UNIVERSITY MASSAGE THERAPIST AGREEMENT STATE OF NORTH CAROLINA WAKE COUNTY Rev. 3/14 NORTH CAROLINA STATE UNIVERSITY MASSAGE THERAPIST AGREEMENT THIS AGREEMENT ( Agreement ) is made by and between ( Contractor ), and North Carolina State University,

More information

Anesthesia Providers, Inc. CRNA GENERAL INFORMATION FORM. Name First Name M.I. Last Name. Address Street Address Apt. # City State Zip Code

Anesthesia Providers, Inc. CRNA GENERAL INFORMATION FORM. Name First Name M.I. Last Name. Address Street Address Apt. # City State Zip Code Anesthesia Providers, Inc. CRNA GENERAL INFORMATION FORM *Please Print Name First Name M.I. Last Name Address Street Address Apt. # City State Zip Code Date of Birth / / Mo. Date Year Home Telephone -

More information

CARVER COUNTY INDEPENDENT CONTRACTOR/PROFESSIONAL SERVICE AGREEMENT

CARVER COUNTY INDEPENDENT CONTRACTOR/PROFESSIONAL SERVICE AGREEMENT CARVER COUNTY INDEPENDENT CONTRACTOR/PROFESSIONAL SERVICE AGREEMENT This Agreement is entered into by and between the County of Carver, 600 East 4 th Street, Chaska, Minnesota 55318, through (Division),

More information

BENTON COUNTY PERSONAL SERVICES CONTRACT

BENTON COUNTY PERSONAL SERVICES CONTRACT BENTON COUNTY PERSONAL SERVICES CONTRACT This is an agreement by and between BENTON COUNTY, OREGON, a political subdivision of the State of Oregon, hereinafter called COUNTY, and, hereinafter called CONTRACTOR.

More information

INDEPENDENT CONTRACTOR AGREEMENT FOR HEALTH CARE PROVIDERS

INDEPENDENT CONTRACTOR AGREEMENT FOR HEALTH CARE PROVIDERS INDEPENDENT CONTRACTOR AGREEMENT FOR HEALTH CARE PROVIDERS This Independent Contractor Agreement ( Agreement ) is made this day of, 20, between Purdue University, its employees, officers, trustees, affiliates,

More information

AGREEMENT FOR FINANCIAL AND ACCOUNTING CONSULTATION SERVICES

AGREEMENT FOR FINANCIAL AND ACCOUNTING CONSULTATION SERVICES AGREEMENT FOR FINANCIAL AND ACCOUNTING CONSULTATION SERVICES THIS AGREEMENT is made as of December 1, 2003, by and between the San Francisquito Creek Joint Powers Authority, a body corporate and politic

More information

EDUCATIONAL INSTITUTION AFFILIATION AGREEMENT

EDUCATIONAL INSTITUTION AFFILIATION AGREEMENT EDUCATIONAL INSTITUTION AFFILIATION AGREEMENT This Educational Institution Affiliation Agreement ("Agreement") is by and between ("Educational Institution") and Life Care Centers of America, Inc. ("LCCA"),

More information

NORTH CAROLINA STATE UNIVERSITY AGREEMENT

NORTH CAROLINA STATE UNIVERSITY AGREEMENT STATE OF NORTH CAROLINA Rev. 11/12 WAKE COUNTY NORTH CAROLINA STATE UNIVERSITY AGREEMENT THIS AGREEMENT ( Agreement ) made and entered into this day of 20, by and between ( Contractor ), and North Carolina

More information

LIBERTY UNIVERSITY, INC. CLINICAL PROGRAMS AFFILIATION AGREEMENT (GRADUATE PROGRAM - COUNSELING)

LIBERTY UNIVERSITY, INC. CLINICAL PROGRAMS AFFILIATION AGREEMENT (GRADUATE PROGRAM - COUNSELING) LIBERTY UNIVERSITY, INC. CLINICAL PROGRAMS AFFILIATION AGREEMENT (GRADUATE PROGRAM - COUNSELING) THIS AGREEMENT ( Agreement ) made this day of, 20 (the Effective Date ), by and between LIBERTY UNIVERSITY,

More information

Massachusetts Clean Energy Internship Program Participating Host Employer Application Form 2014 Spring Session

Massachusetts Clean Energy Internship Program Participating Host Employer Application Form 2014 Spring Session Massachusetts Clean Energy Internship Program Participating Host Employer Application Form 2014 Spring Session The Massachusetts Clean Energy Internship Program (the Program ) is a workforce development

More information

GOODS AND SERVICES AGREEMENT BETWEEN SOUTHERN CALIFORNIA PUBLIC POWER AUTHORITY AND COMPANY/CONTRACTOR NAME

GOODS AND SERVICES AGREEMENT BETWEEN SOUTHERN CALIFORNIA PUBLIC POWER AUTHORITY AND COMPANY/CONTRACTOR NAME GOODS AND SERVICES AGREEMENT BETWEEN SOUTHERN CALIFORNIA PUBLIC POWER AUTHORITY AND COMPANY/CONTRACTOR NAME This GOODS AND SERVICES AGREEMENT ("Agreement") is entered into and effective [DATE], by and

More information

NON EXCLUSIVE BROKER REFERRAL AGREEMENT

NON EXCLUSIVE BROKER REFERRAL AGREEMENT NON EXCLUSIVE BROKER REFERRAL AGREEMENT THIS NON-EXCLUSIVE BROKER REFERRAL AGREEMENT (this Broker Contract ) is made this day of, 2013 by and between [NAME] (herein after called the "IFPG FRANCHISE CONSULTANT/BROKER

More information

Attachment C. AGREEMENT between the County Department of. Social Services, (referred to in this Agreement as "the Social Services

Attachment C. AGREEMENT between the County Department of. Social Services, (referred to in this Agreement as the Social Services Attachment C AGREEMENT BETWEEN A SOCIAL SERVICES DISTRICT AND AN ASSISTED LIVING PROGRAM AGREEMENT between the County Department of Social Services, (referred to in this Agreement as "the Social Services

More information

AGREEMENT FOR INTERCONNECTION AND PARALLEL OPERATION OF DISTRIBUTED GENERATION

AGREEMENT FOR INTERCONNECTION AND PARALLEL OPERATION OF DISTRIBUTED GENERATION AGREEMENT FOR INTERCONNECTION AND PARALLEL OPERATION OF DISTRIBUTED GENERATION This Interconnection Agreement ( Agreement ) is made and entered into this day of,, by Sharyland Utilities, L.P. McAllen (

More information

ADDENDUM TO AGREEMENT BETWEEN CHIROPRACTIC CARE OF MINNESOTA, INC. AND PROVIDER

ADDENDUM TO AGREEMENT BETWEEN CHIROPRACTIC CARE OF MINNESOTA, INC. AND PROVIDER ADDENDUM TO AGREEMENT BETWEEN CHIROPRACTIC CARE OF MINNESOTA, INC. AND PROVIDER This HealthPartners Workers Compensation Addendum (the Addendum ), dated as of the date set forth on the signature page (the

More information

RECITALS. WHEREAS, VENDOR is a company and a provider of technology services for business, government and education;

RECITALS. WHEREAS, VENDOR is a company and a provider of technology services for business, government and education; ATTACHMENT 9 AGREEMENT FOR CONSULTING SERVICES BETWEEN AND THE CLEVELAND PUBLIC LIBRARY This Agreement is made and entered by and between with a principal place of business at and the BOARD OF TRUSTEES

More information

1476 South Major Street, SLC, Utah 84115 487-4966 Office/487-4986 Fax www.payserv1.com

1476 South Major Street, SLC, Utah 84115 487-4966 Office/487-4986 Fax www.payserv1.com A Benchmark for Excellence Payroll Services 1476 South Major Street, SLC, Utah 84115 487-4966 Office/487-4986 Fax www.payserv1.com New Company Direct Deposit Set-Up Form (Please complete and return this

More information

BUSINESS ASSOCIATE AGREEMENT

BUSINESS ASSOCIATE AGREEMENT BUSINESS ASSOCIATE AGREEMENT This Business Associate Agreement (the Agreement ), is made effective as of the sign up date on the login information page of the CarePICS.com website, by and between CarePICS,

More information

Insurance Market Solutions Group, LLC Sub-Producer Agreement

Insurance Market Solutions Group, LLC Sub-Producer Agreement Insurance Market Solutions Group, LLC Sub-Producer Agreement This Producer Agreement is made and entered into effective the day of, 20, by and between Insurance Market Solutions Group, LLC a Texas Company

More information

EXHIBIT 1 Standard Contract Addendum

EXHIBIT 1 Standard Contract Addendum EXHIBIT 1 Standard Contract Addendum This Standard Contract Addendum ( Addendum ) is between Texas Southern University ( University ) and the other party ( Contracting Party ) indicated in the signature

More information

University of Houston Victoria

University of Houston Victoria University of Houston Victoria Page 1 of 7 Affiliation Agreement This Agreement is entered into and is effective as of the day of, ("the Effective Date"), by and between the University of Houston-Victoria,

More information

AFFILIATE AGREEMENT. 1.2 Territory. Affiliate shall represent Association in the following geographic area: 60 mile

AFFILIATE AGREEMENT. 1.2 Territory. Affiliate shall represent Association in the following geographic area: 60 mile AFFILIATE AGREEMENT This Affiliate Agreement, effective the day of, 2002 is made between the Case Management Society of America, a District of Columbia non-profit corporation, with offices at 8201 Cantrell

More information

SAMPLE AGREEMENT FOR CONTRACTOR SERVICES

SAMPLE AGREEMENT FOR CONTRACTOR SERVICES SAMPLE AGREEMENT FOR CONTRACTOR SERVICES THIS AGREEMENT for construction services ("Agreement") is made as of the Agreement Date set forth below by and between the County of Yuba, a political subdivision

More information

AGENT AGREEMENT. I. Agent s Obligations

AGENT AGREEMENT. I. Agent s Obligations AGENT AGREEMENT This Agent Agreement ( Agreement ) is made on this day of, 2009, by and between Krascar International Travel Club, Inc (hereinafter referred to as Company ) located at 1162 St Georges Ave

More information

PAYROLL SERVICE AGREEMENT. On this day of, 2016, this PAYROLL SERVICE AGREEMENT. ( Agreement ) is entered into by and between ("EMPLOYER")

PAYROLL SERVICE AGREEMENT. On this day of, 2016, this PAYROLL SERVICE AGREEMENT. ( Agreement ) is entered into by and between (EMPLOYER) PAYROLL SERVICE AGREEMENT On this day of, 2016, this PAYROLL SERVICE AGREEMENT ( Agreement ) is entered into by and between ("EMPLOYER") and WE PAY Payroll Processing Company, 3 W. Olive Street, Suite

More information

CONSULTANT AGREEMENT WITNESSETH. Recitals:

CONSULTANT AGREEMENT WITNESSETH. Recitals: CONSULTANT AGREEMENT THIS AGREEMENT, made and entered into this day of, 2000, by and between ( CONSULTANT ) and the City of Santa Ana, a municipal corporation of the State of California ( CITY ). WITNESSETH

More information

WASTE SERVICES & DISPOSAL AGREEMENT. By: By: Name: Name: Title: Title:

WASTE SERVICES & DISPOSAL AGREEMENT. By: By: Name: Name: Title: Title: WASTE SERVICES & DISPOSAL AGREEMENT COMPANY: CUSTOMER: By: By: Name: Name: Date Date Title: Title: Effective Date of Agreement: Initial Term: Contract No. This Waste & Disposal Services Agreement, consisting

More information

This Agreement shall not be interpreted in favor of any Party by virtue of said Party not having prepared this Agreement.

This Agreement shall not be interpreted in favor of any Party by virtue of said Party not having prepared this Agreement. - 1 - INDEPENDENT CONTRACTOR AGREEMENT SAN JOAQUIN COUNTY CONTRACT ID# Contract Amount $ PARTIES: COUNTY: County of San Joaquin Purchasing & Support Services 44 N. San Joaquin Street Suite 540 Stockton,

More information

MASTER ROAD REPAIR AGREEMENT STATE OF TEXAS KNOW ALL MEN BY THESE PRESENTS: COUNTY OF HOOD

MASTER ROAD REPAIR AGREEMENT STATE OF TEXAS KNOW ALL MEN BY THESE PRESENTS: COUNTY OF HOOD SUP-20 - Date or PL-20 - Date GW-20 - Date MASTER ROAD REPAIR AGREEMENT STATE OF TEXAS KNOW ALL MEN BY THESE PRESENTS: COUNTY OF HOOD This Road Repair Agreement, ( Agreement ), is made and entered into

More information

PRODUCER AGREEMENT. Hereinafter ("Producer"), in consideration of the mutual covenants and agreements herein contained, agree as follows:

PRODUCER AGREEMENT. Hereinafter (Producer), in consideration of the mutual covenants and agreements herein contained, agree as follows: PRODUCER AGREEMENT Hereinafter First Choice Insurance Intermediaries, Inc "FCII", a Florida company, having an office at 814 A1A North, Suite 206, Ponte Vedra Beach, FL 32082 and " Producer" having an

More information

EmoeHost agrees to provide to Client the Services agreed upon between EmoeHost and Client as selected by Client at www.emoehostmaine.com.

EmoeHost agrees to provide to Client the Services agreed upon between EmoeHost and Client as selected by Client at www.emoehostmaine.com. EmoeHost Service Agreement 1. Site Services EmoeHost agrees to provide to Client the Services agreed upon between EmoeHost and Client as selected by Client at www.emoehostmaine.com. 2. Payment & Invoicing

More information

BENCHMARK MEDICAL LLC, BUSINESS ASSOCIATE AGREEMENT

BENCHMARK MEDICAL LLC, BUSINESS ASSOCIATE AGREEMENT BENCHMARK MEDICAL LLC, BUSINESS ASSOCIATE AGREEMENT This BUSINESS ASSOCIATE AGREEMENT ( Agreement ) dated as of the signature below, (the Effective Date ), is entered into by and between the signing organization

More information

AFFILIATION AGREEMENT *

AFFILIATION AGREEMENT * AFFILIATION AGREEMENT * This AGREEMENT entered into on this day of 20 BETWEEN Hereandafter referred to as THE AFFILIATE AND STOCKTON UNIVERSITY 101 Vera King Farris Drive Galloway, New Jersey 08205-9441

More information

Buyer s 7 net 3 Telecommunications Service Agreement

Buyer s 7 net 3 Telecommunications Service Agreement Buyer s 7 net 3 Telecommunications Service Agreement This Agreement is made and entered into this day of, 2012, between BARR TELL USA, INC.( BARR TELL ) a Corporation, existing under the Laws of New York,

More information

CLIENT SERVICE AGREEMENT

CLIENT SERVICE AGREEMENT This Agreement is entered into this day of, 20 ( Effective Date ) by and between COBRA-Care Advisors, Inc. ( CCA ) and ( Client ). CCA and Client are hereinafter individually referred to as party or collectively

More information

BROKERAGE AGREEMENT. WHEREAS Broker wishes to gain access to and offer Paragon s specialized insurance products and services to its clients; and

BROKERAGE AGREEMENT. WHEREAS Broker wishes to gain access to and offer Paragon s specialized insurance products and services to its clients; and BROKERAGE AGREEMENT This Agreement, effective 2014 is between Paragon Insurance Holdings, LLC ( Paragon ), 45 Nod Road, Avon, Connecticut 06001 with underwriting office at 850 Fulton Street, Farmingdale,

More information

HOMEOWNERS LIMITED REPRESENTATIVE SERVICE AGREEMENT With SERVICE FIRST INSURANCE GROUP LLC. Of CYPRESS PROPERTY & CASUALTY INSURANCE COMPANY

HOMEOWNERS LIMITED REPRESENTATIVE SERVICE AGREEMENT With SERVICE FIRST INSURANCE GROUP LLC. Of CYPRESS PROPERTY & CASUALTY INSURANCE COMPANY HOMEOWNERS LIMITED REPRESENTATIVE SERVICE AGREEMENT With SERVICE FIRST INSURANCE GROUP LLC. Of CYPRESS PROPERTY & CASUALTY INSURANCE COMPANY This Agreement is made and entered into effective as of October

More information

CLS Investments, LLC Instructions for the Solicitor Application and Agreement

CLS Investments, LLC Instructions for the Solicitor Application and Agreement CLS Investments, LLC Instructions for the Solicitor Application and Agreement Please complete all fields on page 1 of the Solicitor Application and Agreement. Some general guidelines are set forth below.

More information

MEDICAL EQUIPMENT AND SUPPLIES SERVICES AGREEMENT

MEDICAL EQUIPMENT AND SUPPLIES SERVICES AGREEMENT THIS MEDICAL EQUIPMENT SERVICES AGREEMENT (the Agreement ) is made and entered into this day of, (the Effective Date ) by and between Hospice Express, Inc. ( Provider ) and ( Hospice ). RECITALS A. WHEREAS,

More information

Limited Agency/Company Agreement

Limited Agency/Company Agreement Effective, this Agreement is entered into by and between Safepoint MGA, LLC and Safepoint Insurance Company Inc., hereinafter referred to as Company, and hereinafter referred to as Agent. It being the

More information

Consulting Master Services Agreement

Consulting Master Services Agreement Consulting Master Services Agreement THIS CONSULTING AGREEMENT (this Agreement ), made and entered into this 21st day of June, 2002, by and between PrimeContractor, a StateName EntityType, its successors

More information

Neustar Referral Partnership Agreement

Neustar Referral Partnership Agreement Neustar Referral Partnership Agreement This NEUSTAR REFERRAL AFFILIATE PARTNERSHIP AGREEMENT ( Agreement ) is made and entered into between Neustar, Inc. a Delaware Corporation, located at 46000 Center

More information

175 TownPark Drive, Suite 400, Kennesaw, GA 30144 APPROVED UNDERWRITER AGREEMENT

175 TownPark Drive, Suite 400, Kennesaw, GA 30144 APPROVED UNDERWRITER AGREEMENT 175 TownPark Drive, Suite 400, Kennesaw, GA 30144 APPROVED UNDERWRITER AGREEMENT THIS APPROVED UNDERWRITER AGREEMENT (the Agreement ) is made and entered into as of this day of, 20, by and between, (the

More information

AGREEMENT. Solicitor Without Per Diem Compensation

AGREEMENT. Solicitor Without Per Diem Compensation Solicitor Without Per Diem Compensation AGREEMENT Products underwritten by: American General Life Insurance Company Houston, Texas The United States Life Insurance Company in the City of New York New York,

More information

COMPUTER AND INFORMATION TECHNOLOGY MANAGED SERVICES AGREEMENT

COMPUTER AND INFORMATION TECHNOLOGY MANAGED SERVICES AGREEMENT COMPUTER AND INFORMATION TECHNOLOGY MANAGED SERVICES AGREEMENT This Computer and Information Technology Services Agreement is made as of the day of, between Crown Networking Consultants, Inc. (CNC Inc.),

More information

PAYROLL SERVICE AGREEMENT

PAYROLL SERVICE AGREEMENT PAYROLL SERVICE AGREEMENT THIS PAYROLL SERVICE AGREEMENT (the Agreement ) is entered into by and between, (the "Employer") and PayUSA, Inc., ("PayUSA"). WITNESSETH: WHEREAS, the Employer desires to utilize

More information

MEMORANDUM OF UNDERSTANDING BETWEEN RIVERSIDE COMMUNITY COLLEGE DISTRICT and CITY OF RIVERSIDE

MEMORANDUM OF UNDERSTANDING BETWEEN RIVERSIDE COMMUNITY COLLEGE DISTRICT and CITY OF RIVERSIDE MEMORANDUM OF UNDERSTANDING BETWEEN RIVERSIDE COMMUNITY COLLEGE DISTRICT and CITY OF RIVERSIDE THIS MEMORANDUM OF UNDERSTANDING ( MOU ) is made and entered into this day of, 2012 ( Effective Date ), by

More information

CITY OF LEAWOOD. Independent Contractor Agreement

CITY OF LEAWOOD. Independent Contractor Agreement #3 Small Indep Contractor Agreement with Ins Optional, for use with small agreements less than $15k [e.g., entertainment, 4 th of July projects, sports] CITY OF LEAWOOD Independent Contractor Agreement

More information

NURSE PRACTITIONER EMPLOYMENT CONTRACT TEMPLATE FOR PRIMARY CARE SETTING

NURSE PRACTITIONER EMPLOYMENT CONTRACT TEMPLATE FOR PRIMARY CARE SETTING Sample Contract for NPs in Primary Care Setting Note: Your contract should have a specific time period for the agreement and it is important to revisit your contract before the agreement expires. This

More information

BUSINESS ASSOCIATE AGREEMENT

BUSINESS ASSOCIATE AGREEMENT BUSINESS ASSOCIATE AGREEMENT THIS BUSINESS ASSOCIATE AGREEMENT ( Agreement ) by and between OUR LADY OF LOURDES HEALTH CARE SERVICES, INC., hereinafter referred to as Covered Entity, and hereinafter referred

More information

MEMBERSHIP AGREEMENT OF HEALTHCARE SERVICES PLATFORM CONSORTIUM RECITALS

MEMBERSHIP AGREEMENT OF HEALTHCARE SERVICES PLATFORM CONSORTIUM RECITALS MEMBERSHIP AGREEMENT OF HEALTHCARE SERVICES PLATFORM CONSORTIUM Hunton & Williams LLP draft dated 12/19/14 This Membership Agreement (this Agreement ) is entered into effective as of, 2014 by and between

More information

MEMORANDUM OF UNDERSTANDING Between COMPANY And MISSOURI STATE UNIVERSITY

MEMORANDUM OF UNDERSTANDING Between COMPANY And MISSOURI STATE UNIVERSITY MEMORANDUM OF UNDERSTANDING Between COMPANY And MISSOURI STATE UNIVERSITY THIS MEMORANDUM OF UNDERSTANDING (hereinafter referred to as MOU) is by and between COMPANY, LOCATION AND TYPE OF COMPANY (hereinafter

More information

INDEPENDENT CONTRACTOR AGREEMENT FOR SPECIAL SERVICES

INDEPENDENT CONTRACTOR AGREEMENT FOR SPECIAL SERVICES INDEPENDENT CONTRACTOR AGREEMENT FOR SPECIAL SERVICES This Independent Contractor Agreement for Services ( Agreement ) is made as of, 2012, between the Culver City Unified School District ("District")

More information

ASBESTOS/LEAD SURVEY AND CONSULTING AGREEMENT BY AND BETWEEN NEW YORK UNIVERSITY / NYU HOSPITALS CENTER - OWNER - AND - CONSULTANT - --------- PROJECT

ASBESTOS/LEAD SURVEY AND CONSULTING AGREEMENT BY AND BETWEEN NEW YORK UNIVERSITY / NYU HOSPITALS CENTER - OWNER - AND - CONSULTANT - --------- PROJECT APPENDIX A ASBESTOS/LEAD SURVEY AND CONSULTING AGREEMENT BY AND BETWEEN NEW YORK UNIVERSITY / NYU HOSPITALS CENTER - OWNER - AND - CONSULTANT - --------- PROJECT DATED AS OF ASBESTOS/LEAD SURVEY AND CONSULTING

More information

BROKER/AGENT INFORMATION PAGE RETS IDX

BROKER/AGENT INFORMATION PAGE RETS IDX FRESNO ASSOCIATION OF REALTORS IDX / RETS Compliance 6720 N West Ave. Fresno, CA 93711 (559) 490-6400 ~ rets@fresnorealtors.com BROKER/AGENT INFORMATION PAGE RETS IDX IN WITNESS WHEREOF, the parties hereto

More information

Camp Contract and Permission to Use University. Facilities

Camp Contract and Permission to Use University. Facilities Camp Contract and Permission to Use University Facilities This Contract is made and entered into this day of, 201, by and between Seton Hall University (hereinafter referred to as University ), a nonprofit

More information

Insurance Producer Agreement

Insurance Producer Agreement Insurance Producer Agreement THIS AGREEMENT ( Agreement ) is made and entered into on this day of. (the Effective Date ), by and between KPS Health Plans (hereinafter referred to as KPS ), a duly licensed

More information

NORTHEAST OHIO NETWORK FOR EDUCATIONAL TECHNOLOGY SERVICE PROVIDER CONTRACT VoIP Contract Number: 44552-IPTEL1519

NORTHEAST OHIO NETWORK FOR EDUCATIONAL TECHNOLOGY SERVICE PROVIDER CONTRACT VoIP Contract Number: 44552-IPTEL1519 NORTHEAST OHIO NETWORK FOR EDUCATIONAL TECHNOLOGY SERVICE PROVIDER CONTRACT VoIP Contract Number: 44552-IPTEL1519 This agreement for the provision of IP Telephony service ("Agreement") is entered between

More information

BUSINESS ASSOCIATE AGREEMENT FOR ATTORNEYS

BUSINESS ASSOCIATE AGREEMENT FOR ATTORNEYS BUSINESS ASSOCIATE AGREEMENT FOR ATTORNEYS This Business Associate Agreement (this Agreement ), is made as of the day of, 20 (the Effective Date ), by and between ( Business Associate ) and ( Covered Entity

More information

Agent Agreement WITNESSETH

Agent Agreement WITNESSETH PATRIOT NATIONAL UNDERWRITERS, INC. Agent Agreement THIS AGENT AGREEMENT (the Agreement ) is made and entered into by and between Patriot National Underwriters, Inc., a Texas corporation ( Patriot ), and

More information

COMMONWEALTH OF VIRGINIA STANDARD PERFORMANCE BOND

COMMONWEALTH OF VIRGINIA STANDARD PERFORMANCE BOND (Rev 03/02) Page 1 of 6 COMMONWEALTH OF VIRGINIA STANDARD PERFORMANCE BOND KNOW ALL MEN BY THESE PRESENTS: That, the Contractor ( Principal ) whose principal place of business is located at and ( Surety

More information

BUSINESS ASSOCIATE AGREEMENT Health Insurance Portability and Accountability Act (HIPAA)

BUSINESS ASSOCIATE AGREEMENT Health Insurance Portability and Accountability Act (HIPAA) BUSINESS ASSOCIATE AGREEMENT Health Insurance Portability and Accountability Act (HIPAA) This Business Associate Agreement (the Agreement ) is made and entered into as of [Date] (hereinafter Effective

More information

BUSINESS ASSOCIATE AGREEMENT

BUSINESS ASSOCIATE AGREEMENT BUSINESS ASSOCIATE AGREEMENT This Business Associate Agreement (the Agreement ) is entered into by and between Professional Office Services, Inc., with principal place of business at PO Box 450, Waterloo,

More information

NORTHEAST OHIO NETWORK FOR EDUCATIONAL TECHNOLOGY SERVICE PROVIDER CONTRACT INTERNET SERVICE Contract Number: 044552-1415

NORTHEAST OHIO NETWORK FOR EDUCATIONAL TECHNOLOGY SERVICE PROVIDER CONTRACT INTERNET SERVICE Contract Number: 044552-1415 NORTHEAST OHIO NETWORK FOR EDUCATIONAL TECHNOLOGY SERVICE PROVIDER CONTRACT INTERNET SERVICE Contract Number: 044552-1415 This agreement for the provision of Exchange Hosting service ("Agreement") is entered

More information

CHRISTUS PHYSICIAN GROUP STANDARD TERMS AND CONDITIONS APPLICABLE TO ALL EMPLOYMENT AGREEMENTS

CHRISTUS PHYSICIAN GROUP STANDARD TERMS AND CONDITIONS APPLICABLE TO ALL EMPLOYMENT AGREEMENTS CHRISTUS PHYSICIAN GROUP STANDARD TERMS AND CONDITIONS APPLICABLE TO ALL EMPLOYMENT AGREEMENTS The following Standard Terms and Conditions ( STC s ), as posted on the following site (the STC Site ): http://christusphysiciancareers.org

More information

NOW, THEREFORE, in consideration of the mutual promises and covenants herein contained, the Parties hereby agree as follows:

NOW, THEREFORE, in consideration of the mutual promises and covenants herein contained, the Parties hereby agree as follows: Tulane Template PSA and Medical Director (for TUMG physicians providing services to physician group/community practice) PROFESSIONAL AND MEDICAL DIRECTOR SERVICES AGREEMENT For the services of [insert

More information

Ana G. Méndez University System Tampa Bay Campus Department of Education CLINICAL EXPERIENCE AGREEMENT

Ana G. Méndez University System Tampa Bay Campus Department of Education CLINICAL EXPERIENCE AGREEMENT Ana G. Méndez University System Tampa Bay Campus Department of Education Accreditted by the Middle States Commission on Higher Education. Licensed by the Florida Commission for Independent Education: License

More information

Sewage Sludge Utilization Performance Bond

Sewage Sludge Utilization Performance Bond Sewage Sludge Utilization Performance Bond Total Sum of the Performance Bond (the Bond ) Bond. No. This Bond assures performance for Sewage Sludge Utilization Permit(s) ( Permit for Permits ) No(s). authorizing

More information

UPMC PRACTICE SOLUTIONS PARTICIPATION AGREEMENT

UPMC PRACTICE SOLUTIONS PARTICIPATION AGREEMENT UPMC PRACTICE SOLUTIONS PARTICIPATION AGREEMENT This UPMC Practice Solutions Participation Agreement sets forth the terms and conditions pursuant to which (the Practice ), and the physician(s) listed on

More information

CONSOLIDATED EDISON COMPANY OF NEW YORK, INC. TARGETED STEAM AIR CONDITIONING INCENTIVE PROGRAM CUSTOMER AGREEMENT

CONSOLIDATED EDISON COMPANY OF NEW YORK, INC. TARGETED STEAM AIR CONDITIONING INCENTIVE PROGRAM CUSTOMER AGREEMENT CONSOLIDATED EDISON COMPANY OF NEW YORK, INC. TARGETED STEAM AIR CONDITIONING INCENTIVE PROGRAM CUSTOMER AGREEMENT This Agreement ( Agreement ) is entered into as of the date set forth on the signature

More information

Real Estate Agent Website Linking Agreement

Real Estate Agent Website Linking Agreement Real Estate Agent Website Linking Agreement Please fill in this form and fax it to the Toll Brothers Marketing Department Fax # - (215) 938-8217 [Date] [Address] [Telephone] Fax: Attn: [Name and title]

More information

SAMPLE SERVICES CONTRACT

SAMPLE SERVICES CONTRACT SAMPLE SERVICES CONTRACT The parties to this contract are the SAN DIEGO COUNTY WATER AUTHORITY, a county water authority, (the Water Authority) and, [a / an], having its principal place of business at

More information

AGREEMENT FOR SERVICES BETWEEN [INSTITUTION] AND [CONTRACTOR] THIS AGREEMENT is made by and between [INSTITUTION] ( Institution ), and ( Contractor ).

AGREEMENT FOR SERVICES BETWEEN [INSTITUTION] AND [CONTRACTOR] THIS AGREEMENT is made by and between [INSTITUTION] ( Institution ), and ( Contractor ). AGREEMENT FOR SERVICES BETWEEN [INSTITUTION] AND [CONTRACTOR] THIS AGREEMENT is made by and between [INSTITUTION] ( Institution ), and ( Contractor ). WHEREAS, the Institution anticipates that the Services

More information

BUSINESS ASSOCIATE AGREEMENT

BUSINESS ASSOCIATE AGREEMENT BUSINESS ASSOCIATE AGREEMENT The parties to this ( Agreement ) are, a _New York_ corporation ( Business Associate ) and ( Client ) you, as a user of our on-line health record system (the "System"). BY

More information