Fill and Sign the Agreement Staffing PDF Form

Agreement Between Hospital and Nurse Staffing Agency Agreement made on the _________________________________ (date), between __________________________________________________ (Name of Nurse Staffing Agency), a corporation organized and existing under the laws of the state of __________________________, with its principal office located at _________________ ________________________________________________________________________ ___________________________________ (street address, city, county, state, zip code) , referred to herein as NSA, and _______________________________________________ (Name of Hospital), a corporation organized and existing under the laws of the state of ______________________________, with its principal office located at _____________ ________________________________________________________________________ __________________________ (street address, city, county, state, zip code) , referred to herein as Hospital. Whereas, Hospital wishes to contract with NSA for the services of NSA in providing registered nurses (RN) , licensed practical nurses (LPN) and nursing assistants (NA) to Hospital ; and Whereas, NSA is ready, willing, and able to provide such services as may be required by Hospital. Now, therefore, for and in consideration of the mutual covenants contained in this agreement, and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the parties agree as follows: 1. Services A. NSA understands and agrees that services to be provided Hospital under and pursuant to this Agreement shall be so provided on a day-to-day, as-needed, basis and that Hospital in its sole discretion shall determine its need, if any, for services or the continuation of services as may be provided by NSA under and pursuant to this Agreement. B. NSA agrees to provide services upon the written request of Hospital and further agrees that the cost of such services shall not exceed the limitation of the cost set forth by Hospital’s request. C. When requesting services, Hospital shall specify the nursing classifications required ( e.g., RN, LPN and/or NA ); the applicable hourly or daily price for each specified nursing classification; the maximum allowable cost for each nursing classification; and the duration of services applicable to the request, including beginning dates and, when applicable, ending dates. D. Hospital shall have sole discretion to establish the minimum qualifications necessary for the performance of any service to be rendered under and pursuant to this Agreement. Further, if at any time and at its sole discretion, Hospital determines that the services performed under and pursuant to this Agreement by any of the persons provided by NSA are not satisfactory, Hospital will so notify NSA in writing and NSA shall immediately withdraw such individual and, at Hospital’s option, furnish an individual who meets the qualifications required. 2. Compensation For services provided under and pursuant to this Agreement and the written requests of Hospital , NSA shall be compensated as provided below: A. For labor expended by NSA in providing services under and pursuant to this Agreement, NSA shall be paid an amount equal to the applicable hourly or daily rate multiplied by the total number of hours or days actually worked by persons provided by NSA . The hourly or daily rate shall not exceed those rates set forth by Exhibit A attached hereto that are applicable to the labor classifications set forth by Hospital’s written requests. B. Actual expenses of persons provided by NSA incurred in the providing of services and directly related to such services, shall be reimbursed by Hospital to NSA at actual cost when supported by appropriate receipts. 3. Payment Payment for services provided Hospital under and pursuant to this Agreement shall be net _______ (number) days from the date of receipt by Hospital of NSA's invoice. NSA’s invoice shall set forth, as a minimum, details of labor expended and expenses actually incurred as provided below: A. NSA's invoice shall set forth the date or dates that persons provided by NSA actually worked in providing services under and pursuant to this Agreement. Beginning and ending dates shall be shown whenever services are provided uninterrupted over a period of time and individual dates shall be shown whenever services have been provided on a day-to-day basis. NSA's invoice shall clearly show the nursing classification, names of NSA -provided workers, applicable labor rates, and the total dollars claimed for the period. Whenever NSA provides services for an extended period of time, NSA shall submit its invoices for labor expended no less often than once each calendar month. B. The expenses incurred by NSA- provided workers directly related to the providing of services under and pursuant to this Agreement shall be reimbursed by Hospital to NSA. Such expenses shall be supported by appropriate receipts and such other supporting details as may be required by Hospital . Payment shall be net _____ ( number) days from the date of receipt of invoice. 4. NSA-Provided Workers NSA- provided workers who perform services for Hospital under and pursuant to this Agreement shall be bound by the provisions of this Agreement and NSA shall, at the request of Hospital , furnish to Hospital satisfactory evidence to that effect. 5. NSA Representation NSA represents and warrants that NSA and its NSA -supplied workers have the right to perform the services required under and pursuant to this Agreement without violation of obligations to others, and that NSA and its NSA -supplied workers have the right to disclose to Hospital all information transmitted to Hospital in the performance of services under and pursuant to this Agreement. 6. Duration and Termination This agreement shall become effective as of the date stated above and shall continue for a period of _________________________________________ (period of agreement) . In addition, this Agreement may be terminated pursuant to the following: A. By either party, with or without cause at any time, upon ______ ( number) days' prior written notice; or B. By Hospital , at any time, upon ______ ( number) days' prior written notice, if NSA assigns this Agreement, or any right or obligation under this Agreement, without Hospital’s prior written consent; or if there is a change in the control or management of NSA that is unacceptable to Hospital ; or if NSA ceases to function as a going concern, or to conduct its operations in the normal course of business. 7. Independent Contractor The status of NSA is that of an independent contractor and not of an agent or employee of Hospital and, as such, NSA shall not have the right or power to enter into any contracts, agreements, or any other commitments on behalf of Hospital. 8. Health Insurance Portability and Accountability Act (HIPPA) NSA agrees to execute a HIPPA business associates agreement should it now, or hereafter, be classified as a business associate as defined by HIPPA. 9. Insurance NSA shall maintain in full force and effect, and upon the request of Hospital, shall furnish evidence satisfactory to Hospital that NSA maintains the following insurance coverages: A. Comprehensive general liability insurance in the minimum amount of $_______________ combined single limit that will cover any and all losses to Hospital property, property of third parties, or personal injuries caused by the acts or omissions of NSA. B. NSA will carry workers' compensation and employer's liability insurance in accordance with applicable law. 10. Agreement Not to Hire NSA Nurses or Nurse’s Assistants Hospital acknowledges that the nurses and nurse’s assistants to be supplied by NSA have been or will be recruited, oriented, and trained at great expense by NSA, and NSA has a compelling interest in maintaining its contractual relationship and expectancy of future contractual relationships with said nurses and nurse’s assistants it supplies to Hospital. In addition, if the nurses and/or nurse’s assistants supplied by NSA were to terminate their relationships with NSA and render services to the hospital as employees of the Hospital , the Hospital would be unfairly benefited, without adequate compensation to NSA. Accordingly, Hospital covenants that it shall not, during the term of this agreement and any renewals of it, and for a period of (e.g., one year) _____________________ after such term and renewals, directly or indirectly, impair or initiate any attempt to impair the relationship or expectancy of a continuing relationship which exists or will exist between NSA and the nurses and/or nurse’s assistants it supplies to Hospital. Hospital further covenants that during such term it shall not make offers or contracts of employment with said nurses and nurse’s assistants for a period of (e.g., one year) ____________________ after the initial term and any renewal of this Agreement. 11. No Waiver The failure of either party to this Agreement to insist upon the performance of any of the terms and conditions of this Agreement, or the waiver of any breach of any of the terms and conditions of this Agreement, shall not be construed as subsequently waiving any such terms and conditions, but the same shall continue and remain in full force and effect as if no such forbearance or waiver had occurred. 12. Governing Law This Agreement shall be governed by, construed, and enforced in accordance with the laws of the State of _____________________. 13. Notices Any notice provided for or concerning this Agreement shall be in writing and shall be deemed sufficiently given when sent by certified or registered mail if sent to the respective address of each party as set forth at the beginning of this Agreement. 14. Mandatory Arbitration Any dispute under this Agreement shall be required to be resolved by binding arbitration of the parties hereto. If the parties cannot agree on an arbitrator, each party shall select one arbitrator and both arbitrators shall then select a third. The third arbitrator so selected shall arbitrate said dispute. The arbitration shall be governed by the rules of the American Arbitration Association then in force and effect. 15. Entire Agreement This Agreement shall constitute the entire agreement between the parties and any prior understanding or representation of any kind preceding the date of this Agreement shall not be binding upon either party except to the extent incorporated in this Agreement. 16. Modification of Agreement Any modification of this Agreement or additional obligation assumed by either party in connection with this Agreement shall be binding only if placed in writing and signed by each party or an authorized representative of each party. 17. Assignment of Rights The rights of each party under this Agreement are personal to that party and may not be assigned or transferred to any other person, firm, corporation, or other entity without the prior, express, and written consent of the other party. 18. Counterparts This Agreement may be executed in any number of counterparts, each of which shall be deemed to be an original, but all of which together shall constitute but one and the same instrument. WITNESS our signatures as of the day and date first above stated. ___________________________________ ____________________________________ (Name of Hospital) (Name of NSA) By: ________________________________ By: ________________________________ (P rinted or typed name) (P rinted or typed name) ___________________________________ ____________________________________ ___________________________________ ____________________________________ (Name & Office in Corporation) (Name & Office in Corporation)