Surgical Service Proposal

Surgical Service Proposal

This Surgical Service Proposal (the "Proposal") is made between Provider Name: and Client Name: on Proposal Date: .

WHEREAS

WHEREAS, Provider is duly licensed and qualified to deliver surgical services, supplies, professional personnel and related clinical oversight for the procedures described herein; and

WHEREAS, Client seeks to engage Provider to perform surgical services at the Site of Service identified below on the terms and conditions set forth in this Proposal.

WHEREAS, the parties desire to document the scope, fees, scheduling, insurance and operational obligations for the proposed services.

PARTIES AND CONTACTS

SCOPE OF WORK

Site of Service: Principal Surgeon:

Anticipated Case Count: Estimated Procedure Dates (range): to

Services included (check applicable): Pre-operative evaluation Anesthesia services Intra-operative surgical services Post-operative care

PAYMENT TERMS

Total Estimated Fee: Currency:

Deposit Amount (if required): Payment Due Within: days of invoice.

Late Payment Penalty: Interest shall accrue on any overdue amount at the lesser of the maximum legal rate or , plus any collection costs reasonably incurred.

All fees are exclusive of taxes and third-party payor adjustments. Client shall be responsible for any applicable taxes and for resolving payment denials by payors; Provider will cooperate in appeals and documentation as requested.

INSURANCE AND INDEMNITY

Provider represents that it maintains professional liability insurance and general liability insurance in amounts customary for the specialty and acceptable to Client. Insurance carrier: Policy Number:

Indemnification: Provider shall indemnify, defend and hold harmless Client and its affiliates, officers and employees from claims arising from Provider's negligence, willful misconduct or breach of this Proposal, subject to any applicable statutory limits and the parties' respective insurance coverages.

TERM AND TERMINATION

Term Start Date: Term End Date:

Either party may terminate this Proposal for convenience upon written notice to the other party delivered at least days prior to the effective termination date. Termination for cause may be immediate if the non‑breaching party provides written notice of material breach and the breach is not cured within ten (10) days of such notice, or immediately if cure is not reasonably possible.

Upon termination, Client shall promptly pay Provider for all services performed and documented costs incurred through the effective date of termination.

CONFIDENTIALITY

Each party shall hold in confidence all confidential information disclosed by the other party in connection with this Proposal, shall not use such confidential information except to perform its obligations hereunder, and shall not disclose such information to any third party except to the extent required by law or to its employees and professional advisors on a need-to-know basis who are bound by confidentiality obligations no less protective than those herein. Confidential information does not include information that is or becomes publicly available through no fault of the receiving party.

COMPLIANCE WITH LAWS

Provider shall perform services in accordance with applicable federal, state and local laws, professional licensing requirements and facility policies. Provider shall maintain required credentials for personnel assigned to perform services and shall provide evidence of such credentials and clearances upon Client request.

GOVERNING LAW; ENTIRE AGREEMENT

Governing Law: This Proposal shall be governed by and construed in accordance with the laws of , without regard to its conflict of law principles.

Entire Agreement: This Proposal, together with any attachments, exhibits and accepted scopes of work executed by the parties, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, proposals, negotiations and understandings, whether written or oral. No amendment shall be effective unless in writing and signed by authorized representatives of both parties.

MISCELLANEOUS

Assignment: Neither party may assign its rights or delegate its duties under this Proposal without the prior written consent of the other party, except that either party may assign to an affiliate or successor in interest.

Notices: All notices required under this Proposal shall be in writing and delivered to the parties at the contact information provided above or to such other address as a party may designate in writing.

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