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11 <br />N <br />SAMPLE <br />ORANGE COUNTY IN -HOME CARE <br />PROVIDER AGREEMENT <br />This is to certify -that Medical Personnel Pool Home Heal_thA_encY <br />(Name of Agency) <br />herein after known as the Provider agency, located at <br />3326 Chapel Hill Blvd., Building A, Suite 230 Durham, N.C. _27707 <br />(Address) <br />on this first day of July, 1991 agrees to participate as a provider in <br />the Orange County Elderly In -Home Care Program for the period July 1, <br />1991 through June 30, 1992. <br />1. The Provider agency agrees to provide necessary In -Home Care at <br />Levels I, II and III to approved recipients at a rate not to <br />exceed $ 9.50 per hour upon the request of the Orange County <br />Department on Aging's Care Management Program, hereinafter known <br />as the lead Administrative Agency. <br />2. The Provider agency agrees to meet all service provision <br />standards for In -Home Care Levels I, II and III, such as training <br />as required by the State of North Carolina and provide <br />documentation upon request. (Attachment A) <br />3. The provider agency agrees to provide the In -Home Care service <br />within ten working days from the beginning service date specified <br />in the Purchase of Service Authorization on each approved <br />recipient. (Attachment B) <br />4. The provider agency agrees to ensure that such records as <br />necessary are kept to fully disclose the extent of the service <br />provided to recipients for four years and available for <br />inspection. <br />5. The Provider agency agrees to submit a monthly bill for services <br />rendered payable within 30 days from date of receipt. <br />6. The Provider agency agrees to adhere to the Inter - agency Long Term <br />Care Management Procedures in the provision of the service. <br />(Attachment C) <br />7. The Provider agrees to indemnify and save harmless Orange County, <br />its agents and employees from and against any and all loss, cost, <br />damages, expense and liability caused by the failure of the <br />Provider to fully perform its obligations under this agreement and <br />in accordance with its terms; or by an accident or other <br />occurrence causing bodily injury, including death, sickness, <br />products or services rendered under this Agreement. <br />Provider shall maintain general liability insurance with <br />limits no less than $100,000 /occurrence. Certificates of <br />Insurance reflecting such coverage must be furnished to <br />Orange County and shall contain the provision that Orange <br />county will be given thirty days written notice of any intent <br />to amend or terminate such policies by either the Provider or <br />the insuring company. <br />1 <br />