Table Of ContentThe Life Choice Project
Prandtl Care Geondination Services - Servica Ptovider Cantaci Caring fo Love Ministies!ife
Choice Prajest herr after referred to as “CTLMILGP", “Life Choice Project/CTLM™, *CTLMVLIfe
Choice Project, “Life Chaise Project, or simarclestgnatlon, rereby onto nto an
agreament wth
Serve Praviéar Name: Lops
(Serice Provider Name} —1CP #, 3 provide ofthe LOP Prenaia Care wed Coutdination Services
hereinafler refers ta as (SERVICE PROVIDER NANI}, to prove sanviogs to tha Caring ta Love
inst ies. fe Choice Prost subject io te fatanirg terms and condi an:
4. Bence Provider Name} acknowledges that CTLMILGP garvag asthe contracts Ter the
roposed soniogs and reimbursement is based on final anprovl by he Ste of Louiiaa,
2). The sanract sna becare efacive upon appsoyal by OOFS rmfoactve ta March 1, 2318 for
all seniges provide in ecenndanca with ins conractané stall ante in elect at han ne
20, 2018 ar uni trinated in ecoandance wi ts contact, The expected imo to camplelé the
idoove services is not lu exceed uly 8, 2018 GTLMLGP here agraes io reimburse ASERVIOL
PROV'OER Nel
‘ar services rendered ugar completion and sub vision f menthlyrepors,
invoces and reimbursement request if ae only f CTLNVLCP has heen pi fa sid vervoes by
the Slate cf Lou-iara and the apple comractng state agency. This contact shall at contrue
beyond the speed enmination date and may be tenninated by eer party atenytme, whic
termination shall be affactve immediately uson the date of depot of writer rice nt the Lied
Steles Mal
3. CTLMILCF shall impure he (Serve Psider Nar) for serioas and tems 2
authorized and propery provided under ths prograi in accardance withthe ~ Terns of
‘deimbursemenl, es re now in fect ar asta lor te amanded.
4. {Gorvlee Provider Name shal submi tne Request for Remibuiserank bythe 2 day of
each moth na later nan 5:00 pm, unlss othervise Sect ty CTLM
docimentatin the alle
(CP. Supposing
spenciures msl accompany tie Request for Reimburserent
Form.
Lip Ghoie Project :STLM Senie Provider Conbact
AL_PAGES OF THE PROVIDER AGREENENT MUST 3 RETURNED TOGETIIER,
Paget 8
3e
@
The Life Choice Project
8. Claims sutvito lata than 2:00 pan. onthe lay of cach month or submited thout
invoive or suppoting dosumen-slin are deemed untimely ll payments due an undimely las
shallbe feted (S=RVICE PROVIDER NAME) ur
detemines by CILMSLCP, rhe ustmelysubrita,
the Provider shows good cause, as
5. Imagresing to ‘he ams of the contact, (SERVICE PRO¥IDER NAME) understands thet
‘hey wil na he reimburse for any sersices or expenses for any resgon Uatl CT-MFLG? receives
‘paymant. If CTLAVLCE dogs not ree ve paymenif-m CHHIOFS ar State of Louis far services
‘or expenses, han CTLANLCP wil nat be equi‘ to compensa or remburse any exenses of
salt contract for any reason.
7. (SERVICE PROVIDER NAME) agrees lo abide by al CTLANLCH Consactor Assurances
For TANF Intatves in so far nese absarances ae applicable to sence providers
Boo (SERVICE PROVICER NANCE; agraes to partiipate flyin the Lite Chole Project onto.
moritorng and avciuction reviews ws cule nthe Cutty Assurance Progen information Te
on-site reviews will te performed by te
CChaico Project Compllarce Tear and ss beuses to
determine the (SFRVIGE PROVICER NAME} 's achetence fo and cant ution in “he Lite Gna
Pree:
4. _ (SERVICE PROY DER NAM) agr2es to elmuise CTI M ALCP for mouies ‘eceled for sy
setvoes c e'ents wha ae found fo be ineigible for TANF funded seriogs ar“ saris found to
‘be in rar andor not ened tn be received as deterred by The Life Choice Project Complanoe
“Team, (SERVICE PROVIDER NAME) fulnerauthoizes CTLAMLGe to whk! ary hitae
relniburserent a Serioe Provider ad apply i satisfaction ofthe amount owed! th CTLMA.CP ay
(SERVICE PROVIDER VAME)
10. (SERVICE PROVIDER NAW) anderstards ard agrees that tr einlursement vi Inot
iseved Jnl marcato application procedures Hoslh Fat, and cemptance issues are satis.
‘1. Izooondance with CT_MILCP recardeeping requiremats, SERVICE PROVIDER NAME)
agrees te keep all woods pstaing to services proved to TAN
ble oregram parciocns for
P any anal such
‘records an informator including Sul not ii ta records end ia’ermation regarding services
provided and puyinens cleimad by (SERVIGE PROVIDER NAME) farrnishing services under
‘he Prenctal Cae Cooninatina Serves
-atleasl seven {7] years, ard agroze upon recuest fa fumish fo STLM
Le Ohoice Poet /CTLM Serve Provider Cantaa:
ALL PAGES OF THEPROMIDER AGREEMENT MIST GC RETURNED TOGETHER,
Page 20!
SN
The Life Choice Project
42, (SERVICE PROVIDER NOME} must sub Lal Fwoice with anprepiae supporting
dacurer taiun to CTLMULCE within Tve (5) busines
ser terninalion of eertrac
(SERVICE PROVIDER NAME} agrees to comaly wih ie clsclosue requirements
‘established by CTLIANLCP as now neffector as may be amerded. (SERVIOE PROVIDER
ANE) “icher agrees that twil prevde any changes or updated ‘ftrmaton wring ta
GTLMVLGP within ane (3) busines day ram the effecive dale of eucn changes unless directed
cthermise by CTLMILCP, Repartatle changes ar urls nls Gu are natlimited to he
informatonraquestod in tc Losisiona Lif Choice Project 2048 Request for Agpiction othe
most rece Reyes Apia,
14, (SERVICE PROVIDER NAME) agrees to use only apgroved brochures and ining
‘18e>(SERVICE PROVIDER NAME) hereby arms thatils organization and any persor
rrployed by tdoes not and wil ot isste a foe for cantreptives,
“8. (SERVICE PROVIDER NAME) harohny ati tral onaizalion and any parson
‘employed by toss not end will nol adveoate, obusal, 2° er foran abortion.
17. [SERW.CE PROVIDER NENE} consants athe use of setsiealsanping as an aocepted
means to determine he avaunis owed by (SERVIDE PRCVIDER NAME) ta CTLWLC? 28a
rosul ofan rvestgation oF avait canduried hy GTLNILGP ar an allnizedl agency of CTLAVLCR,
18. (SERVICE PROVIDER NAME) agmes ta jrovide ‘he mid-nenthrepors or ar before the
‘8th of every monty and dail terete in tr la assist in tackirg Lie Cn
Pecect monty
targets
49. (SERVICE PROVIDER NAME) agiecs to parcipat as drecteo by CTL
mandatory Fanirgs made avaiable through the fe Cinige Prac
20, (SERVICE PROVIDER NAME) cetiies tat the seriscsconiactd fr herein ae rs
thanise availabe fom ‘re conttector ona rar reimbursable basis
21, (SERVICE PROVIDER NAME) agrees ioe env'ooh
erment
2 (6
vith all applicable standards orders or raqi‘errons issued under Seston 306 a the Gioan Pir
At
gator end icbasso-tee
VICE PROVIJERNAE) agrees ta adhere tothe prov sia. hat requires campliance
Life Choice ProjaesCTLN:Saivoa Provider Contact
ALLPAGES CF THE PROVIDER AGREEMENT MUST BE RETURNED TOGETHER.
Page ate
36
The Life Choice Project
2, (SERUM
= PROVIDE NAME) recognizes the randatory stardards and poles reaing 12
‘energy effclercy the! are contsinedn the Stste Enefay Conservation Pan issue in compliance
wih the Energy Poly and Conservation Ac (P-L. 94-163}.
24. (SERVIDE PROVIDER NANE) agrees :o adhere fo ah appcab'e standrds, orders, cr
requirements iste unr Section $98 of he Clean Waar ct
75, CLM nas-vas the right fo deviate fom tris Prenatal Care Cuounation Service, 2nd
(SERVICE PROVIDER N*M
23. (SERVICE PROVIZER NAME) hereby cette: tate Infr~ ation
ROVIDER NANE} in he Request Fer Applveion ior Lousiana Lite Choies Project 2016-2016 or
-rost event RFs uve aad comet. ‘SERVICE PROVIOER NAME) teeby agrees to fly comply
‘ul ake actons as drooted by CTLMILGP in econo with and inutile of the
{VICE PROVIDER KAME? in such renner as may be determines
and créctod andor mor! fad by CILAYLCP ined bat not ied to ne folowing
grees to copy wih any davations andia: changes,
represenlaions maeby (8
2. SERVICE PROVIDER NAME} 2grees to maintain a fax machine fully connate wth any
and alllechncigical specications as drscied by CTLWLCE tat shall rave ane dosicatad Tex
rumeer wich sl he some fax uae for hee mo period of te contre. (SERWIOC
PROV.DER NAME} tutes agrees that sed tax macrne shal be workirg and avatable x rece
Faxes 24 hours per dey, exon days per meek, and thal ‘SERVICE PROVIDER NAME) shal sign
nd respond to any faved commu ican fort CTLMFLCP in the manner snd tne frame as,
cirecied by STUMILCP. Ilthe (SCRV.CE PROVIDER NAME fax rachine fsdeomed
unsatstac'-y, CTLNULCP wit quire she fax machine tobe replanedt within fve busines ays by
(SERVIOE PROWIDER NAME)
Ue Cheic Preise /CTLN Senvce Provider Contact
ALL PAGES OF “HE PROVIDER AGREEMENT MUST BE RETUR
Poged ofa
TOGETHER,
Aa
The Life Choice Project
b (SERVICE PROVIDER NAME] agrees to anquit, provide and mainczn exuler and
{echrologizal hanware and software as dcotad by C™LMVLGP sd to iemedisalyeacure any
upgrades as may be drecied by CTLMFLC® incul/ng auf nt imited to te folawing requirements
‘yuser rust have a PC wilh high spaed acoass to the Interne, 2 user must have Icernet explore
Aor tiger, 8) us
must nave Mlicroscfl Access 2009 ot highor, 4} fr ning purposes, each
ener must have lepiop PC ¥h wieless capability, §} exch cenler steve a valid emai
address and fax capatites; and 6) must have Windews 7 ano Gitioe 2002 ar higher. Adarionely,
(SERVICE ®ROVIDER NAF verfase successhally wit erase
‘operating systems 20C7 and above and mast manta Ieorralogy suffcert ic attend and ly
"5 vapors) mus be able ts
iil in Wel aus ipshed by Caring w Loe instr.
©. (SERNICE PRCVIDCR NAME) agrees that its Execuive Diector as ote ints 2045-2016,
Request for Aopeation cr most recenl RFA, oa dasignea as agpmvad by CTLMNLCP, especialy,
should there bea feplacement of fo afomasidnzmed Execulve Sitedor. shal ation al Life
‘chon Prjent mardatory mestirgs.banings,sanierenoes and parispate na conference calls
23 dieoled by CTLMVLEP CFLMILCP raservcs the excuse righ excuse said Sxecutve
Direct, designee orany-cte personnel rem, anf thor dctenm ne who shall be alloyed to
aitend andr presale in any meeting, ta ning, conference, confers we call 0° any eter acy
‘ered o CTLMLCP,
6. {SERV.CE PROVIDER NAME) agrees lo abi by grievance procedures as develoged and
as feler maces and walled
5. (SERVICE PROVIDCR NAME) agraes no: to supplant existing fading wt funding
received ‘om the Lil Chaice Project and lo wimeststely ray CTLMILOO win 2 (1) business
dleyof discovery should SERVICE PROVIDER R&ME} discosorthatil has suppiarted ting
{SERVICE PRCVIDER NAME} irtneragreos fo eimburse the CTLIULCP any ard al funds
received fom Ps Life Ciien Prooat hat were used to sugplant nding ae de-enmined solely by
CTI MH fa Choinn Projen. Service Pravda Leher auerizes CTLMILCP -o withhold any future
reimbursement io SERVICE PROWDER NARiE) and apply in satisfaction ofthe amourt ened
CT_HILG? by (SERVICE PROWIER NAME)
27, (SERVICE PROVIDER NAME) sarees fo bring @ rnimur of ive (5) quests tothe An ual
Coverence,
Lie Cron Projet {CTUM Sere Provider Conact
ALL PAGES OF THE PRCVIDER AGREEWENT MUST BE RETURNED TOGLTHER,
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