HomeMy WebLinkAboutAgreements/Contracts - Veterans ServicesMedical Teams International
PO Box 10
Portland OR 97207-0010
503-624-1205 or 1-800-959-4325
K19-108
M11
Memorandum of Understanding
Start date End date�
I January 1, 2019
December 31, 2019
And-.
Grant County Veterans Advisory Board
35 C St. NW
Ephrata. WA 98823
Eileen Boylston
The mission of Medical Teams International's (Medical Teams) Mobile Dental program is to provide free urgent dental care to
individuals whose incomes are less than 200% of the Federal Poverty Level and who have no dental insurance, no funds, or
reasonable access to care..
All mobile dental van visits are dependent on the availability of volunteer dentists and dentalprofessionals, This
Memorandum of Understanding is not to be construed as a binding contract but rather a Statement of the terms of a
cooperative relationship to successfully provide urgent dental care to qualified patients. The parties agree that the
relationship between them shall be that of independent contractors and not thatof partners, joint adventurers, or principal
and agent. The employees of one party shall not be deemed employees or agents of the other party.
It is UNDERSTOOD that Medical Teams International will:
Confirm that all volunteer dental professionals are appropriately licensed.
Maintain appropriate liability insurance for Medicaf Teams and provide proof of Medical Team's liability insurance if
requested.
Provide urgent care dental services independent of Grant COU-17ty Veterans Advisory Board, This may include,
but is not limited to physical exams, x-rays, cleaning, fluoride treatment, sealants, fillings, extractions, oral hygiene
instruction, and other clinically indicated procedures.
Make every effort to comply with State and Federal regulations regarding the security and confidentiality of patient
health care information.,
Medical Teams' Program Coordinator: Ne g* Khanloo
in
o Phone number: 425-284-1958 email:neginkhanloo@medicalteams,,org
It is UNDERSTOOD that Grant County Veterans Adv'
isoryBoardwin:
Provide a manager who will be responsible for all. communication with Medical Teams" dental clinic manager and
program coordinator, will fulfill all clinic partner guidelines and responsibilities, and be on site the day of the clinic.
Grant County Veterans Advis-ory Board's manager is Jerry Gingrich — Eileen Boylston,,
Follow Medical Teams' scheduling andpatient screening guidelines including the use of Medical Tearns'forms and
provide interpreters when needed.
if Grant County Veterans Advisory Board is recruiting dental volunteers, all application documents must be
received by Medical Teams no later than two weeks prior to the clinic.
If needed, retain and maintain all patient records in a secure., on-site location, in compliance with state laws for a
minimum of seven (7) years,
Provide a safe working environment during the clinic including sufficient staffing and security until all Medical Teams
staff and volunteers depart from the premises.
240v shore power is available. 0 Yes 0 No 11 No, but we are willing to explore adding shore power,
Communicate with Medical Teams' Program Coordinator no later than one week before the clinic if it needs to be
canceled or rescheduled.
used on the availability of appropriate volunteer dental professionals, Grant Count Veterans Ad -
Y VISOry Board has the
capacity to sponsor dental clinics and would like to request that Medical Teams provides I dental clinics during the term of
this understanding,
, Grounds Grant County'Veterans Adviso,ty Board. Grant COUntY FR114 Grounds will pay Medical Teams a dental clinic site fee
of $1.200,per clinic. Medical Teams will provide anlonthly.billing invoice. Payment is due within 30 days of in date.
Grant County Veterans Advisory Board recognizes that there may be unforeseen circumstances such as van
breakdowns, .-Inclement weather, orther force majeure events that may arise and may affect Medical Teams' ability to
0 n
completely meet the anticipated number of clinics request: . ed in this understanding. In the event of unforeseen circumstances,
Medical Teams will contact the site partner immediately. In the event of a clinic cancellation, Medical Teams wil-11 make every
effort to provide aclinic at the earliest mutually agreed upon date.,
Prevention of Sexual Exploitation and Abuse('PSEA)*. Medicaf Teams is committed to the protection of vulnerable
populations, including from sexual exploitation and abuse. By entering into an agreement with Medical Teams, the
Cooperating. Partner undertakes to adhere to the Protection from Sexual Exploitation and Abuse(PSEA) policy and guideltnes
-adopted by Medica. -I Teams, The Cooperating Partner shall ensure that its personnel, agents, contractors and subcontract'.ors
conform to the highest standards of moral and ethical conduct. Any failure by the Cooperating Partner to take preven . tive
measures against sexual exploitation or abuse,, to Investigate allegations thereof or to take corrective action, shall constitute
grounds for termination of the Agreement.
Each party shall fully indemnify, defend, and hold harmless the other party and its directors, -officers, employees,
shareholders., partners, agents, and affiliatesiagalnst all: claims, liability, and expenses (including legal fees). ansing from:
op
(a) any breach .of any representation or warranty contained in this agreement; (b) any breach or violation of any covenantor
other obligation under this agreement or applicable law- Vic) any third party claim orproceeding brought against one party
Y
[based on product liability, infringement, use of goods or services, or personal injury or death];(d) any claim or proceeding
brought by- any governmental agency; (e) any claim alleging [grossly] negligent act or orn-0 I
ission or willful conduct of the other
party or its directors, officers, employees, shareholders, partners, agents,, or affiliates,, (f) any claim ansing from specified
covered: claim(s).
Each party's indemnification obligations are conditioned upon the indemnified :party,,. (a) promptly notifying the indemnifying
party, of any Claim in writing; (b) -cooperating with the indemnifying party in the defense of any claim; and (c).granting the
indemnifying party sole control of the defense or settlement of the claim. The parties shall not be entitled to indemnification
if the claim is based on or results in any material part from the negligence or unlawful or wrongful acts of the party seeking
:Indemnification.
The Parties agree that they will not, during the term of this Agreement, form any relationshi,
p that results in a Conflict of
Interest. Such Conflict of Interest includes, without limitation, any relationship which may affect or whi�ch may reasonably
appear to affect a Party's objectivity or ability to perform the work anticipated under this Agreement. Eachparty shall notify
the other within two (2) business days of any -potential conflict of interest arising from the provision of services to any other
organization, government entity, or corporation through the term: of this Agreement.
The parties shall use their best, good -faith efforts to cooperatively resolve .disputes and problems that arise in -connection with
this Agreement. Both parties will make a good faith -effort to continue inue without delay to carry out their respective
responsibilities m
ibilities under this Agreeent while attempting to resolve the dispute under this section,
Disputes Which remain unresolved after thirty (30) days will be referred to a mediator selected by the American Arbitration
Association. Any such arbitration will be conducted in Portland, Oregon, United States, All costs of arbitration wilf be borne
equatly by the Parties. The Parties agree that any decision rendered pursuant to such rules shall be binding upo::n the Parties
and maybe entered as a final judgment in any court of competent jurisdiction.
This Memorand: m of Understanding may be modified at any time with the written consent of bothparties, and may be
terminated by either party, ty, at its sole discretion, upon 30 days advance written notice to the otherpart y.
Medical Teams International:
terans -dvisory Board",
Ve A
Cindy Breilh 7-28-2019
Authorized Re -presentative Date
U or ze epresenta,tji) Date
Cindy Carter, Vice -Chair
Richard Stevens, Member
Signature: r�
Cindy Bret h(Jul9'
Email: cbreilh@medica[teams.org
Grant County Veterans Advisory Board Exp Dec
2019 Mobile Dental IVIOIJ
Final Audit Report 2019-07-29
"Grant County Veterans Advisory Board Exp Dec 2019 Mobile D
ental MOU" History
i,j Document created by Negin Khanloo (nkhanloo@medicalteams.org)
2019-07-24 - 8:19:27 PM GMT- IP address: 50.125.243.242
I
Document emailed to Cindy Breilh (cbreilh@medicalteams.org) for signature
2019-07-24 - 8:19:51 PM GMT
Email viewed by Cindy Breilh (cbreilh@medicalteams.org)
2019-07-29 - 3:29:44 AM GMT- IP address: 50.205.209.2
Document e -signed by Cindy Breilh (cbreilh@medicalteams.org)
Signature Date: 2019-07-29 - 3:31:04 AM GMT - Time Source: server- IP address: 50.205.209.2
Signed document emailed to Negin Khanloo (nkhanloo@medicalteams.org) and Cindy Breilh
(cbreilh@medicalteams.org)
2019-07-29 - 3:31:04 AM GMT
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