(“Client”) on the terms and conditions set out below:

1. Term of Agreement. The term of this agreement will start on the Effective Date, and will continue on an as-needed basis until the Agreement is terminated by either party, as provided hereunder.

2. Services Requested. We will provide the services (refer to plan of care) requested and agreed upon as set out in the Service Plan enclosed. The preferred day, time and duration of services will be mutually agreed upon by you and/or your representative and the agency.

3. Billing. We bill on a weekly basis for services requested(Monday-Sunday) or monthly basis for permanent service agreements. We will immediately refund any prepaid fees for services that were interrupted or not provided. You also have the option to have the fees deducted from future payments. Any questions regarding your invoice should be directed to our Home Care Manager Tasha Burton (205)358-5690.

4. Payment and Overdue Accounts. Payments may be made by check, money order, cash or credit card. Checks are to be written out to Helping Hands At Home LLC. An account is considered overdue if not paid within 3 day of the due date. We reserve the right to discontinue providing services until the account is paid in full, including any additional charges and accrued interest. A $35.00 returned check fee will be charged.

5. Cancellations. Cancellations may be made up to 2 days in advance of a scheduled visit without charge. We reserve the right to charge for a scheduled visit if insufficient notice is not given. Additional service days need to be requested 2 days in advance of service day so that we can accommodate your request.

6. Termination. Either “Client” or “Agency” may terminate this agreement at any time, with a minimum of 7 days written notice to the other party. If either party terminates this Agreement, all fees due at time of termination will be due and payable by you immediately.

7. Amendments. Should either the Agency or Client wish to amend the Agreement:

a. Either an Agency, Representative or the Client may initiate a meeting to determine the scope of the amendment and determine the sections of the Agreement that need to be modified, added or deleted.
b. When both parties consent to the amendments, the changes shall be recorded in writing.
c. If the Agreement requires extensive changes, an entirely new agreement shall be drawn up. Otherwise, small changes can be handled via a letter or a notation.
d. All parties who signed the original agreement shall sign the Amendment.
e. The Amendment shall be dated with a copy being given to the Client and a copy being filed in the Client’s records at the Agency’s office.
f. Relevant staff and other persons shall be advised about any change in the Agreement terms immediately.

8. Governing Law. The laws of the state of Alabama and applicable federal and municipal regulations shall govern this Agreement, including, but not limited to:

a. Ala. Admin. Code r. 410-2-4-.07; and,

b. those specified in the Agency’s Policy and Procedure Manual, including:

i.P&P #1.140 - Compliance & Accompanying Forms
ii.P&P #4.20 - Pre-employment Background Checks & Accompanying Form
iii.P&P #4.130 - Standards of Conduct & Work Ethics and Accompanying Form

9. Agency’s Responsibilities. Helping Hands At Home LLC responsibilities are outlined on the enclosed “Client and Agency Rights and Responsibilities” form.

10. Client’s Responsibilities. Your responsibilities are outlined on the enclosed “Rights and Responsibilities” form located in our client handbook.

11. Transportation. If an employee of the Agency transports a client in the client’s vehicle or their personal vehicle, the client will release the Agency and/or that employee from all liability should an injury or accident occur. Both parties will be required to have full coverage insurance in order to Service Agreement Page 2 of 3
transport in a personal vehicle. Any transportation in company vehicles will be covered by the agency.

12. Private/Direct Hiring. You may not privately/directly hire an Agency employee for a period of 12 months following the date that employee last provided services for you. In the event you break this condition, a replacement fee of $500 is due to the Agency immediately upon your employment of that individual.

13. Background Checks. The Agency requires that all new employees undergo certain criminal and other background checks as a condition of employment, in accordance with Agency’s Pre-employment Background Check Policy, Federal Department of Labor Regulations and State Laws.

14. Severe/Bad Weather. In severe weather, we may determine it is not safe for our Home Care Workers to travel and provide services to your home that day and may have to cancel that day’s service. When this occurs we will notify you and reschedule. We appreciate your understanding regarding this matter.

15. Supplies and Equipment. You are responsible for supplying all supplies (i.e., cleaning, personal care etc.) and equipment which may be necessary in the provision of services. Extra charges will apply if the Agency provides the supplies and/or equipment.

16. General Information. You will be provided with a list of contact names and numbers in the event you have any questions or concerns or should an emergency arise. Your signature and/or your representative’s signature below indicate that you and/or your representative:

1. have been given sufficient, relative information to be able to give your informed consent to the terms and conditions of this agreement; and,

2. understand, and are in agreement with, the terms and conditions of this Agreement.

I ACCEPT the terms of this Service Agreement: