Third Party Supplier Service Agreement

Third Party Supplier Service Agreement

Please review and complete the details to formalize your engagement with MDHSS.
Background
A. Mallacoota District Health and Support Service Inc (MDHSS) coordinates and/or delivers health, community, aged care
and support services to eligible consumers in Mallacoota and surrounding communities.
B. The Consumer requires the services described in this Agreement and has agreed that the Service Provider may
deliver those services, subject to the Consumer's care/support arrangements and applicable funding requirements.
C. This Agreement sets out the basis on which the Service Provider will deliver the Services, including service standards,
personnel requirements, invoicing, privacy, incident management, work health and safety, insurance and termination.
D. Where services are funded under an Australian Government or other program, the parties will comply with the
requirements applying to that program, including the Aged Care Act 2024 (Cth) and associated rules where applicable
This Agreement is between:
Mallacoota District Health and Support Service (MDHSS)
ABN: 75 698 494 045
Address: Genoa-Mallacoota Road Cnr, Mattsson St, Mallacoota VIC 3892
Phone: (03) 5158 0243
Email: feedback@mdhss.org.au
And

(Independent Contractor/ Service Provider)
Supplier Full Name
Supplier ABN
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Supplier Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code

Consumer Details
Client /Client Representative Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Consumer Representative

First NameLast Name

Service Specifications
Services
Service Descriptions / Outcomes
Length and Frequency
Location of Service

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Service Fee $
$ ________ per hour / session (GST: Inclusive / Exclusive / Not applicable)
Travel Transport
As agreed in writing and only where permitted by the relevant funding arrangement
Required Qualifications
Required Checks
Relevant professional registration, police check, worker screening and other checks required by law or MDHSS
Care Coordinator/ Contact
Please enter a valid phone number.Format: (000) 000-0000.
Additional Provisions

Agreement Overview
Agreement between Mallacoota District Health and Support Service (MDHSS) and Supplier (Independent Contractor)
Purpose of the Agreement

This agreement sets out the terms under which the Supplier will provide services as an independent contractor to MDHSS under the Self Managed Support at Home Model.

Nature of Engagement

The Supplier is engaged as an independent contractor, not as an employee or agent of MDHSS.

Approval Requirements

No services may commence until written approval is provided by MDHSS.

Scope of Services

Services to be provided as agreed in writing with MDHSS.

Fees and Rates

Fees and rates are as agreed in writing and must be invoiced in accordance with MDHSS requirements.

Invoicing and Payment

Invoices must be submitted as per MDHSS guidelines. Payment will be made following invoice approval.

No Direct Engagement

The Supplier must not engage directly with clients without MDHSS consent.

Insurance Requirements

The Supplier must maintain Public Liability Insurance ($10M minimum) and, if applicable, Professional Indemnity Insurance. Proof of insurance must be provided before commencement and upon renewal.

Compliance and Quality

The Supplier must comply with all relevant laws, regulations, and quality standards.

Records and Documentation

The Supplier must maintain accurate records and provide documentation as requested.

Work Health and Safety (WHS)

The Supplier must comply with all WHS obligations.

Confidentiality and Privacy

All information must be kept confidential and used only for the purposes of this agreement.

Limitation of Liability

MDHSS’s liability is limited to the extent permitted by law.

Suspension and Termination

MDHSS may suspend or terminate this agreement in accordance with the terms.

Capacity and Service Conditions

The Supplier must ensure they have the capacity and meet all conditions to provide the agreed services.

Dispute Resolution

Any disputes will be resolved in accordance with the agreement and governing law.

Governing Law

This agreement is governed by the laws of Victoria, Australia.

By signing below, both parties confirm acceptance of these terms.
Acceptance
Supplier Name
Signature
Date Signed (Supplier)

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
MDHSS Client Care Representative Full Name

First NameLast Name
Signature
Date Signed (MDHSS Client Care Representative)

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
- Should be Empty:

Third Party Supplier Service Agreement

Background

This Agreement is between:

And

Consumer Details

Service Specifications

Agreement Overview

Acceptance