■ ■ -;.y
•k
April 26, 2023
Dear Chairman Mendelson:
Sincerely,
WWW.UNITED-MEDICALCENTER.COM
Council action is necessary to approve the December 13, 2022, partially exercised Option
Year 2 Modification #10 (in the amount of $925,000.00 and a period ofDecember 9,2022
through February 7,2023) and Proposed Modification #11 (in the amount of $2,500,000.00
and a period of February 8, 2023 through December 8, 2023) because when combined, the
total retroactive contract value of Option Year 2 would be $3,425,000.00 for the period
December 10,2022 to December 9,2023. Continued approval is vital to avoiding a major
disruption in these services despite the unfortunate retroactivity, which as discussed during
recent oversight hearings, is due to constantly increasing nurse agency costs, extended time
needed to negotiate financial terms, nationwide industry shortages, and the pending wind
down.
As always, I am available to discuss any questions you may have regarding this submittal.
In order to facilitate a response to any questions you may have, please have your staff
contact me at (202) 574-6611.1 look forward to a favorable consideration on this contract.
The Honorable Phil Mendelson
Chairman, Council of the District of Columbia
John A. Wilson Building
1350 Pennsylvania Avenue, N.W.
Suite 504
Washington, DC 20004
Enclosed for consideration and approval by the Council of the District of Columbia is
Contract No. NFPHC-MS-22-C-00043 Modifications 10 and 11 between the Not-for-Profit
Hospital Corporation and Maxim Healthcare Staffing Services, Inc. Approval and Payment
Authorization Emergency Act of 2023, and Contract No. NFPHC-MS-22-C- 00043
Modifications 10 and 11 between the Not-for-Profit Hospital Corporation and Maxim
Healthcare Staffing Services, Inc. Approval and Payment Authorization
Emergency Declaration Resolution of 2023, for the provision of nurse staffing services
pertaining to emergency department, intensive care unit, and telemetry services
(“Contract”).
■Jacqueline Payne-Borden '
Chief Executive Officer
Not-for-Profit Hospital Corporation
Enclosures
1310 SOUTHERN AVENUE, SE WASHINGTON. D.C. 20032-4623 • 202-574-6000 A
BILL
IN THE COUNCIL OF THE DISTRICT OF COLUMBIA
BE IT ENACTED BY THE COUNCIL OF THE DISTRICT OF COLUMBIA,
That this act may be cited as the “Conttact No. NFPHC-MS-22-C-00043 Modifications27
10 & 11 between Not-fdr-Profit Hospital Corporation and Maxim Healthcare Staffing28
Services, Inc. Approval and Payment Authorization Emergency Act of 2023”.29
30
31
32
33
the Council approves Contract No NFPHC-MS-22-C-00043 Modifications 10 & 1134
between the Not-for-Profit Hospital Corporation and Maxim Healthcare Staffing35
Services, Inc. for the provision of nurse staffing services pertaining to the emergency36
approved December 24, 1973 (87 Stat. 803; D.C. Official Code § 1-204.51), and
notwithstanding the requirements of section 202 of the Procurement Practices Reform
Act
of 2010, effective April 8, 2011 (D.C. Law 18-37i; D.C. Official Code § 2-352.02),
1
2
3
4
5
6
'7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
To approve, on an emergency basis, Contract No. NFPHC-MS-22-C-00043
Modifications 10 & 11 between the Not-for-Profit Hospital Corporation,
commonly known as United Medical Center (“Hospital”) and Maxim Healthcare
Staffing Services, Inc. for the provision of nurse staffing services pertaining to the
emergency department, intensive care unit, and telemetry services, and to
authorize payment for the services received and to be received under the Contract.
Chairman Phil Mendelson
on behalf of the Not-for-Profit
Hospital Corporation
Sec. 2. Pursuant to section 451 of the District of Columbia Home Rule Act, department, intensive care unit, and telemetry services, and autliorizes payment for the37*
services received and to be received under this Contract and payment in the amount of38
$3,425,000.00.39
Sec. 3. Fiscal impact statement.40
41
42
Act of 1975, approved October 16, 2006 (120 Stat. 2038; D.C. Official Code § 1-43
301.47a).44
Sec. 4. Effective date.45
This act shall take effect following approval by the Mayor (or in the event of veto46
47
48
Columbia in section 412(a) of the District of Columbia Home Rule Act, approved49
December 24, 1973 (87 Stat. 788; D.C. Official Code § l-204.12(a)).50
51
2
by the Mayor, action by the Council to override the veto), and shall remain in effect for
no longer than 90 days, as provided for emergency acts of the Council of the District of
The Council adopts the fiscal impact statement of the Chief Financial Officer as
the fiscal impact statement required by section 4a of the General Legislative Procedures I
(A) Contract Number: NFPHC-MS-22-C-00043 Modifications 10 and 11
Proposed Contractor: Maxim Healthcare Staffing Services, Inc.
Contract Amount:
Unit and Method of Compensation: Monthly with proper invoices
December 10, 2022 - December 9, 2023; retroactiveTerm of Contract:
Fixed Fee, with monthly reconciliationType of Contract:
Sole Source under 27 DCMR 4618Source Selection Method:
,o
1
Pursuant to section 202(c-l) of the Procurement Practices Reform Act of 2010, as amended, D.C.
Official Code § 2-352.02(c-l), the following contract summary is provided:
Modification 10: $925,000.00 (Dec 10, 2022-Feb 7, 2023)
Proposed Modification 11: $2,500,000.00 (Feb 8 - Dec 9, 2023)
Option Year 1 Amount: $3,425,000.00 (Dec 10, 2022 - Dec 9, 2023)
o
o
o
GOVERNMENT OF THE DISTRICT OF COLUMBIA
Office of Contracting and Procurement
COUNCIL CONTRACT SUMMARY
(Retro)
(B) For a contract containing option periods, the contract amount for the base period and for
each option period. If the contract amount for one or more of the option periods differs from
the amount for the base period, provide an explanation of the reason for the difference:
Base Period:
$300,000.00 Base Period: (December 10, 2020 to December 9, 2021)
$600,000.00 Modification #1: (December 10, 2020 to December 9, 2021)
$2,600,000.00 Modification #2: (December 10, 2020 to December 9, 2021) Modification
#2 revised the total 12-month Base Period to $3,500,000.00. Base Year approved by
Council as A24-115 on June 29, 2021
I Mods #3 & #4: No fiscal impact o
There were no protests associated with this procurement.
2
(C) The goods or services to be provided, the methods of delivering goods or services, and any
significant program changes reflected in the proposed contract:
(D) The selection process, including the number of offerors, the evaluation criteria, and the
evaluation results, including price, technical or quality, and past performance components:
Maxim Healthcare Staffing Services, Inc. is a privately held medical staffing company
headquartered in Columbia, Maryland, that was founded in 1988. Maxim is accredited by the
Accreditation Commission for Health Care (ACHC) for our private duty nursing and certified home
o
o
(F) The background and qualifications of the proposed contractor, including its organization,
financial stability, personnel, and performance on past or current government or private
sector contracts with requirements similar to those of the proposed contract:
As reported for the Base Year and Option Year 1, this contract was sole sourced under 27
DCMR 4618.
$143,835.62 Modification #5: (December 10, 2021 to December 24, 2021)
$1,726,027.40 Modification #6: (December 25, 2021 to June 22, 2022) Modification #6
revised the Partial Option Year 1 total to $1,869,863.02. Modifications #5 and #6 were
approved by Council as A24-416 on May 3, 2022
$1,500,000.00 Modification #7: (June 23, 2022 to Sept 30, 2022)
Modification 47 revised the Option Year 1 value to $3,369,863.02. Modifications 45 -47
were approved by Council as A24-478 on June 28, 2022.
$890,000.00 Modification 8: (June 23, 2022 to Sept 30, 2022)
$2,000,000.00 Modification 9: (Oct 1, 2022 - Dec 9, 2022). Modification 9 revised the
Option Year 1 total to $6,259,863.02, with a period of Dec 10, 2021 - Dec 9, 2022.
Modifications 48 &49 were approved by Council as A24-653 on November 1, 2022.
(E) A description of any bid protest related to the award of the contract, including whether the
protest was resolved through litigation, withdrawal of the protest by the protestor, or
voluntary corrective action by the District. Include the identity of the protestor, the grounds
alleged in the protest, and any deficiencies identified by the District as a result of the protest:
- Option Year 1:
o
o
This Contract is for the provision of nurse staffing services at United Medical Center (“UMC”) for
the emergency department (“ED”) and intensive care unit (“ICU”), and for telemetry services, for a
period from December 10, 2022 to December 9, 2023.
-Option Year 2:
o Modification #10: $925,000.00 (December 10, 2022 to February, 7, 2023)
o Proposed Modification #11: $2,500,000.00 (February 8, 2023 - December 9, 2023). If
approved, Mod 410 will revise Option Year 2 total to $3,425,000.00. The value of work performed pursuant to OY 2 Modification #10: $925,000.00
The value of work performed pursuant to Proposed OY2 Modification #11: $1,946,573.35
(J) The date on which the contracting officer was notified of the proposed change:
March 15, 2023
(L) The reason for the proposed change:
3
(G) The period of performance associated with the proposed change, including date as of which
the proposed change is to be made effective:
(K) The reason why the proposed change was sent to Council for approval after it is intended to
take effect:
Modifications #10 and #11 are required to allow for the continued provision of nurse staffing
services and to avoid a major disruption in nurse staffing at the Hospital.
healthcare programs and is accredited by The Joint Commission for healthcare staffing services.
Maxim is committed to adhering to standards set forth by The Joint Commission. In keeping with
this
dedication to quality service, Maxim has adapted The Joint Commission’s standards into daily
business practices and internal training programs.
Modification #10 (December 10, 2022 - February 7, 2023) was executed December 13, 2022.
Proposed Modification #11 (February 8, 2023 - December 9, 2023) would be effective upon the
date of Council approval, should Council approve the Contract.
The aggregate dollar value of Modification #10’s change is $925,000.00. The aggregate value of
the of Proposed Modification #11 is $2,500,000.00, totaling $3,425,000.00.
(H) The value of any work or services performed pursuant to a proposed change for which the
Council has not provided approval, disaggregated by each proposed change if more than one
proposed change has been aggregated for Council review:
(I) The aggregate dollar value of the proposed changes as compared with the amount of the
contract as awarded:
As conveyed during recent oversight hearings, UMC faces ongoing nursing specific staffing
challenges due to constantly increasing agency costs, extended time needed to negotiate financial
terms,
nationwide industry shortages, and the pending wind down. These factors directly contribute
to the retroactivity of nurse staffing modifications. Despite these difficulties, UMC continues to use
its best efforts to build and maintain a panel of nurse staffing agencies that can provide qualified
staff to UMC at the most favorable terms. t
(M) The legal, regulatory, or contractual authority for the proposed change:
NFPHC Contracting Authority; NFPHC Establishment Act; Home Rule Act.
(O) Performance standards and the expected outcome of the proposed contract:
Expenditure pursuant to Modification #10 to Option Year 2: $925,000.00
Expenditure pursuant to Proposed Modification #11 to Option Year 2: $221,754.30
See enclosed fiscal certification from the OCFO.
See enclosed legal certification from UMC Counsel.
4
(P) The amount and date of any expenditure of funds by the District pursuant to the contract
prior to its submission to the Council for approval:
(R) A certification that the contract is legally sufficient, including whether the proposed
contractor has any pending legal claims against the District:
The Contractor's performance will be monitored by the Not-for-Profit Hospital Corporation
Interim CEO and Chief Nursing Officer. The performance standards are as outlined in the
proposed Contract and as required by applicable local, federal, industry, and licensing entities.
(N) A summary of the subcontracting plan required under section 2346 of the Small, Local, and
Disadvantaged Business Enterprise Development and Assistance Act of 2005, as amended,
D.C. Official Code § 2-218.01 etseq. (“Act”), including a certification that the subcontracting
plan meets the minimum requirements of the Act and the dollar volume of the portion of the
contract to be subcontracted, expressed both in total dollars and as a percentage of the total
contract amount:
As conveyed during recent oversight hearings, UMC remains challenged to staff specialty and non
specialty temporary nurses due to constantly increasing agency costs, extended time needed to
negotiate financial terms, nationwide industry shortages, and the pending wind
down. Unfortunately, previous attempts to contract with DSLBD’s CBEs did not yield qualified
staff and the Hospital’s clinical needs could not wait. Despite these difficulties, UMC remains
undeterred in its efforts to create and maintain opportunities for small, local, and disadvantaged
businesses at UMC across all areas of the hospital and looks forward to continuing to work with
DSLBD and the community to improve.
(Q) A certification that the proposed contract is within the appropriated budget authority for the
agency for the fiscal year and is consistent with the financial plan and budget adopted in
accordance with D.C. Official Code §§ 47-392.01 and 47-392.02:
(S) A certification that Citywide Clean Hands database indicates that the proposed contractor is
current with its District taxes. If the Citywide Clean Hands Database indicates that the See enclosed Clean Hands Certification.
The proposed contractor has certified its compliance.
The Contractor is not certified as a local, small, or disadvantaged business enterprise.
All relevant aspects of the proposed Contract are enclosed.
None.
5
As of March 21, 2023, the Contractor does not appear on the District or Federal Excluded
Parties List.
(U) The status of the proposed contractor as a certified local, small, or disadvantaged business
enterprise as defined in the Small, Local, and Disadvantaged Business Enterprise
Development and Assistance Act of 2005, as amended, D.C. Official Code § 2-218.01 et seq,’.
(V) Other aspects of the proposed contract that the Chief Procurement Officer considers
significant:
(W) A statement indicating whether the proposed contractor is currently debarred from providing
services or goods to the District or federal government, the dates of the debarment, and the
reasons for debarment:
(Y) Where the contract, and any amendments or modifications, if executed, will be made
available online:
proposed contractor is not current with its District taxes, either: (1) a certification that the
contractor has worked out and is current with a payment schedule approved by the District;
or (2) a certification that the contractor will be current with its District taxes after the District
recovers any outstanding debt as provided under D.C. Official Code § 2-353.01(b):
The Hospital's website is currently being upgraded and the Hospital intends to post the
executed Contract as soon as possible. Until then, the contract remains available onsite.
(T) A certification from the proposed contractor that it is current with its federal taxes, or has
worked out and is current with a payment schedule approved by the federal government:
(X) Any determination and findings issues relating to the contract’s formation, including any
determination and findings made under D.C. Official Code § 2-352.05 (privatization
contracts):
(Z) Where the original solicitation, and any amendments or modifications, will be made available
online: 1
6
The Hospital’s website is currently being upgraded and the Hospital intends to post the
executed Contract as soon as possible. Notice Number: LOOO93538O8Date of Notice:March 16, 2023
CERTIFICATE OF CLEAN HANDS
1101 4th Street SW, Suite W270, Washington, DC 20024/Phone: (202) 724-5045/MyTax.DC.gov
To validate this certificate, please visit MyTax.DC.gov. On the MyTax DC homepage, click the
“Validate a Certificate of Clean Hands” hyperlink under the Clean Hands section.
Authorized By Melinda Jenkins
Branch Chief, Collection and Enforcement Administration
Government of the District of Columbia
Office of the Chief Financial Officer
Office of Tax and Revenue
1101 4‘h Street, SW
Washington, DC 20024
MAXIM HEALTHCARE STAFFING SERVICES INC
7227 LEE DEFOREST DR
COLUMBIA MD 21046-3236
As reported in the Clean Hands system, the above referenced individual/entity has no outstanding
liability
with the District of Columbia Office of Tax and Revenue or the Department of Employment
Services. As of the date above, the individual/entity has complied with DC Code § 47-2862, therefore
this Certificate of Clean Hands is issued.
FEIN: **-***6157
Case ID: 1459241
TITLE 47. TAXATION, LICENSING, PERMITS, ASSESSMENTS, AND FEES
CHAPTER 28 GENERAL LICENSE
SUBCHAPTER II. CLEAN HANDS BEFORE RECEIVING A LICENSE OR PERMIT
D.C. CODE § 47-2862 (2006)
§ 47-2862 PROHIBITION AGAINST ISSUANCE OF LICENSE OR PERMIT Jacqueline Payne-Borden, Chief Executive OfficerTo:
Date: April 24, 2023
Re:
/
From: Lilian Chukwuma, CFO - Not-for-Profit Hospital Corporatio
MEMORANDUM
\
Contract No. NFPHC-MS-22-C-00043 Modifications 10 & 11 between Not-for-
Profit Hospital Corporation and Maxim Healthcare Staffing Services, Inc.
Approval and Payment Authorization Emergency Act of 2023
:•
i
Government of the District of Columbia
Office of the Chief Financial Officer
★ ★ ★
I
fl
li
are included in the
The Not-for-Profit Hospital Corporation (NFPHC) intends to contract with Maxim Healthcare
Staffing Services, Inc. the provision of nurse staffing services pertaining to the emergency
department, intensive care unit, and telemetry services. Modification 10 of the Contract
exercised Option Year 2 for a total amount of $925,000.00 for the period from December 10,
2022 and terminating on February 7, 2023. Proposed Modification .il of the Contract would
extend the term of Option Year 2 to December 9, 2023, for a total value of $ $2,500,000.00,
revising the total dollar amount of Option Year 2 to $3,425,000.00.
The Office of the Chief Financial Officer hereby certifies that the funds
NFPHC FY 2023 and FY24 budget.
r' DocuSIgn Envelope ID: 02D52AAB-7081-47AD-9DD7-13815276E421
0
C
MEMORANDUM
To:
From:
Reference:
April 24, 2023Date:
Legal SufficiencySubject:
WWW.UNITED-MEDICALCENTER.COM
[^QiirQKlilR^ijiTin5Siriilvia)RP.0RATjotv
I hereby certify that it appears to be legally sufficient. Please be advised that my finding
is premised on the Contract being submitted to and approved by the Council of the
District of Columbia.
Jacqueline Payne-Borden
Chief Executive Officer
Eric Goulet
General Counsel
Contract No. NFPHC-MS-22-C-00043 Modifications 10 & 11 between
Not-for-Profit Hospital Corporation and Maxim Healthcare Staffing
Services, Inc. Approval and Payment Authorization Emergency Act of
2023
oUMC
^UNITED
— MEDICAL CINTEH
I have reviewed the above-referenced Contract No. NFPHC-MS-22-C-00043
Modifications between the Not-for-Profit Hospital Corporation, commonly known as
United Medical Center (“Hospital”), and Maxim Healthcare Staffing Services, Inc., for
the provision of nurse staffing services pertaining to the emergency department, intensive
care unit, and telemetry services.
1310 SOUTHERN AVENUE, SE WASHINGTON, D.C. 20032-4623 • 202-574-6000 DocuSign Envelope ID: 460741OA-263E-43DC-8331-0667EB0DB171
Page
CONTRACT MODIFICATION/ CHANGE ORDER
I of I
NFPHC-NSD-21-C-00027
4. Requisition/Purchase Ordcr/Task Order/Modification Number:
Modification #10
7. Subject:6. Contractor: name; address; phone number and email address
Other:Change Order8.
X
Date:Date:
Signature: L2/13/2O22
Signature:
14. GENERAL COUNSEL - LEGAL SUFFICIENCY
Legal Sufficiency:
Michael Austin, NFPHC Associate Counsel •
Date: Signature:
Lilian Chuk'
FOR INTERNAL PURPOSES ONLY
: NFPHC Chief Executive Officer
: NFPHC Budget OfficerOCFO REVIEW APPROVAL:
I
*A1I other terms and conditions of the contract shall remain the same.
* Modification reflects new rates
13. Signature of Contracting Officer: Kendrick Dandridge,
Contracting Officer
Maxim Healthcare Staffing Services, Inc.
962 Wayne Avenue, Suite 600
Silver Spring, MD 20910
Supplemental
Agreement
/ hereby certify funds are sufficiently included in the District's FY 2023 budget and
financial plan to support this Contract.
NOT-FOR-PROFIT HOSPITAL CORPORATION, commonly known as
United Medical Center,
an instrumentality of the District of Columbia government, hereinafter
known as the “Hospital”.
Modification to partially exercise Option Year Two (OY2) for sixty (60)
days, commencing on December 10, 2022 and terminating on February
7, 2023.
12. Name ofContractor: Rob Coombs
______
2. Address (Send invoices here)
Not-For-Profit Hospital Corporation
United Medical Center - Accounts Payable
1310 Southern Avenue, S.E.
Washington, D.C. 20032
5. Department(s) Using Goods or Services: Nursing Department
3a. Effective Date:
December 10, 2022
3b. Date of Council
Approval.
Exercise of
____Option
9. Modification/Change Order Amount: $925,000.00
Letter Contract/
Contract Extension
10. Total Contract Amount: $925,000.00
11. Modification to partially exercise Option Year Two (OY2) for sixty (60) days for the provision of Nurses.
Unit:
ED
ICU
MS/T
RT
Rates
$138.00
$135.00
$115.00
$110.00
JP
CEO REVIEW APPROVAL: Ul
12/6/2022
Date:
15. CERTIFICATION OF FUNDS
•wurrta^ NFPHC CFO
This contract appears legally sufficient. Please be advised that my finding is premised on the Contract receiving any and all requisite approvals. In additions, the Hospital
continues to work with other District agencies to determine the most effective manner for all involved to achieve their respective legislative mandates while the Hospital
strives to meet: (i) its Establishment Act purposes (D.C Official Code §44-95 1.02(b)): (ii) the Hospital Board of Directors approved Strategic Plan (all thirteen
Councilmcmbcrs introduced the Sense of the Council Not-for-Profil Hospital Corporation Transformation and Sustainability Resolution of2014 (PRO-731)), which
expressed the desire that the Hospital move swiftly to implement the strategic plan); and (iii) its clarified District government charged legislative mandate in the Fiscal Year
2015 Budget Support Emergency Act of 2014 (B20-849), which required the Hospital move forward expeditiously with improving UMC operations and soliciting proposals
for private sector takeover of the ownership and management of the United Medical Center. • Maryland barred attorney not licensed to practice law in D.C.. work is
supervised by a D.C. Bar Member. Page of Pages
I of 1
NFPHC-MS-22-C-00043
4. Requisilion/Purchasc Order/Task Order/Modification Number:
Modification #11
7. Subject:
Other:Change Order8.
X
10. Total Contract Amount: $3,425,000.009. Modification/Change Order Amount: $2,500,000.00
11. Modification to increase NTE amount and to exercise the remainder of contract Option Year Two (OY2) for the provision of Nurses.
Date:Date:12. Name of Contractor: Maxim Healthcare Staffing Services. Inc.
/C. (Zfehi&i' 3/21/2023Signature:
14. GENERAL COUNSEL - LEGAL SUFFICIENCY •
Legal Sufficiency:
j NFPHC Chief Operating OfficerCEO REVIEW APPROVAL:OCFO REVIEW APPROVAL:.
All terms of the Contract shall remain in full force and effect.
Modification reflects new rates
Maxim Healthcare Staffing Services, Inc.
962 Wayne Avenue, Suite 600
Silver Spring, MD 20910
Exercise of
Option Supplemental
Agreement
CONTRACT MODIFICATION/ CHANGE
ORDER
Letter Contract/
Contract Extension
/ hereby certify funds are sufficiently included in the District's FY 2023 budget and
financial plan to support this Contract.
13. Signature ofContracting Officer: Kendrick Dandridge,
Contracting Officer
Signature:
a.
b.
Modification/change order to increase NTE and to exercise the remainder of
Option Year two (OY2), commencing on February 8, 2023 and concluding on
December 09, 2023.
3a. Effective Date:
February 8, 2023
3b. Date of Council
Approval:
DocuSign Envelope ID: D6CE3BD4-EFE0-49CA-9BEB-5201F6C60613
NOT-FOR-PROFIT HOSPITAL CORPORATION, commonly known as
United Medical Center,
an instrumentality of the District of Columbia government, hereinafter
known as the “Hospital”.
FOR INTERNAL PURPOSES ONLY
-----------------------
3/21/2023
; NFPHC Budget Officer
Unit:
ED
ICU
MS/T
RT
Rates
$125.00
$122.00
$110,00
$98.00
2. Address (Send invoices here)
Not-For-Profit Hospital Corporation
United Medical Center - Accounts Payable
1310 Southern Avenue, S.E.
Washington, D.C. 20032
5. Department(s) Using Goods or Services: Nursing Department
6. Contractor: name; address; phone number and email address
0^:3/21/202
15. CERTIFICATION OF FUNDS
Signaturc:/ ____________
Lilian Chukwuma, NFPHC CFO
This contract appears legally sufficient. Please be advised that my finding is premised on the Contract receiving any and all requisite approvals. In additions, the Hospital
continues to work with other District agencies to determine the most effective manner for all involved to achieve their respective legislative mandates while the Hospital
strives to meet: (i) its Establishment Act purposes (D.C Official Code §44-95 1.02(b)): (ii) the Hospital Board of Directors approved Strategic Plan (all thirteen
Councilmembers introduced the Sense of the Council Not-for-Profit Hospital Corporation Transformation and Sustainability Resolution of 2014 (PRO-731)), which
expressed the desire that the Hospital move swifily to implement the strategic plan); and (iii) its clarified District government charged legislative mandate in the Fiscal Year
2015 Budget Support Emergency Act of 2014 (B20-849), which required the Hospital move forward expeditiously with improving UMC operations and soliciting proposals
for private sector takeover of the ownership and management of the United Medical Center.
3/21/2023
Date:
Yanira van den Broeck Nieves, NFPHC Associate General Counsel DocuSign Envelope ID: D6CE38D4-EFE0-49CA-9BEB-5201F6C60613
Page
CONTRACT MODIFICATION/ CHANGE ORDER
1 of 1
NFPHC-NSD-21-C-00027
4. Rcquisition/Purchase Ordcr/Task Order/Modification Number:
Modification #10
7. Subject:6. Contractor: name; address; phone number and email address
Other:Change Order8.
X
Date:Date:
Signature: L2/13/2022
Signature:
14. GENERAL COUNSEL - LEGAL SUFFICIENCY
Legal Sufficiency:
Michael Austin, NFPHC Associate Counsel •
Date: Signature:
fa; NFPHC CFO
FOR INTERNAL PURPOSES ONLY
: NFPHC Chief Executive OfficerCEO REVIEW APPROVAL: : NFPHC Budget OfficerOCFO REVIEW APPROVAL:
Maxim Healthcare Staffing Services, Inc.
962 Wayne Avenue, Suite 600
Silver Spring, MD 20910
*A11 other terms and conditions of the contract shall remain the same.
* Modification reflects new rates
Supplemental
Agreement
13. Signature of Contracting Officer: Kendrick Dandridge,
Contracting Officer
/ hereby certify funds are sufficiently included in the District's FY 2023 budget and
financial plan to support this Contract.
Modification to partially exercise Option Year Two (OY2) for sixty (60)
days, commencing on December 10, 2022 and terminating on February
7, 2023.
12. Name of Contractor: Rob Coombs
NOT-FOR-PROFIT HOSPITAL CORPORATION, commonly known as
United Medical Center,
an instrumentality of the District of Columbia government, hereinafter
known as the “Hospital”.
2. Address (Send invoices here)
Not-For-Profit Hospital Corporation
United Medical Center - Accounts Payable
1310 Southern Avenue, S.E.
Washington, D.C. 20032
5. Department(s) Using Goods or Services: Nursing Department
3a. Effective Dale:
December 10, 2022
3b. Date of Council
Approval: N/A
Exercise of
_____
Option____________
9. Modification/Change Order Amount: $925,000.00
11. Modification to partially exercise Option Year Two (OY2) for sixty (60) days for the provision of Nurses.
Unit:
ED
ICU
MS/T
RT
Letter Contract/
Contract Extension
10. Total Contract Amount: $925,000.00
Rates
$138.00
$135.00
$115.00
$110.00
12/6/2022
Dale:
15. CERTIFICATION OF FUNDS
Lilian Chuk^wtfa; NFf
This contract appears legally sufficient. Please be advised that my finding is premised on the Contract receiving any and all requisite approvals. In additions, the Hospital
continues to work with other District agencies to detennine the most effective manner for all involved to achieve their respective legislative mandates while the Hospital
strives to meet: (i) its Establishment Act purposes (D.C Official Code §44-95 1.02(b)): (ii) the Hospital Board of Directors approved Strategic Plan (all thirteen
Councilmembers introduced the Sense of the Council Not-for-Profil Hospital Corporation Transformation and Sustainability Resolution of 2014 (PRO-731 )), which
expressed the desire that the Hospital move swiftly to implement the strategic plan); and (iii) its clarified District government charged legislative mandate in the Fiscal Year
2015 Budget Support Emergency Act of 2014 (B20-849), which required the Hospital move forward expeditiously with improving UMC operations and soliciting proposals
for private sector takeover of the ownership and management of the United Medical Center. * Maryland barred attorney not licensed to practice law in D.C., work is
supervised by a D.C. Bar Member. Page of Pages
1 of i
NFPHC-NSD-21-C-00027
4. Requisition/Purchase Ordcr/Task Ordcr/Modification Number:
Modification #9
7. Subject:
Other:Change Order8.
X
10. Total Contract Amount: $6,259,863.029. Modification/Changc Order Amount: $2,000,000.00
11. Modification to increase NTE amount for the remainder of the contract for the provision of Nurses.
All terms of the Contract shall remain in full force and effect.a.
Date:Date:racting Onicer: Kendnck I
11/10/2022
10/07/2022
14. GENERAL COUNSEL - LEGAL SUFFICIENCY
Legal Sufficiency:
Michael Austin, NFPHC Attorney*
Date:
FOR INTERNAL PURPOSES ONLY
: NFPHC Chief Executive OfficerCEO REVIEW APPROVAL:: NFPHC Budget OfficerOCFO REVIEW APPROVAL:.
t
Maxim Healthcare Staffing Services, Inc.
962 Wayne Avenue, Suite 600
Silver Spring, MD 20910
Exercise of
Option
Supplemental
Agreement
13. Signature of Contracting Officer: Kendrick Dandridge,
Contracting Officer
Signature: /_
CONTRACT MODIFICATION/ CHANGE
ORDER
Modification to partially exercise Option Year One (OYI), commencing on October
1, 2022 and concluding on December 09, 2022.
Letter Contract/
Contract Extension
DocuSign Envelope ID: D6CE3BD4-EFE0-49CA-9BEB-5201F6C60613
NOT-FOR-PROFIT HOSPITAL CORPORATION, commonly known as
United Medical Center,
an instrumentality of the District of Columbia government, hereinafter
known as the “Hospital”.
2. Address (Send invoices here)
Not-For-Profit Hospital Corporation
United Medical Center - Accounts Payable
1310 Southern Avenue, S.E.
Washington, D.C. 20032
5. Dcpartmcnt(s) Using Goods or Services: Nursing Department
6. Contractor: name; address; phone number and email address
3a. Effective Date:
October 1,2022
3b. Date of Council
Approval: 11/01/2022
Unit:
ED
ICU
MS/T
RT
Rates
$138.00
$135.00
$115.00
$110.00
15. CERTIFICATION OF FUNDS
Signaturc: / >______
Lilian ChukwumaTffFPHC CFO
This contract appears legally sufficient subject to the Contract receiving CFO fiscal sufficiency and all requisite approvals from the
NFPHC Board and/or DC Council. In addition, this certification is subject to apl requirements set forth in the DC laws and regulations
including but not limited to: The Procurement Practices Reform Act, as amended; the contractor’s execution of NFPHC Business
Associate Agreements; and, inclusion of NFPC Standard Contract Provisions (SCPs) and UMC contract clauses. *Maryland barred
attorney not licensed to practice law in D.C., work is supervised by a D.C. Bar Member.
/ hereby certify funds are sufficiently included in the District's FY 2023 budget and
10/21/202^nancia/pian to support this Contract.
10/21/2022
Date:
12. Name of Contractor: Rob Coombs
Maxim Healthcare Staffing Services, Inc.
Signature: Page of Pages
1 of 1
NFPHC-NSD-21-00027
4. Requisition/Purchase Order/TaskOrder/Modification Number:
Modification #8
7. Subject:
Other:Change Order
X
10. Total Contract Amount: $4,259,863.029. Modification/Change Order Amount: $890,000.00
11. Modification to increase NTE amount for the remainder of the contract for the provision of Nurses.
a.
All other terms of the Contract shall remain in full force and effect.b.
Date:
rSep-22
11/10/202 >Signature:
14. GENERAL COUNSEL - LEGAL SUFFICIENCY
9/28/2022
Date: Legal Sufficiency: .
Date:
FOR INTERNAL PURPOSES ONLY
; NFPHC Chief Operating OfficerCOO REVIEW APPROVAL:; NFPHC Budget OfficerOCFO REVIEW APPROVAL:.
Exercise of
Option
Supplemental
Agreement
CONTRACT MODIFICATION/ CHANGE
ORDER
This Modification is for additional funds for supplemental staffing of Nurses for a
period from June 23,2022 and terminating on September 30,2022.
Letter Contract/
Contract Extension
Healthcare Staf4iW^c5enrt|c^®?^o£5'on^n8(Jffi5r: KendrickDandrid8e-
28
2. Address (Send invoices here) y
Not-For-Profit Hospital Corporation
United Medical Center - Accounts Payable
1310 Southern Avenue, S.E.
Washington, D.C. 20032
5. Department(s) Using Goods or Services: Nursing Department
6. Contractor: name; address: phone number and email address
DocuSign Envelope ID: D6CE3BD4-EFE0-49CA-9BEB-5201F6C60613
NOT-FOR-PROFIT HOSPITAL CORPORATION, commonly known as
United Medical Center.
an instrumentality of the District of Columbia government, hereinafter
known as the “Hospital”.
Rates
$138.00
$135.00
SI 15.00
$110.00
3a. Effective Date: See box
7
3b.-Date of Council
Approval: 11/01/2022
Unit:
ED
ICU
MS/T
RT
Modification reflects new rates.
Maxim Healthcare Staffing Services, Inc.
962 Wayne Avenue, Suite 600
Silver Spring, MD 20910
15. CERTIFICATION OF FUNDS
Signature:
Lilian ChWnrtima, NFPHC CFO
a/7R/7D7> hereby certify funds are sujficientty included in the District's FY 2022 budget and
y/Zo/2U2 . financial p/an to support this Contract.
„ .. ____ jntracting Officer: Kendric
■Contracting Officer 7^/ /
Signature: /
< J
MichaerAustin, NFPHC Attorney *
12. Name
This contract appears legally sufficient. Please be advised that my finding is premised on the Contract receiving any and all requisite approvals. In additions, the Hospital
continues to work with other District agencies to determine the most effective manner for all involved to achieve their respective legislative mandates while the Hospital
strives to meet: (i) its Establishment Act purposes (DC Official Code §44-951.02(b)): (ii) the Hospital Board of Directors approved Strategic Plan (all thirteen
Councilmembers introduced the Sense of the Council Not-for-Profit Hospital Corporation Transformation and Sustainability Resolution of 2014 (PRO-731)). which
expressed the desire that the Hospital move swift ly to implement the strategic plan), and (iii) its clarified District government charged legislative mandate in the Fiscal Year
2015 Budget Support Emergency Act of 2014 (B20-849). which required the Hospital move forward expeditiously with improving (JMC operations and soliciting proposals
for private sector takeover of the ownership and management of the United Medical Center. ‘Maryland barred attorney not licensed to practice law in D.C., work is
supervised by a D.C. Bar Member. Page of Pages
1 of 1
NFPHC-NSD-21-C-00027
4. Requisition/Purchase Order/Task Ordcr/Modification Number:
Modification #7
7. Subject:
Other:Change Order8.
X
10. Total Contract Amount: $3,369,863.029. Modification/Changc Order Amount: $1,500,000.00
All other terms of the Contract shall remain in full force and cfTect.a.
b.
Date:Date:
6/13/2022 6/30/2022Signature:
Signature:
14. GENERAL COUNSEL - LEGAL SUFFICIENCY
Legal Sufficiency:
Michael Austin, NFPHC Attorney
OFFENDS
Date:
FOR INTERNAL PURPOSES ONLY
N/A
; NFPHC Chief Operating OfficerCOO REVIEW APPROVAL:.; NFPHC Budget OfficerOCFO REVIEW APPROVAL:.
Maxim Healthcare Staffing Services, Inc.
962 Wayne Avenue, Suite 600
Silver Spring, MD 20910
Exercise of
Option
Contracting Officer’s Technical Representative (COTR) for this Contract is:
Teka Henderson
Director of Nursing
Email: TEHenderson@Unitcd-MedicalCcntcr.com
Supplemental
Agreement
CONTRACT MODIFICATION/ CHANGE
ORDER
Letter Contract/
Contract Extension
Modification to extend Option Year One (OY1) commencing on June
23, 2022 and terminating on September 30, 2022.
13. Signature of Contracting Officer: William Strudwick,
Interim Chief Executive Officer
12. Name of Contractor: Maxim Healthcare Staffing Services. Inc.
Signature:_____________
Lilian Chukwuma, NFPHC CFO
DocuSign Envelope ID: D6CE3BD4-EFE0-49CA-9BEB-5201F6C60613
NOT-FOR-PROFIT HOSPITAL CORPORATION, commonly known as
United Medical Center,
an instrumentality of the District of Columbia government, hereinafter
known as the “Hospital”.
3a. Effective Date:
June 23, 2022
3b. Date of Council
2. Address (Send invoices here)
Not-For-Profit Hospital Corporation
United Medical Center - Accounts Payable
1310 Southern Avenue, S.E.
Washington, D.C. 20032_______________
5. Dcpartment(s) Using Goods or Services: Nursing Department
6. Contractor: name; address; phone number and email address
6/15/2022
Date:
15. CERTIFICATING
I hereby certify funds are sufficiently included in the District's FY 2022 budget and
6/17/2O2 . financial plan to support this Contract.
This contraci appears legally sufficient. Please be advised that my finding is premised on the Contract receiving any and all requisite approvals. In additions, the Hospital
continues to work with other District agencies to determine the most effective manner for all involved to achieve their respective legislative mandates while the Hospital
strives to meet: (i) its Establishment Act purposes (D.C Official Code §44-95 1.02(b)): (ii) the Hospital Board of Directors approved Strategic Plan (all thirteen
Councilmcmbcrs introduced the Sense of the Council Not-for-Profii Hospital Corporation Transformation and Sustainability Resolution of2014 (PRO-731)), which
expressed
the desire that the Hospital move swiftly to implement the strategic plan); and (iii) its clarified District government charged legislative mandate in the Fiscal Year
2015 Budget Support Emergency Act of 2014 (B20-849), which required the Hospital move forward expeditiously with improving UMC operations and soliciting proposals
for private sector takeover of the ownership and management of the United Medical Center.
11. Modification to extend Option Year One (OY1) for a period from June 23, 2022 to September 30, 2022. DocuSign Envelope ID: D6CE3BD4-EFE0-49CA-9BEB-5201F6C60613
NFPHC-NSI>*21-C-00027
4. Rcquisition/Purchase Order/Task Order/Modificalion Number
Modification #6
7. Subject:
Other:Change Order8.
X
10. Total Contract Amount $1,869,863.029. Modification/Change Order Amount: $1,726,027.40
Date:
12/13/2021
Signature:
a.NFPHCCFO
FOR INTERNAL PURPOSES ONLY
NFPHC Chief Operating OfficerCOO REVIEW APPROVAL:.
Hospital Intis (Re: Sections 7,11,12):
Exercise of
Option
Supplemental
A&eement
CONTRACT MODIFICATION/ CHANGE
ORDER
Modification to extend Option Year One (OY1) for one- hundred
eighty (180) days, commencing on December 25, 2021 and
terminating on June 22,2022.
1 hereby certifyfunds are syfficienlfy included in the District *s FY 2022
budge! andfinancial plan to support this Cartract.
t
Maxim Healthcare Staffing Services, Inc.
962 Wayne Avenue, Suite 600
Silver Spring, MD 20910
Letter Contract/
Contract
Extension
Page
1 of2
ATTN: John Miller
(301) 585-9773
www.maximhealthcare.com
| SertiH Glcarontc Signa tur a
................
Date:.
/18/2022
DocuSign Envelope ID: 2982078E-B4C4-4331-8673-4F6F3B0D371C
NOT-FOR-PROFIT HOSPITAL CORPORATION, commonly known as
United Medical Center,
m instrumentality of the District of Columbia government, hereinafter
known as the “Hospital”.
Signan
AlexP
14. GE
3a. Effective Date:
See box 13
3b. Date of Council
Approval:
2. Address (Send invoices here)
Not-For-Profit Hospital Corporation
United Medical Center - Accounts Payable
1310 Southern Avenue, S£.
Washington, D.C. 20032
5. Departments) Using Goods or Services: Nursing Department
6. Contractor name; address; phone number and email address
Contractor Intis (Re: Sections 7,11,12): P,^o^
12. nf Cnnhmrfnr* Maxim Hgfilthi
Service
11. Modification to extend Option Year One (O Y1) for one-hundred eighty (180) days for a period from
December 25,2021 to June 22,2022 All other terms and condition of the Contract shall remain in effect.
12/16/2021
Date:
Legal Sufficiency:
yrpim k. Dhillon, NFPHC Outside Counsel
15. CERTIFICATION OF FUNDS
Signature: /
Lilian Chi
13. Signature of Contracting Officer Marcela Maamari,
Chief Contracting Officer
n—ureruEaero* -
5D?ZUilfti3h5634568
This contract appears legally sufficient Please be advised that my finding is premised on the Contract receiving any and all requisite approvals. In additions, the Hospital
continues to work with other District agencies to determine the most effective manner for all involved to achieve their respective legislative mandata while the Hospital
strives to meet (i) its Establishment Act purposes (D.C Official Code J44-951.02(b)): (ii) the Hospital Board of Directors approved Strategic Plan (aD thirteen
Councilmerabers introduced the Sense of the Council Not-foHYofit Hospital Corporation Transformation and Sustainability Resolution of 2014 (PRO-731)), which
expressed the desire that the Hospital move swiftly to implement the strategic plan); and (iii) its clarified District government charged legislative mandate In the Fisal Year
2015 Budget Support Emergency Act of 2014 (B20-849), which required the Hospital move forward expeditiously with improving UMC operations and soliciting proposals
for private sector takeover of the ownership and management of the United Medical Center.
OCFO REVIEW APPROVAL:/^ : NFPHC Budget Officer
12/13/2021
Date:
ifflir ^tarfinn
E-SJyned: 12/13/2021 04:00 PM ST
<^4, dPrfor
BtpnorAmaxheBnh.com
IP: 136.226.48.252
mavn*. luunimc NFPHC-NSD-21-C-00027
4. Requisition/Purchase Ordcr/Task Order/Modification Number:
Modification #5
7. Subject:
Other:Change Order8.
X
10. Total Contract Amount: $143,835.629. Modification/Change Order Amount: $143,835.62
Date:Date:
12/6/2021
Signature:
Signatu:
2/03/2021
Legal Sufficiency:
12/6/202
Date:
FOR INTERNAL PURPOSES ONLY
.: NFPHC Chief Operating OfficerCOO REVIEW APPROVAL:,.: NFPHC Budget OfficerOCFO REVIEW APPROVAL:.
Doc ID: 20211203123034585
Sertlfi Electronic Signature
11. Modification to partially exercise Option Year One (OY1) for fifteen (15) days for a period from December
9, 2021 to December 24, 2021. All other terms and condition of the Contract shall remain in effect.
Maxim Healthcare Staffing Services, Inc.
962 Wayne Avenue, Suite 600
Silver Spring, MD 20910
12. Nan
Service
Exercise of
Option
Supplemental
Agreement
CONTRACT MODIFICATION/ CHANGE
ORDER
Letter Contract/
Contract
Extension
I hereby certify funds are sufficiently included in the District's FY 2021 budget
and financial plan to support this Contract.
Modification to partially exercise Option Year One (OY1) for fifteen
(15) days, commencing on December 9, 2021 and terminating on
December 24, 2021.
Page
1 of2
ATTN: John Miller
(301) 585-9773
www.maximhealthcare.com
13. Signature of Contracting Officer: Marcela Maamari,
Chief Contracting Officer
/kA.
Signature: ( y
_____ Lilian Chukwuma, NFPHC CFO
OocuSign Envelope ID: D6CE3BD4-EFE0-49CA-9BEB-5201F6C60613
NOT-FOR-PROFIT HOSPITAL CORPORATION, commonly known as
United Medical Center,
an instrumentality of the District of Columbia government, hereinafter
known as the “Hospital”.
3a. Effective Date:
Sec box 13
3b. Date of Council
Approval: N/A
2. Address (Send invoices here)
Not-For-Profit Hospital Corporation
United Medical Center - Accounts Payable
1310 Southern Avenue, S.E.
Washington, D.C. 20032
5. Department(s) Using Goods or Services: Nursing Department
6. Contractor: name; address; phone number and email address
Megan K. Dhillon, NFPHC Outside Counsel
15. CERTIFICATION OF FUNDS
E-Signed: 12/03/2021 01:34 PM EST
^innifer &Qymann.
jeheyman@maxhealth.com
IP: 136.226.49.7
14. GENERAL COUNSEL - LEGAB<8I9FFIOW2NE¥034S85
This contract appears legally sufficient. Please be advised that my finding is premised on the Contract receiving any and all requisite approvals. In additions, the Hospital
continues to work with other District agencies to determine the most effective manner for all involved to achieve their respective legislative mandates while the Hospital
strives to meet: (i) its Establishment Act purposes (D.C Official Code §44-95 1.02(b)): (ii) the Hospital Board of Directors approved Strategic Plan (all thirteen
Councilmcmbcrs introduced the Sense of the Council Not-for-Profii Hospital Corporation Transformation and Sustainability Resolution of 2014 (PRO-731)), which
expressed the desire that the Hospital move swiftly to implement the strategic plan); and (iii) its clarified District government charged legislative mandate in the Fiscal Year
2015 Budget Support Emergency Act of 2014 (B20-849), which required the Hospital move forward expeditiously with improving UMC operations and soliciting proposals
for private sector takeover of the ownership and management of the United Medical Center.
12/3/2021
Date: NFPHC-NSD-21-C-00027
4. Requisition/Purchase Ordcr/Task Order/Modification Number:
Modification #3
7. Subject:
Other:Change Order8.
X
10. Total Contract Amount: $3,500,000.009. Modification/Changc Order Amount: N/A
Date:Jennifer Heymann, AssistantDate:
7/9/2021
07/02/2021
14. GENERAL COUNSEL - LEGAL SUFFICIENCY
7/8/2021
Dale:
FOR INTERNAL PURPOSES ONLY
; NFPHC Chief Operating OfficerCOO REVIEW APPROVAL:.NFPHC Budget OfficerOCFO REVIEW APPROVAL:
DOC ID: 20210701111251707
Maxim Healthcare Staffing Services, Inc.
962 Wayne Avenue. Suite 600
Silver Spring, MD 20910
Exercise of
Option
Supplemental
Agreement
CONTRACT MODIFICATION/ CHANGE
ORDER
Letter Contract/
Contract
Extension
Modification to reflect new rates, as set forth in the enclosed
amendment.
The total contract amount shall not change.
Page
1 of2
ATTN: John Miller
(301)585-9773
www.maximhcalthcarc.com
/ hereby certify funds are sufficiently included in the District's FY 2021 budget
and financial plan io support this Contract.
DocuSign Envelope ID: D6CE3BD4-EFE0-49CA-9BEB-5201F6C60613
NOT-FOR-PROFIT HOSPITAL CORPORATION, commonly known as
United Medical Center,
an instrumentality of the District of Columbia government, hereinafter
known
as the “Hospital".
3a. Effective Date:
See box 13
3b. Date of Council
Approval: N/A
2. Address (Send invoices here)
Not-For-Profit Hospital Corporation
United Medical Center - Accounts Payable
1310 Southern Avenue, S.E.
Washington, D.C. 20032
5. Department(s) Using Goods or Services: Nursing Department
6. Contractor: name; address; phone number and email address
11. Modification to reflect new rates, as set forth in the enclosed amendment. All other terms and condition of the
Contract shall remain in effect.
15.CERTIFIC.
Signature:
________Lilian Chukwuma, NFPHC CFO
13. Signature ofContracling Officer: Marcela Maamari,
Chief Contracting Officer
c. K ykA-.
Signature: _____________________________
12. Name of Contractor:
Controller
mann
Signature: jeheyman@maxhealth.com
Dau:7/9/2021
This contract appears legally sufficient. Please be advised that my finding is premised on the Contract receiving any and all requisite approvals. In additions, the Hospital
continues to work with other District agencies to determine the most effective manner for all involved to achieve their respective legislative mandates while the Hospital
strives to meet: (i) its Establishment Act purposes (D.C Official Code §44-95 1.02(b)): (ii) the Hospital Board of Directors approved Strategic Plan (all thirteen
Councilmembcrs introduced the Sense of the Council Not-for-profit Hospital Corporation Transformation and Sustainability Resolution of 2014 (PRO-731)), which
expressed the desire that the Hospital move swiftly to implement the strategic plan); and (iii) its clarified District government charged legislative mandate in the Fiscal Year
2015 Budget Support Emergency Act of 2014 (B20-849), which required the Hospital move forward expeditiously with improving UMC operations and soliciting proposals
for private sector takeover of the ownership and management of the United Medical Center.
^f^----
Legal Sufficiency: •
Megan K. Dhillon, NFPHC Outside Counsel
!£LlpN 0? FUNDS DocuSign Envelope ID: D6CE3BD4-EFE0-49CA-9BEB-5201F6C60613
AGREEMENT AMENDMENT
RECITALS
WHEREAS, FACILITY and MAXIM entered into the Agreement, with an effective date of 12/10/2020.
All other terms and conditions will
STAFFING
NFPHC - UNITED MEDICAL CENTER
Printed Name & Title
07/01/2021
DateDate
>i
Doc ID: 20210701104754367
This Amendment (hereinafter “Amendment”) to the Facility Staffing Agreement (hereinafter “Agreement”) is
entered into this 28th day of June, 2021, by and between The Not-for-Profit Hospital Corporation DBA United
Medical Center located at 1310 Southern Ave SE, Washington, DC 20032 , referred'to in this Agreement as
“FACILITY,” and Maxim Healthcare Staffing Services, Inc., a. Maryland Corporation including its affiliates-and
subsidiaries, with, an office located at 962 Wayne Avenue, Suite 600, Silver Spring, MD 20910, referred to in this
Agreement as “MAXIM.” ,,
WHEREAS, FACILTY and MAXIM wish to amend the Agreement to incorporate the following terms and
conditions. \
The terms and conditions of this Amendment are effective as of 6/28/2021.
remain unchanged as stated in the Agreement.
FACILITY and MAXIM have acknowledged their understanding of and agreement to the mutual promises written
above by executing and delivering this Agreement as of the date set forth above.
Copyright 2021
All Rights Reserved
axim
healthcare services
Services
RN | ICU / CCU
RN | ER
RN | M/S
Rate
$132
$112
$110
__________________
Signature
Marcela Maamari, Chief Contracting Officer
Printed Name & Title
7/9/2021
MAXIM HEALTHCARE
SERVICE
bramcgee@maxhealth.com
Signature
Brandan McGee - Assistant Controller
Rate Amendment i
Maxim Healthcare Staffing Services, Inc. •
THEREFORE, in consideration of the above premises set forth herein, and for other good and valuable
consideration, the receipt and sufficiency of which are acknowledged by the parties, and intending to be legally
bound, FACILITY and MAXIM hereby agree to amend the Agreement to reflect the following terms and conditions.
The following rates shalbbe applicable as of the Effective Date listed below and are for new employees only.
' Employees already in contract shall not be impacted by the rates below: NFPHC-NSD-2I-C-00027
4. Requisition/Purchase Ordcr/Task Order/Modiflcation Number:
Modification #2
7. Subject:
Other:Change Order8.
X
CCO Initials:10. Total Contract Amount: 53,500,000.009. Modification/ChangcOrder Amount: $2,600,000.00
Maam3ii
Date:
Alex Prior: Controller Date:12.Name ofContractor:
7/7/2021
5/28/2021
Date: Legal Sufficiency:
FOR FNTERNAL PURPOSES ONLY
.: NFPHC ChiefOpcrating Officer
OCFO REVIEW APPROVAL
Maxim Healthcare Staffing Services, Inc.
962 Wayne Avenue, Suite 600
Silver Spring, MD 20910
Exercise of
Option
Supplemental
Agreement
CONTRACT MODIFICATION/ CHANGE
ORDER
Modification to increase NT E amount for the remainder of the
contract for the provision of supplemental staffing in nursing
specifically in the ICU and ER Department through December 9,
2021, at the new rates, as set forth in the enclosed Amendment.
No change to period; contract to be submitted to Council
Letter Contract/
Contract
Extension
/ hereby certify funds are sufficiently included in the District's FY 2021 budget
and financial plan to support this Contract.
ATTN: John Miller
(301)585-9773
www.maximhealthcare.com
Page
1 of 1
DocuSign Envelope ID: D6CE3BD4-EFE0-49CA-9BEB-5201F6C60613
NOT-FOR-PROFIT HOSPITAL CORPORATION, commonly known as
United Medical Center,
an instrumentality of the District of Columbia government, hereinafter
known as lhe“Hospitar’.
2. Address (Send invoicesherc)
Not-For-Profit Hospital Corporation
UnitedMcdical Center-Accounts Payable
1310 Southern Avenue, S.E.
Washington, D.C. 20032
5. Departmcnt(s)UsingGoods orScrvices: Nursing Department
6. Contractor: name; address; phone number and email address
3a. Effective Date:
Sec box 13
3b. DateofCouncil
Approval: TBD
Signature:
14. GENERAL COUNSEL - LEGAL SUFFICIENCY
13. Signature ofContractingOfficer:
Signature:
—OS
: NFPHC Budget Officer
MdTCfil3
ii. Modification to increase NTE amount for the remainder of the contract for the provision of supplemental
staffing in nursing specifically in the ICU and ER Department, and for telemetry services, through December 9,
2021, at the new rates, as set forth in the enclosed Amendment. All other terms and conditions of the Contract
shall remain in effect.
n 5/28/2021
Date: ________
— ps
COO REVIEW approval):
This contract appears legally sufficient. Please be advised that my finding is premised on the Contract receiving any and al I requisite approvals. In additions, the Hospital
continues to work with other District agencies to determine the most effective manner for all involved to achieve their respective legislative mandates while the Hospi tai
strives to meet: (i) its Establishment Act putposcs (D.C Official Code §44-95 1.02(b)): (ii) the Hospital Board of Directors approved Strategic Plan (all thirteen
Councilmembcrs introduced the Sense ofthc Council Not-fcr-Profit Hospital Corporation Transformation and Sustainability Resolution of2014 (PRO-731)), which
expressed the desire that the Hospital move swiflly to implement the strategic plan); and (iii) its clarified District government charged legislative mandate in the Fiscal Year
2015 Budget Support Emergency Act of 2014(820-849). which required the Hospital move forward expeditiously with improving UMC operations and soliciting proposals
for private sector takeover of the ownership and management of the United Medical Center.
OocuSignod by:
MegajHfe-EBSH6fiP>ai WtCOutside Counsel
15. CERTlFICATIOiy^PW^^^u
Signature: I
Lilian ChukwunCTft^ffi^" NFPHC-NSD-21-C-00027
4. Rcquisilion/Purchasc Ordcr/TaskOrder/Modificaiion Number:
Modification #1
7. Subject:
Other:Change Order8.
X
10. Total Contract Amount: 5900,000.009. Modification/Changc Order Amount: $600,000.00
Date:Date:Brandan McGee, Assistant
5/21/2021
Signature:
S
1
4/12/2021
Date: Legal Sufficiency:
FOR INTERNAL PURPOSES ONLY
NFPHC Chief Operating OfficerCOO REVIEW APPROVAL:..: NFPHC Budget OfficerOCFO REVIEW APPROVAL:.
Doc ID: 20210401115957952
Sertifi Electronic Signature
04/01/2021
I_______
Maxim Healthcare Staffing Services, Inc.
962 Wayne Avenue, Suite 600
Silver Spring, MD 20910
Exercise of
Option
Supplemental
Agreement
CONTRACT MODIFICATION/ CHANGE
ORDER
Letter Contract/
Contract
Extension
Modification to increase NT E amount for the remainder of the
contract for the provision of supplement al staffing in nursing
specifically
in the ICU and ER Department through December 9,
2021, and to reflect new rates, as set forth in the enclosed
Amendment.
/ hereby certify funds are sufficiently included in the District‘s FY 2021 budget
and financial plan to support this Contract.
Page
1 of3
ATTN: John Miller
(301)585-9773
www.maximhealthcarc.com
13.Signature of Contracting Officer: Marcela Maamari,
Contracting Officer
15.CERTIFK
Signature:____
Lilian Chukwuma, NFPHC CFO
DocuSign Envelope ID: D6CE3BQ4-EFE0-49CA-9BEB-5201F6C60613
NOT-FOR-PROFIT HOSPITAL CORPORATION, commonly known as
United Medical Center,
an instrumentality of the District of Columbia government, hereinafter
known as the“Hospital”.
2. Address (Send invoices here)
Not-For-Profit Hospital Corporation
UnitedMedical Center-Accounts Payable
1310 Southern Avenue, S.E.
Washington, D.C. 20032
5. Department(s) UsingGoods or Services: Nursing Department
6. Contractor: name; address; phone number and email address
3a. Effective Date:
See box 13
3b. DatcofCouncil
Approval: N/A
11. Modification to increase NTE amount for the remainder of the contract for the provision of supplemental
staffing in nursing specifically in the ICU and ER Department through December 9, 2021, and to reflect new
rates, as set forth in the enclosed Amendment.
Megan K. Dhillon, NFPHC Outside Counsel
q^JONO>F FUNDS
OocID: 20210401115957952
This contract appears legally sufficient. Please be advised that my finding is premised on the Contract receiving any and all requisite approvals. In additions, the Hospital
continues to work with other District agencies to determine the most effective manner for all involved to achieve their respective legislative mandates while the Hospital
strives to meet: (i) its Establishment Act purposes (D.C Official Code §44-95 1.02(b)): (ii) the Hospital Board of Directors approved Strategic Plan (all thirteen
Councilmcmbcrs introduced the Sense of the Council Not-for-Profit Hospital Corporation Transformation and Sustainability Resolution of2014(PRO-73l)), which
expressed the desire (hat the Hospital moveswifily to implement the strategic plan); and (iii) its clarified District government charged legislative mandate in the Fiscal Year
2015 Budget Support Emergency Act of 2014(820-849), which required the Hospital move forward expeditiously with improving UMC operations and soliciting proposals
for private sector takeover of the ownership and management of the UnitedMedical Center.
Dale:S/2O/2O21
12. Name ofContractor:
Controller
E-Signed: 04/01/2021 04:S9 PM EOT
bramcgee@maxhea1th.com
IP: 148.59.45.118 DocuSign Envelope ID: D6CE3BD4-EFE0-49CA-9BEB-5201F6C60613
AGREEMENT AMENDMENT
RECITALS
WHEREAS, FACILITY and MAXIM entered into the Agreement, with an effectixe date of December 10th, 2020.
The following rates shall be applicable as of the Effective Date listed below:
Services
All other terms and
All
Doc ID: 20210401115957952
THEREFORE, in consideration of the above premises set forth herein, and for other good and valuable
consideration, the receipt and sufficiency of which are acknowledged by the parties, and intending to be
legally bound, FACILITY and MAXIM hereby agree to amend the Agreement to reflect the following terms and
conditions.
This Amendment (hereinafter “Amendment”) to the COVID-19 Addendum (hereinafter "Agreement”) is entered
into this ,4th day of March, 2021, by and between United Medical Center located at 1310 Southern Avs SE
Washington, DC 20032, referred to in this Agreement as "FACILITY,1’ and Maxim Healthcare Staffing
Services, Inc., a Maryland Corporation including its affiliates and subsidiaries, with an office located at 962
Wayne Avenue Suite 600 Silver Spring, MD 20910, referred to in this Agreement as “MAXIM.”
WHEREAS, FACILTY and MAXIM wish to amend the Agreement to incorporate the following terms and
conditions.
The terms and conditions of this Amendment are effective as of March 4th, 2021.
conditions will remain unchanged as stated in the Agreement.
I
1
S'? maxim
healthcare services
RN - ICU
RN-ER
RN - Telemetry
Rate
$180.00
$150.00
$135.00
Rate Amendment
Copyright 2021
Maxim Healthcare Staffing Services, Inc.
Rights Reserved
\ DocuSign Envelope ID: D6CE3BD4-EFE0-49CA-9BEB-5201F6C60613
i
UNITED MEDICAL CENTER STAFFING
Printed Name & Title
04/01/2021
• \
DateDate
1
•5
2
Doc ID: 20210401115957952I
I
FACILITY and MAXIM have acknowledged their understanding of and agreement to the mutual promises .
written above by executing and delivering this Agreement as of the date set forth above.
Signature
Brandan McGee, Assistant Controller
Signature '
Marcela Maamari, Contracting Officer
Printed Name & Title
5/21/2021
MAXIM HEALTHCARE
SERVICES, INC.:
■ Dramcgee@maxhealth.com NFPHC-NSD-21-C-00027
4. Requisilion/Purchase Ordcr/Task Order/Modification Number:
Modification#!
7. Subject:
Other:Change Order8.
X
10. Total Contract Amount: 5900,000.009. Modification/ChangeOrder Amount: $600,000.00
Date:Date:Brandan McGee, Assistant
5/21/2021
Signature:
S
I
4/12/2021
Date: Legal Sufficiency:
FOR INTERNAL PURPOSES ONLY
,: NFPHC Chief Operating OfficerCOO REVIEW APPROVAL:..: NFPHC Budget OfficerOCFO REVIEW APPROVAL:.
Doc ID: 20210401115957952
Scrtifi Electronic Signature
04/01/2021
I_______
Maxim Healthcare Staffing Services, Inc.
962 Wayne Avenue, Suite 600
Silver Spring, MD 20910
Exercise of
Option
Supplemental
Agreement
CONTRACT MODIFICATION/ CHANGE
ORDER
Letter Contract/
Contract
Extension
Modification to increase NT E amount for the remainder of the
contract for the provision of supplemental staffing in nursing
specifically
in the 1CU and ER Department through December 9,
2021, andto reflect new rates, as set forth in the enclosed
Amendment.
Page
1 of 3
ATTN: John Miller
(301) 585-9773
www.maximhealthcare.com
13. Signature of ContractingOfficer: Marcela Maamari,
Contracting Officer
A/L
15.CERTIFK
Signature:___
Lilian Chukwuma, NFPHC CFO
11. Modification to increase NTE amount for the remainder of the contract for the provision of supplemental
staffing in nursing specifically in the ICU and ER Department through December 9, 2021, and to reflect new
rates, as set forth in the enclosed Amendment.
3a. Effective Date:
See box 13
3b. Dale ofCouncil
Approval: N/A
2. Address (Send invoiceshcrc)
Not-For-Profit Hospital Corporation
UnitedMedical Center-Accounts Payable
1310 Southern Avenue, S.E.
Washington, D.C. 20032
5. Department(s) UsingGoods or Services: Nursing Department
6. Contractor: name; address; phone number and email address
DocuSign Envelope ID: D6CE3BD4-EFE0-49CA-9BEB-5201F6C60613
NOT-FOR-PROFIT HOSPITAL CORPORATION, commonly known as
UnitedMedical Center,
an instrumentality of the District of Columbia government, hereinafter
known as the“Hospital”.
Megan K. Dhillon, NFPHC OutsideCounsel
GgONQiF FUNDS
DoclD: 20210401115957952
This contract appeare legally sufficient. Please be advised that my finding is premised on the Contract receiving any and all requisite approvals. In additions, the Hospital
continues to work with other District agencies to determine the most effective manner for all involved to achieve their respective legislative mandates while the Hospital
strives to meet: (i) its Establishment Act purposes (D.C Official Code §44-95 1.02(b)): (ii) the Hospital Board of Directors approved Strategic Plan (all thirteen
Councilmembers introduced the Sense of the Council Nol-for-Profit Hospital Corporation Transformation and Sustainability Resolution of 2014 (PRO-731)), which
expressed the desire that the Hospital moveswiflly to implement the strategic plan); and (iii) its clarified District government charged legislative mandate in the Fiscal Year
2015 Budget Support Emergency Act of 2014(620-849), which required the Hospital move forward expeditiously with improving UMC operations and soliciting proposals
for private sector takeover of the ownership and management of the United Medical Center.
Date;5/20/2021
/ hereby certify funds are sufficiently included in the District's FY 2021 budget
and financial plan to support this Contract.
12. Name of Contractor:
Controller
E-Signed: 04/01/2021 04:59 PM EOT
bramcgee@maxhealtn.com
IP: 148.59.45.115 DocuSign Envelope ID: D6CE3BD4-EFE0-49CA-9BEB-5201F6C60613
AGREEMENT AMENDMENT
RECITALS
WHEREAS, FACILITY and MAXIM entered into the Agreement, with an effecti\« date of December 10th, 2020.
The following rates shall be applicable as of the Effective Date listed below:
Services
All other terms and
All
Doc ID: 20210401115957952
Rate Amendment
Copyright 2021
Maxim Healthcare Staffing Services, Inc.
Rights Reserved
WHEREAS, FACILTY and MAXIM wish to amend the Agreement to incorporate the following terms and
. conditions.
This Amendment (hereinafter "Amendment”) to the COVID-19 Addendum (hereinafter “Agreement”) is entered
into this 4th day of March, 2021, by and between United Medical Center located at 1310 Southern Ave SE z
Washington, DC 20032, referred to in, this Agreement as “FACILITY," and Maxim Healthcare Staffing
Services, Inc., a Maryland Corporation including its affiliates and subsidiaries, with an office located at 962
Wayne Avenue Suite 600 Silver Spring, MD 20910, referred to in this Agreement as “MAXIM.”
The*terms and conditions of this Amendment are effective as of March 4th, 2021.
conditions will remain unchanged as stated in the Agreement.
THEREFORE, in consideration of the above premises set forth herein, and for other good and valuable
consideration, the receipt and sufficiency of which are acknowledged by the parties, and intending to be
legally bound, FACILITY and’MAXIM hereby agree to amend the Agreement to reflect the following terms and
conditions. '
i
■ i
i
RN - ICU
RN - ER
RN - Telemetry
Rate
$180.00
$150.00
$135.00
, maxim
healthcare services DocuSign Envelope ID/D6CE3BD4-EFE0-49CA-9BEB-5201F6C60613
I.
STAFFINGUNITED MEDICAL CENTER
04/01/2021
Date Date
f
2
DOC ID: 20210401115957952
I
i
r
i
FACILITY and MAXIM hava acknowledged their understanding of and agreement to the mutual promises
written above by executing and delivering this Agreement as of the date set forth above.
Signature
Marcela Maamari, Contracting Officer
Printed Name & Title
5/21/2021
MAXIM HEALTHCARE
SERVICES, INC.:
Signature t>'■amcgee@maxhealth.com
Brandan McGee, Assistant Controller
Printed Name & Title DocuSign Envelope ID: D6CE3BD4-EFE0-49CA-9BEB-5201F6C60613
Page 1 of 17
NFPHC-NSD-21-C-00027
2. Address
4b. Dcpartment(s) Using Goods or Services:
Nursing Department
6. Subject:5. Contractor:
DescriptionSection
11 A. Name of Contracting Officer: Colenc Y. Daniel, Chief Executive Officer
IOC. Date Signed
12/30/2020
12. GENERAL COUNSEL - LEGAL SUFFICIENCY
: NFPHC Chief Operating OfficerCOO REVIEW APPROVAL: : NFPHC Budget Officer
Page 1NOT-FOR-PROFIT HOSPITAL CORPORATION
Doc ID: 20201230131207515
Provision of supplemental staffing in nursing specifically in the ICU and ER
Department.
NOT-FOR-PROFIT HOSPITAL CORPORATION,
commonly known as United Medical Center,
an instrumentality of the District of Columbia government,
hereinafter known as the “Hospital”.
Not-For-Profit Hospital Corporation
Accounts Payable
1310 Southern Avenue, S.E.
Washington, D.C. 20032
Maxim Healthcare Staffing Services, Inc.
962 Wayne Avenue, Suite 600
Stiver Spring, MD 20910
/ hereby certify funds are sufficiently included in the District's FY
2021 budget and financial plan to support this Contract.
ATTN: John Miller
(301)585-9773
www.maximhealthcarc.com
3c. Date of Council Approval:
N/A
4a. Rcquisition/Purchasc Ordcr/Task Order.
N/A
11C. Date Signed
12/31/2020
10. CONTRACTOR
By: Authorized Contractor Representative
11. NOT-FOR-PROFIT HOSPITAL CORPORATION
By: Authorized Contracting Officer
I IB. Signature
Agreement for Contractor to provide supplemental nursing staff for Hospital.
Addendum to Agreement to set forth certain provisions applicable during the COVID-19 outbreak.
Facility Staffing Agreement
COVID-19 Addendum
7. Base Year Funding Request: $300,000.00
8. Number of Option Years: 4
9.
3a. Effective Date; December 10,
2020___________________________
3b. Date work begins if different from
Effective Date: N/A
_________CONTRACT
I. Contract Number:
IOA. Name and Title: (Type or print):
Brandan McGee - Asst. Controller
IOB. Signature:
OCFO REVIEW APPROVAL:
12/30/2020
Date:
This contract appears legally sufficient. Please be advised that my finding is premised on the Contract receiving any and all requisite approvals. In additions, the Hospital
continues to work with other District agencies to determine the most effective manner for all involved to achieve their respective legislative mandates while the Hospital strives
to meet: (i) its Establishment Act purposes (D.C Official Code §44-95 1.02(b)): (ii) the Hospital Board of Directors approved Strategic Plan (all thirteen Councilmembers
introduced the Sense of the Council Not-for-Profii Hospital Corporation Transformation and Sustainability Resolution of 2014 (PRO-731)), which expressed the desire that the
Hospital move swiftly to implement the strategic plan); and (iii) its clarified District government charged legislative mandate in the Fiscal Year 2015 Budget Support
Emergency Act of 2014 (B20-849), which required the Hospital move forward expeditiously with improving UMC operations and soliciting proposals for private sector
takeover of the ownership and management of the United Medical Center.
Approved as to Legal Sufficiency:
__________________________________
._____Megan K. Dhillon. NFPHC Outside Counsel
13. CFO - CERTIFICATIONJDF FUNDS
12/31/2020
Certification of Funds: ( ______________ Date:
Lilian ChuEwuma, NFPHC Chief Financial Officer
FOR INTERNAL PURPOSES ONLY DocuSign Envelope ID: D6CE3BD4-EFE0-49CA-9BEB-5201F6C60613
FACILITY STAFFING AGREEMENT
RECITALS
ARTICLE 1. TERM OF AGREEMENT
Section 1.1
Section 1.2
ARTICLE 2. RESPONSIBILITIES OF MAXIM
Section 2.1
Doc ID: 20201230131207515
Facility Staffing Agreement
Maxim Healthcare Staffing Services, Inc.
Term. This Agreement will be in effect for one (1) year, commencing on the
Effective Date and concluding twelve (12) months thereafter on the Expiration
Date. Prior to the Expiration Date, FACILITY may in its sole discretion and by
written notice to MAXIM extend this Agreement for up to four (4) additional
one-year optional terms. Such written notice shall be provided to MAXIM no
later than sixty (60) days prior to the expiration of the then-current term, and
shall be subject to MAXIM’S then-current pricing. The total duration of this
Agreement, including the exercise of any optional terms, shall not exceed fixe
(5) years from the Effective Date.
V.1.1 -2020.08
Copyright 2020 - All Rights Reserved
maxim
healthcare services
WHEREAS, MAXIM operates a supplemental staffing agency and employs licensed health
care personnel to provide healthcare services to FACILITY.
This Facility Staffing Agreement (hereinafter '‘Agreement”) is entered into this 10th day of
December, 2020, by and between United Medical Center located at 1310 Southern Ave SE
Washington, DC 20032, referred to in this Agreement as '‘FACILITY," and Maxim Healthcare
Staffing Services, Inc., a Maryland Corporation including its affiliates and subsidiaries, with
an office located at 962 Wayne Avenue Suite 600 Silver Spring, MD 20910 referred to in this
Agreement as "MAXIM.”
Termination. Either party may terminate this Agreement at any time, with or
without cause, by providing at least thirty (30) days advance written notice of
the termination date to the other party. If termination cause is payment
default, MAXIM may terminate this Agreement upon seven (7) days advance
written notice of the termination date to FACILITY. Such termination will have
no effect upon the rights and obligations resulting from any transactions
occurring prior to the effective date of the termination.
THEREFORE, in consideration of the above premises set forth herein, and for other good and
valuable consideration, the receipt and sufficiency of which are acknowledged by the parties,
and intending to be legally bound, FACILITY and MAXIM hereby agree to the following terms
and conditions.
WHEREAS, FACILITY operates a Hospital located in Washington D.C. and wishes to
engage MAXIM to provide personnel to supplement FACILITY'S staff.
Services. Maxim will, upon request by FACILITY, provide one or more
licensed healthcare providers (i.e. LPNs, LVNs, RNs, CNAs) or other non-
clinical personnel ("Non-Clinical Personnel”) as specified by FACILITY DocuSign Envelope ID: D6CE3BD4-EFE0-49CA-9BEB-5201F6C60613
Section 2.2
3)
4)
5)
r
6)
7)
Section 2.3
Section 2.4
Doc ID: 20201230131207515
1)
2)
Facility Staffing Agreement
Maxim Healthcare Staffing Services, Inc.
V.1.1 -2020.08
Copyright 2020 - All Rights Reserved
(collectivaly Personnel) for supplemental staffing services, subject to the
availability of qualified Personnel. In the event FACILITY requires MAXIM to
provide non-clinical Personnel with the Personnel Requirements as outlined in
Section 2.2, FACILITY shall notify MAXIM in writing of its request to abide by
such Personnel Requirements. Subject to the terms of Section 6.8 of this
Agreement, to the extent that MAXIM is unable to provide the type of
healthcare provider requested by FACILITY, MAXIM will provide FACILITY with
a higher skilled healthcare provider. MAXIM must, however, bill that higher
skilled provider at that provider’s fair market value rate.
Use of Independent Contractorsand Subcontractors. Personnel provided
to FACILITY are employees of MAXIM and are subject to MAXIM'S standard
screening process, as well as additional qualifications as required in this
Agreement. If MAXIM deems it necessary to obtain the services of a
subcontractor to fulfill its requirements under this Agreement, MAXIM will
notify FACILITY in writing of its intent to use subcontractors and will obtain
written approval from FACILITY. MAXIM will ensure that any subcontractor
will comply with all applicable terms of this Agreement. MAXIM will provide
written notification to FACILITY if it becomes necessary for MAXIM to utilize
independent contractors to fulfill its staffing obligations to FACILITY. Any
Personnel provided to FACILITY by an independent contractor will be subject
to the same qualifications as MAXIM employees.
Personnel. MAXIM will supply FACILITY with Personnel who meet the
following criteria and will provide evidence of the following to FACILITY upon
written request:
Possess current state license/registration and/or certification.
Possess CPR certification, as requested in writing by FACILITY to
comply with applicable law.
Completed pre-employment physical as requested in writing by
FACILITY to comply with applicable law.
Possess proof of pre-employment screening to include: (a) TB skin
test or chest X-ray as required by law, (b) criminal background
check(s), (c) drug screenings as requested in writing, and (d) anything
additional as required by the Agreement.
Possess a preferred one (1) year of relevant professional experience
and a preferred one (1) year of specialty experience.
Possess current skills competency to include, (i) written exam; (ii)
skills checklist; and (iii) verified work history.
Completed MAXIM standard OSHA and HIPAA training.
Insurance. MAXIM will maintain (at its sole expense), or require the
individuals it provides under this Agreement to maintain, valid policies of
insurance evidencing general and professional liability coverage of not less
than $1,000,000 per occurrence and $3,000,000 in the aggregate, covering the
sole negligent acts or omissions which may give rise to liability for services
provided under this Agreement. MAXIM will provide a certificate of insurance
evidencing such coverage upon request by FACILITY. DocuSign Envelope ID: D6CE3BD4-EFE0-49CA-9BEB-5201F6C60613
Section 2.5
Section 2.6
ARTICLE 3. RESPONSIBILITIES OF FACILITY
Section 3.1
Section 3.2
Section 3.3
Section 3.4
Section 3.5
Doc ID: 20201230131207515
Facility Staffing Agreement
Maxim Healthcare Staffing Services, Inc.
Record Access. In instances where FACILITY is Medicare and/or Medicaid
‘ certified, MAXIM agrees that in accordance with Section 952 of the Omnibus
Budget Reconciliation Act of 1980, its contracts, books, documents and
records will be made available to the Comptroller General of the United
States, the United States Department of Health and Human Services and their
duly authorized representatives ("USDHHS") until the expiration of four (4)
years after the date on which such services were furnished under this
Agreement.
V.1.1 - 2020.08
Copyright 2020 - All Rights Reserved
Employment and Taxes. MAXIM will follow its standard employment
policies and procedures to verify that all Personnel meet applicable licensing
requirements. MAXIM, or its subcontractor if applicable, will maintain direct
responsibility as employer for the payment of wages and other compensation,
and for any applicable mandatory withholdings and contributions such as
federal, state, and local income taxes, social security taxes, worker’s
compensation, and unemployment insurance. To the extent FACILITY is not
tax exempt, FACILITY shall be responsible for any sales tax, gross receipts
tax, excise tax or other state taxes applicable to the Services provided by
MAXIM.
Staff Order Cancellation. If FACILITY changes or cancels an order less
than eight (8) hours prior to the start of a shift, MAXIM will bill FACILITY for
four (4) hours at the established fee for each scheduled Personnel. MAXIM
- will be responsible for contacting MAXIM Personnel prior to reporting time.
Short-notice Requests. MAXIM will bill FACILITY for the entire shift if an
order for staff is made less than eight (8) hour(s) prior to the start of the shift,
as long as the Personnel report for work within a reasonable prompt period of
time under existing conditions after receiving notice of the assignment.
I
Requests for Personnel. FACILITY will use its best efforts to request
Personnel at least twenty-four (24) hours prior to reporting time in order to
assure prompt arrival of assigned Personnel. All information regarding
reporting time and assignment will be provided by FACILITY at the time of the
initial call.
Orientation. FACILITY will promptly provide MAXIM Personnel with an
adequate and timely orientation to FACILITY. FACILITY shall review
instructions regarding confidentiality (including patient and employee), and
orient MAXIM Personnel to the specific Exposure Control Plan of the
FACILITY as it pertains to OSHA requirements for bloodborne pathogens, as
well as any of the FACILITY’S specific policies and procedures provided to
MAXIM for such purpose.
Responsibility for Patient Care. FACILITY retains full authority and
responsibility for professional and medical management of care for each of its
patients and for ensuring that services provided by MAXIM Personnel under
this agreement are furnished in a safe and effective manner and in accordance
with applicable standards. DocuSign Envelope ID: D6CE3BD4-EFE0-49CA-9BEB-5201F6C60613
Section 3.6
andtraining,
Conversion Fee
Section 3.7
Section 3.8
Section 3.9
Doc ID: 20201230131207515
This Section 3.6 notwithstanding, CLIENT may hire any Personnel provided by
MAXIM once Personnel have completed a minimum number of hours of work
for CLIENT through MAXIM, according to the following schedule:
Float Policy. Subject to prior written notification, FACILITY may reassign
Personnel to a different FACILITY department, unit, facility, or to a different
V.1.1 -2020.08
Copyright 2020 - All Rights Reserved
Aggregate Hours Worked By Personnel
For Client in a Twelxe (12) month period
Prior to completing 200 hours_______
After Completions of 400 hours______
After Completions of 600 hours______
After Completions of 800 hours______
After Completions of 1080 hours_____
30 % of annualized starting salary
20 % of annualized starting salary
15 % of annualized starting salary
10 % of annualized starting salary
5 % of annualized starting salary
Facility Staffing Agreement
Maxim Healthcare Staffing Services, Inc.
Non-Performance. If FACILITY concludes, in its sole discretion, that any
Personnel provided by MAXIM ha\e engaged in misconduct, or ha\e been
negligent, FACILITY may require the Personnel to lea\® the premises and will
notify MAXIM immediately in writing, providing in reasonable detail the
reason(s) for such dismissal. FACILITY'S obligation to compensate MAXIM for
such Personnel's services will be limited to the number of hours actually
worked. MAXIM will not reassign the individual to FACILITY without prior
approval of the FACILITY.
Placement Fee. For a period of twel\« (12) months following that date on
which MAXIM Personnel last worked a shift at FACILITY, FACILITY agrees
that it will take no steps to recruit, hire or employ as its own employees or as
a contractor those Personnel provided by MAXIM during the term of this
Agreement. FACILITY understands and agrees that MAXIM is not an
employment agency and that Personnel are assigned to the FACILITY to
render temporary service(s) and are not assigned to become employed by the
FACILITY. The FACILITY further acknowledges and agrees that there is a
substantial investment in business related costs incurred by MAXIM in
recruiting, training and employing Personnel, to include adxertisement,
recruitment, interviewing, evaluation, reference checks,
supervising Personnel. In the exent that FACILITY, or any affiliate, subsidiary,
department, or division of FACILITY hires, employs or solicits MAXIM
Personnel, FACILITY will be in breach of this Agreement. FACILITY agrees to
give MAXIM either (a) one hundred and eighty (180) days prior written notice
of its intent to hire, or employ, continuing to staff Personnel through MAXIM
for.a minimum of thirty-six (36) hours per week through the one hundred and
eighty (180) days notice period; OR (b) to pay MAXIM a placement fee equal
to the greater of: five thousand dollars ($5,000) or the sum of thirty percent
(30%) of such Personnel's annualized salary (calculated as Weekday Hourly
Pay Rate x 2080 Hours x 30%). The obligations set forth in this Section shall
survix® the termination of this Agreement.
Right to Dismiss. FACILITY may request the dismissal of any MAXIM
Personnel for any reason. FACILITY agrees to notify MAXIM of any such
action immediately in writing, providing in reasonable detail the reason(s) for
such dismissal. FACILITY shall be obligated to compensate MAXIM for all
Personnel hours worked prior to dismissal. DocuSign Envelope ID: D6CE3BD4-EFE0-49CA-9BEB-5201F6C60613
Section 3.10
Section 3.11
ARTICLE 4. MUTUAL RESPONSIBILITIES
Section 4.1
ARTICLES. COMPENSATION
Section 5.1
Section 5.2
Doc ID: 20201230131207515
Facility Staffing Agreement
Maxim Healthcare Staffing Services, Inc.
Invoicing. MAXIM will supply Personnel under this. Agreement at the rates
listed in the Attachment(s). MAXIM will submit inwices to FACILITY every
week for Personnel provded to FACILITY during the preceding week. Invoices
shall be submitted to the following address:
Payment. All amounts due to MAXIM are due and payable within fifteen (15)
days from date of invoice. FACILITY will send all payments to the address
set forth on the invoice.
V.1.1 -2020.08
Copyright 2020 - All Rights Reserved
Incident Reports. FACILITY shall report to MAXIM any unexpected incident
known to involve any Personnel (such as Personnel errors, unanticipated
deaths or other unanticipated patient-related events or injuries known to be
attributable to Personnel, and any safety hazards known to be related to the
services provided by Personnel) if the incident may have an adverse impact on
the FACILITY and/or MAXIM in order to comply with MAXIM’S incident
tracking program. Complaints and grievances regarding MAXIM Personnel
may be reported to the local MAXIM representative at any time.
Non-discrimination. Neither MAXIM nor FACILITY will discriminate on the
basis of age, race, color, national origin, religion, sex, disability, being a
qualified
disabled veteran, being a qualified veteran of the Vietnam era, or any
other category protected by law.
Insurance. FACILITY will maintain at its sole expense valid policies of
general and professional liability insurance with minimum limits of $1,000,000
per occurrence and $3,000,000 annual aggregate covering the acts or
omissions of its employees, contractors and agents which may givs rise to
liability in connection with the Services under this Agreement. FACILITY will
give MAXIM prompt written notice of any material change in FACILITY
coverage.
staff classification (hereinafter “Float”), if Personnel satisfy the requisite
specialty qualifications. If FACILITY Floats Personnel, the Personnel must
perform the duties of the revised assignment as if the revised assignment
were
the original assignment. FACILITY will provide the Personnel with
additional orientation regarding the Float as necessary. If Personnel Floats to
a staff classification that has a lower reimbursement rate, then the
reimbursement rate that was applicable to the original Personnel assignment
remains the applicable reimbursement rate despite the Float. If Personnel
Floats to a staff classification that has a higher reimbursement rate, then the
reimbursement rate that is applicable to the newly assigned staff
classification is the applicable reimbursement rate for as long as the
Personnel continues to work in that staff classification.
United Medical Center
1310 Southern Avenue SE
Washington, DC 20032
ATTN: Herlinda Brown DocuSign Envelope ID: D6CE3BD4-EFE0-49CA-9BEB-5201F6C60613
Section 5.3
Section 5.4
Section 5.5
ARTICLE 6. TRAVEL SERVICES
Section 6.1
Section 6.2
Section 6.3
Section 6.4
Section 6.5
Doc ID: 20201230131207515
Facility Staffing Agreement
Maxim Healthcare Staffing Services, Inc. ;
Bankruptcy by FACILITY. FACILITY agrees that in the event FACILITY files
bankrupty, (i) to the extent MAXIM pays the salary and other direct labor
costs of MAXIM Personnel it provides to FACILITY and such amounts incurred
within one-hundred eighty (180) days prior to bankruptcy are not paid by
FACILITY to MAXIM prior to bankruptcy, and/or (ii) FACILITY is the assignee
of claims held by such MAXIM Personnel against FACILITY for such amounts
incurred within one-hundred eighty (180) days prior to bankruptcy, then
MAXIM has a claim against FACILITY in bankruptcy for the amount of such
salary and other direct labor costs, which is entitled to a priority under 11
U.S.C. §507(a)(4). All pre-bankruptcy conduct, including amounts due and.
actions related to payment that could be brought by FACILITY are released.
Assignment Continuation. FACILITY agrees that all Travel Personnel
introduced by MAXIM and/or accepted for assignment by FACILITY, will
V.1.1 -2020.08
Copyright 2020 - All Rights Reserved
Late Payment. Payments not received within fifteen (15) days from
the applicable invoice date will accumulate interest, until paid, at the rate of
one percent (1%) per month on the unpaid balance, equating to an annual
percentage rate of twelve percent (12%), or the maximum rate permitted by
applicable law, whichever is less.
Travel Services. In addition to the Services outlined herein, MAXIM provides
supplemental travel staffing services and agrees to assign such personnel
(“Travel Personnel”) to work such specified assignments as agreed to by the
Parties. To the extent Travel Personnel are assigned, the terms of this Article
shall apply.
Travel Coordination. MAXIM shall be solely responsible for coordinating
Travel Personnel’s travel assignments to FACILITY including housing, payroll
and related functions.
Annual Rate Increases. FACILITY agrees to and accepts annual rate
increases at the percentage listed on Attachment A of this Agreement.
Travel Assignment Cancellation. MAXIM may cancel the remaining term
of an assignment with notification to FACILITY. MAXIM will use its best
efforts to provide a qualified replacement for such cancelled Travel Personnel
within fourteen (14) days from the date of notification.
Interviews. MAXIM will provide FACILITY with names of Travel Personnel
interested in traveling assignments and provide all pertinent information
requested by FACILITY for an interview. FACILITY reserves the right to
conduct a telephone interview with any Travel Personnel prior to accepting
such Travel Personnel for assignment. If FACILITY requests a face-to-face
interview, MAXIM will bill FACILITY for cost of travel and lodging. FACILITY
has the opportunity to interview all interested Personnel recruited by MAXM,
before said Travel Personnel provide Services. Therefore, MAXM will not have
any liability to FACILITY if said Travel Personnel fails to meet his/her
requirements. Additionally, FACILITY will not be relieved of paying MAXM the
established fees set forth in this Agreement for said Travel Personnel. DocuSign Envelope ID: D6CE3BD4-EFE0-49CA-9BEB-5201F6C60613
Section 6.6
Section 6.7
Section 6.8
Section 6.9
ARTICLE 7. GENERAL TERMS
Section 7.1
Doc ID: 20201230131207515
Facility Staffing'Agreement
Maxim Healthcare Staffing Services, Inc.
V.1.1 -2020.08
Copyright 2020. - All Rights Reserved
Travel Personnel Non-Performance. If FACILITY concludes, in its sole
discretion, that any Personnel prodded by MAXIM have engaged in
misconduct, or have been negligent, FACILITY may require the Personnel to
leave the premises and will notify MAXIM immediately in writing, providing in
reasonable detail the reason(s) for such dismissal. FACILITY'S obligation to
compensate MAXIM for such Personnel's services will be limited to the
number of hours actually worked. MAXIM will not reassign the individual to
FACILITY without prior approval of the FACILITY.
Incorporation of Assignment Confirmations. FACILITY agrees that any
Assignment Confirmation(s) and/or Attachment(s) attached hereto are
incorporated herein by reference and form a part of this Agreement. If there is
any conflict between this Agreement and any Assignment Confirmation(s)
and/or Attachment(s), the terms of the Assignment Confirmation(s) and/or
Attachment(s) will govern.
Travel Assignment Cancellation for Convenience. FACILITY agrees to
utilize Travel Personnel for the specified period of time, outlined in the
Assignment Confirmation. Should FACILITY staffing needs change and
FACILITY wishes to cancel Travel Personnel already being utilized on
contract, FACILITY must give MAXIM fourteen (14) days’ notice before
cancellation date. If FACILITY does not provide required notice, FACILITY will
be required to pay MAXIM a fee equal to: the sum of seventy-two (72) hours
of such Personnel's rate subtracted by any hours worked by Travel Personnel
after notice is given (calculated as Travel Bill Rate x 72 Hours - Hours
Worked after cancelation notice). MAXIM will make reasonable effort to place
Travel Personnel in other facilities in the area.
Independent Contractors. MAXIM and FACILITY are independent legal
entities. Nothing in this Agreement shall be construed to create the
relationship of employer and employee, or principal and agent, or any
relationship other than that of independent parties contracting with each other
solely for the purpose of carrying out the terms of this Agreement. Neither
MAXIM nor FACILITY nor any of their respective agents or employees shall
continue to work future FACILITY assignments solely as employees of MAXIM
during
the term of this Agreement.
Confirmations. Each assignment will be confirmed in writing with the
specific hourly rates to be charged for specific Travel Personnel to work a
specific assignment. Assignment Confirmations (Exhibit B) will be sent via
electronic mail, facsimile, or reliable carrier as agreed upon by the FACILITY
and MAXIM. In the event that FACILITY fails to respond to the Assignment
Confirmation within two (2) business days, the FACILITY will be deemed to
have accepted the terms in said Assignment Confirmation and FACILITY will
assume responsibility for any applicable payment terms as outlined in the
Assignment Confirmation. Should a dispute arise, the Assignment
Confirmation shall supersede any and all prior oral and written
understandings. ' DocuSign Envelope ID: D6CE3BD4-EFE0-49CA-9BEB-5201F6C60613
Section 7.2
Section 7.3
Attorneys’ Fees. Intentionally omitted.Section 7.4
Section 7.5
United Medical Center
COPY TO:
Section 7.6
Section 7.7
Doc ID: 20201230131207515
Facility Staffing Agreement
Maxim Healthcare Staffing Services, Inc.
control or havs any right to control the activities of the other party in carrying
out the terms of this Agreement.
1310 Southern Ave SE
Washington, DC 20032
ATTN: Herlinda Brown
Maxim Healthcare Staffing Services,
Inc.
7227 Lee DeForest Drive
Columbia, MD 21046
ATTN: Contracts Department
Maxim Healthcare Staffing Services,
Inc.
962 Wayne Avenue Suite 600
Silver Spring, MD 20910
ATTN: John Miller
V.1.1 -2020.08
Copyright 2020 - All Rights Reserved
Notices. Any notice or demand required under this Agreement will be in
writing; will be personally served or sent by certified mail, return receipt
requested, postage prepaid, or by a recognized overnight carrier which
provides proof of receipt; and will be sent to the addresses below. Either
party may change the address to which notices are sent by sending written
notice of such change of address to the other party.
Headings, file headings of sections and subsections of this Agreement are
for reference only and will not affect in any way the meaning or interpretation
of this Agreement,
t
Assignment. Neither party may assign this Agreement without the prior
written consent of the other party, and such consent will not be unreasonably
withheld. No such consent will be required for assignment to an entity owned
by or under common control with assignor or in connection with any
acquisition of all of the assets or capital stock of a party; provided however,
the assigning party will provide notice of such transaction to the other party
and remain fully responsible for compliance with all of the terms of this
Agreement.
Indemnification. MAXIM shall indemnify and hold harmless the FACILITY,
elected and appointed officers, employees, agents and volunteers (“FACILITY
Indemnitees”) only for negligent acts, errors, or omissions of MAXIM or its
employees, agents, and/or subcontractors, for services performed under this
Agreement, and only to the extent that passive and/or vicarious liability for
such negligent acts, errors or omissions is imposed upon the FACILITY
Indemnitees in a claim or suit, up to the applicable state cap(s) for healthcare
services. No indemnity shall be provided by MAXIM for any liability imposed
upon the FACILITY Indemnitees for their concurrent negligence, active
negligence, sole negligence, and/or willful misconduct.
Entire Contract; Counterparts. This Agreement constitutes the entire
contract between FACILITY and MAXIM regarding the services to be provided DocuSign Envelope ID: D6CE3BD4-EFE0-49CA-9BEB-5201F6C60613
Section 7.8
Section 7.9
Section 7.11
Section 7.12
/
Section 7.13
Doc ID: 20201230131207515
Facility Staffing Agreement
Maxim Healthcare Staffing Services, Inc.
Availability of Personnel. The parties agree that MAXIM'S duty to supply
Personnel on request of FACILITY is subject to the availability of qualified
MAXIM Personnel. The failure of MAXIM to provide Personnel or the failure of
FACILITY to request Personnel shall result in no penalty to FACILITY or any
party claiming by or through it and shall not constitute a breach of this
Agreement.
Compliance with Laws. MAXIM agrees that all services provided pursuant
to this Agreement shall be performed in compliance with all applicable federal,
state, and/or local rules and regulations. In the e\ent that applicable federal,
state or local laws and regulations or applicable accrediting body standards
are modified, MAXIM reserves the right to notify FACILITY in writing of any
modifications to the Agreement in order to remain in compliance with such
law, rule or regulation.
V.1.1 -2020.08
Copyright 2020 - All Rights Reserved
Limitation on Liability. Neither MAXIM nor FACILITY will be responsible for
special, indirect, incidental, consequential, or other similar damages,
including but not limited to lost profits, that the other party may incur or
experience in connection with this Agreement or the services provided,
however caused, even if such party has been advised of the possibility of such
damages.
Governing Law, Jurisdiction. This Agreement will be governed by and
construed in accordance with the laws of the District of Columbia, without
regard to its principles of conflict of laws. Any dispute or claim from this
Agreement shall be resolved exclusively in the courts of the District of
Columbia and the parties hereby irrevocably submit to the personal
jurisdiction of said courts and waivs all defenses thereto.
Section 7.14 Conflict of Interest. By entering into this Agreement, the Parties agree that
. all conflicts of interest shall be disclosed to the other Party for review in
accordance with that Party’s policies and procedures. A conflict of interest
occurs when an employee or Contractor has professional or personal interests
that compete with his/her services to or on behalf of MAXIM or the FACILITY,
Incorporation of Recitals. The recitals set forth at the top of this
Agreement are incorporated by reference as if fully set forth herein.
hereunder. Any agreements, promises, negotiations, or representations not
expressly set forth in this Agreement are of no force or effect. This
Agreement may be executed simultaneously in one or more counterparts,
each of which shall be deemed an original but all of which together shall
constitute one and the same instrument. Facsimile and electronic signatures
shall also constitute original signatures for the purpose of this Agreement. No
amendments to this Agreement will be effective unless made in writing and
signed by duly authorized representatives of both parties except as provided
in Section 6.9.
Section 7.10 Severability. In the event that one or more provision(s) of this Agreement is
deemed invalid, unlawful and/or unenforceable, then only that provision will be
omitted, and will not affect the validity or enforceability of any other provision;
the remaining provisions will be deemed to continue in full force and effect. DocuSign Envelope ID: D6CE3BD4-EFE0-49CA-9BEB-5201F6C60613
ARTICLE 8. CONFIDENTIALITY OF PROTECTED HEALTH INFORMATION
Confidentiality.Section 8.1
Doc ID: 20201230131207515
Facility Staffing Agreement
Maxim Healthcare Staffing Services, Inc.
or the best interests of patients. Such competing interests may make it
difficult for an employee or Contractor to fulfill his or her duties impartially.
V.1.1 -2020.08
Copyright 2020 - All Rights Reseived
A. MAXIM/FACILITY Information. The parties recognize and
acknowledge that, by virtue of entering into this Agreement and providing
services hereunder, the parties will have access to certain information of the
other party that is confidential and constitutes valuable, special, and unique
property of the party. Each of the parties agrees that neither it nor his/her
staff shall, at any time either during or subsequent to the term of this
Agreement, disclose to others, use, copy, or permit to be copied, except
pursuant to his duties for or on behalf of the other party, any secret or
confidential information of the party, including, without limitation, information
with respect to the party's patients, costs, prices, and treatment methods at
any time used, developed or made by the party during the term of this
Agreement and that is not available to the public, without the other party's
prior written consent.
B. Terms of this Agreement. Except for disclosure to his/her legal
counsel, accountant or financial or other advisors/consultants neither party
nor
its respective staff shall disclose the terms of this Agreement to any
person who is not a party or signatory to this Agreement, unless disclosure
thereof is required by law or otherwise authorized by this Agreement.
Unauthorized disclosure of the terms of this Agreement shall be a material
breach of this Agreement and shall provide the party with the option of
Section 7.15 EXCLUSION FROM FEDERAL HEALTH CARE PROGRAMS. MAXIM
represents and warrants that it, or any of the Personnel under this Agreement,
has not been nor is about to be excluded from participation in any Federal
Healthcare Program. MAXIM agrees to notify FACILITY within five (5)
business day of its/his or her receipt of a notice of intent to exclude or actual
notice of exclusion from any such program. The listing of MAXIM on the
Office of Inspector General's exclusion list (OIG website) or the General
Services Administration’s Lists of Parties Excluded from Federal Procurement
and Nonprocurement Programs (GSA website) for excluded individuals and
entities shall constitute “exclusion” for purposes of this paragraph. In the
event that MAXIM is excluded from any Federal Healthcare Program, this
Agreement shall immediately terminate. For the purposes of this paragraph,
the term “Federal Healthcare Program" means the Medicare program, the
Medicaid program, the Maternal and Child Health Services Block Grant
program, the Block Grants for State for Social Services program, any state
Children’s Health Insurance program, or any similar program. Further, MAXIM
agrees to indemnify and hold FACILITY harmless from and against any loss,
liability, judgment, penalty, fine, damages (including punitive and/or
compounded damages), costs (including reasonable attorneys’ fees and
expenses) incurred by FACILITY as a result of MAXIM’s failure to notify
FACILITY of MAXIM’s or any of the Personnel’s exclusion from any Federal
Healthcare Program. DocuSign Envelope ID: D6CE3BD4-EFE0-49CA-9BEB-5201F6C60613
c.
D.
Section 8.2
I-
1 Doc ID: 20201230131207515
Facility Staffing Agreement
Maxim Healthcare Staffing Services, Inc.
: HIPAA/HITECH Obligations. Each party and its respective staff shall comply
with all federal and state laws and regulations, and all rules, regulations, and
policies of the other party, regarding the confidentiality of patient information,
to include, without.limitation, HIPAA and HITECH. In addition, if necessary,
the parties agree to resist any effort to obtain access to such records or
information in judicial proceedings, except such access as is expressly
permitted by federal/state regulations.
pursuing remedies for breach or immediate termination of this Agreement in
accordance with the provisions stated herein.
The obligations set forth in this Section shall surviva the termination of
this Agreement.
Notwithstanding the foregoing, MAXIM and all staff provided to FACILITY
hereunder shall comply with confidentiality, medical records and/or other
applicable laws and regulations with regard to any and all information directly
or indirectly accessed or used by MAXIM and their personnel, including
without limitation HIPAA and HITECH.
V.1.1 -2020.08
Copyright 2020 - All Rights Reserved
Patient/Customer Information: Neither party nor its employees shall
disclose any financial or medical information regarding patients/customers
treated hereunder to any third-party, except where permitted or required by
law or where such disclosure is expressly approved by FACILITY, MAXIM and
patient/customer in writing. Further, each party and its employees shall
comply with the other party's rules, regulations and policies regarding the
confidentiality of such information as well as all federal and state laws and
regulations including, without limitation, the Health Insurance Portability and
Accountability Act of 1996 (“HIPAA”) and the Health Information Technology
for Economic and Clinical Health Act (“HITECH”).
To the extent that FACILITY may be a “Covered Entity” as defined by HIPAA,
and would therefore be subject to applicable requirements, including, but not
limited to, requirements to enter into certain contracts with their “business
associates,” by HIPAA, the parties acknowledge that a business associate
agreement is not needed due to the nature of services provided by MAXIM.
Specifically, the parties acknowledge that under HIPAA, Personnel provided
hereunder are considered part of FACILITY’S workforce and to that end, all
Protected Health Information (“PHI”) is created, viewed, used, maintained and
otherwise stored and safeguarded in FACILITY’S work environment. The
parties further acknowledge that PHI is not exchanged between the parties in
order for MAXIM to provide Personnel as part of FACILITY’S temporary
workforce. DocuSign Envelope ID: D6CE3BD4-EFE0-49CA-9BEB-5201F6C60613
I
STAFFINGHEALTHCAREUNITED MEDICAL CENTER:
DateDate
l
♦
Doc ID: 20201230131207515
I
I-
i
)
\
Signature
Colene Daniel
FACILITY and MAXIM have acknowledged their understanding of and agreement to the mutual
promises written abo\e by executing and delivering this Agreement as of the date set forth
above.
Facility Staffing Agreement
Maxim Healthcare Staffing Services, Inc.
Printed Name & Title
12/30/2020
V.1.1 -2020.08
Copyright 2020 - All Rights Reserved
MAXIM
bramcgee@maxhealth.com________
Signature
Chief Executive Offi cg^ndan McGee Asst. Controller
Printed Name & Title
12/31/2020 k DocuSign Envelope ID: D6CE3BD4-EFE0-49GA-9BEB-5201F6C60613
Charges will be based on the following hourly rate schedule effective 12/10/2020:
UNITED MEDICAL CENTER:
Chief Executive
Date
■i
Doc ID: 20201230131207515
f
t
I
■i
Signature
colene Daniel
Facility Staffing Agreement
Maxim Healthcare Staffing Services, Inc.
Thanksgiving Day
Labor Day
Christmas Eve (from 3 PM)
Christmas Day
Presidents Day
Pioneer Day (Utah Only)
ATTACHMENT A
Maxim Healthcare Staffing Services, Inc.
Facility Staffing Rates For
UNITED M EPICAL CENTER
Printed Name & Title
12/30/2020
V.1.1 - 2020.08
Copyright 2020 - All Rights Reserved
Printed Name & Title
12/31/2020
Date
Service
RN - M/S
RN-ER
RN - ICU/CCU
Local Rate
$70.00
$72.00
$72.00
Travel Rate
$75.00
$78.00
$78.00
MAXIM HEALTHCARE STAFFING
SEF
bramcgee@maxhealth.com
Signature
Officer Brandan McGee Asst. Controller
Annual Rate Increase. An annual rate increase of 3% will be added to each services type
listed above on 12/10 every yearbegining in 2021.
Weekend. Weekend rates will apply to shifts beginning at 11:00 p.m. on Friday and ending
at
7:00 a.m. on Monday.
Orientation. Rates listed above will be charged for all time spent in required FACILITY
orientation.
Overtime. Overtime rates are charged for all hours worked in excess of forty (40) per week
or according to applicable state law. Overtime must have FACILITY supervisory approval.
The overtime rate is one and one-half (1.5) times the regular billing rate for such hours.
Holidays. Holiday rates will apply to shifts beginning at 11:00 p.m. the night before the
holiday through 11:00 p.m. the night of the holiday: Time and one-half will be charged for the
following holidays:
New Year's Eve (from 3 PM)
New Year's Day
Memorial Day
Independence Day
Easter
Martin Luther King Day This Addendum will be adding COVID-19 Support Personnel for CLIENT.I.
B.
Doc ID: 20201230131207515
WHEREAS, CLIENT and MAXIM entered into a Facility Staffing Agreement (hereinafter “Agreement”), with
an effective date of December 10th, 2020;
WHEREAS, In addition to the Services outlined in the Agreement, CLIENT is requesting that MAXIM
provide COVID-19 (Coronavirus Disease 2019) Support Personnel.
WHEREAS, CLIENT and MAXIM wish to amend the Agreement to incorporate the following terms and
conditions governing the provision of COVID-19 Support;
Section 1.1 Term. This Amendment will remain in effect for the duration of the COVID-19 outbreak and will
follow current Center for Disease Control (CDC) guidelines. Notwithstanding the foregoing, this Addendum does
not alter the Term as set forth in this Agreement
Section 1.5 Mileage. Mileage will be reimbursed at the Internal Revenue Service (IRS) standard mileage rate
and shall apply to all Personnel.
Section 1.4 Overtime. Overtime rates are charged for all hours worked in excess of forty (40) hours per week of
according to applicable state law. The overtime rate is one and one-half (1.5) times this Addendum rate.
COVID-19 ADD
Maxim Healthcare Staffing Services, Inc.
Rev. 03/2020
A// rights reserved.
This Amendment (hereinafter “Amendment”) is entered into this 10th day of December, 2020, by and
between United Medical Center, referred to in this Agreement as “CLIENT,” and Maxim Healthcare Staffing
Services, Inc., referred to in this Agreement as “MAXIM.”
RECITALS
Rates (per hour)
$225.00___________
$195.00___________
$165.00
Section 1.6 Credentialing.
A. All Personnel required for COVID-19 labor support must meet the following qualifications:
a. 1-stepTBTest
b. Background Checks
c. License Verification, if applicable (Pending license is acceptable)
d. For all additional requested credentialing items by CLIENT, Personnel may present to CLIENT by end of
assignment
If CLIENT accepts MAXIM Personnel to begin work assignment(s) while any credentialing requirement(s)
THEREFORE, in consideration of the above premises set forth herein, and for other good and
valuable consideration, the receipt and sufficiency of which are acknowledged by the parties, and intending
to be legally bound, CLIENT and MAXIM hereby agree as follows:
Section 1.2 Principles of Construction. Except as noted herein, whenever the terms and conditions of the
Agreement and this Addendum conflict, the terms and conditions of this Addendum control. Except as
specifically modified by the terms and conditions of this Addendum, all of the Agreement remains in full force
and effect.
DocuSign Envelope ID: D6CE3BD4-EFEO-49CA-9BEB-5201F6C60613
maxim
healthcare services
COVID-19 Addendum
Section 1.3 Services and Rates.
a) CLIENT retains full authority and responsibility for professional and medical management of care for
each of its patients and for ensuring that services provided by MAXIM Personnel under this agreement are
furnished in a safe and effective manner and in accordance with the applicable standards.
b) The following rates shall apply:
' Services
RN - ICU________________
RN-ER_________________
RN - Telemetry DocuSign Envelope ID: D6CE3BD4-EFE0-49CA-9BEB-5201F6C60613
r
Section 1.8 Quarantine, intentionally omitted.
All other terms and conditions will remain unchanged as stated in the Agreement.II.
UNITED MEDICAL CENTER:
DateDate
I
Doc ID: 20201230131207515
CLIENT and MAXIM have acknowledged their understanding of and agreement to the mutual promises written
above by executing and delivering this Agreement as of the date set forth above.
Section 1.7 Orientation. CLIENT agrees Personnel may begin first shift the day after credentialing is complete
and CLIENT will provide Orientation on as-needed basis.
COVID-19ADD
Maxim Healthcare Staffing Services, Inc.
Printed Name & Title
12/31/2020
Rev. 03/2020
A// rights reserved.
Signature
colene Daniel
MAXIM HEALTHCARE STAFFING SERVICES,
bramcgee@maxhealth.com
Signature
■ chief” Executive Officer Brandan McGee Asst. Controller
-■ Printed Name & Title
12/30/2020
is/are pending, MAXIM, its directors, officers, shareholders, employees, and agents shall have no and be found to*
have no liability from and against any and all claims, actions, or liabilities arising out of and/or in connection with the
credentialing result(s), or inability to perform credentialing, under this Addendum.