Page 75 - 2021 MHA Start-up Guide

5. Phone line and internet access
6. Use of school bathroom facilities for INSERT NAME OF ORGANIZATION program staff

7. INSERT NAME OF ORGANIZATION may be issued keys to buildings as required for INSERT NAME OF
ORGANIZATION to carry out the terms of this Agreement. If INSERT NAME OF ORGANIZATION is not
issued keys, then NAME OF SCHOOL personnel must be present to open and close buildings for INSERT
NAME OF ORGANIZATION
8. Assistance to INSERT NAME OF ORGANIZATION and program partners (E3 and COH) in collecting data
on student attendance, behavior and achievement as necessary to complete reports required in this Agreement.
9. Annual meeting with the INSERT NAME OF SCHOOL Superintendent.
INSERT NAME OF ORGANIZATION Operational Service Deliverables:
INSERT NAME OF ORGANIZATION will provide to the INSERT NAME OF SCHOOL during the term of the
contract the following:
1. Reporting to INSERT NAME OF SCHOOL. INSERT NAME OF ORGANIZATION will provide campus and
district wide reports within sixty (60) days of the end of the summer break. These reports will indicate the
number of students receiving dental services on each campus served, percentage of preventive and restorative
treatment provided per campus, and total value of donated dental services to the campus and INSERT NAME
OF SCHOOL. (See Sample Report attached.)

2. INSERT NAME OF ORGANIZATION will abide by all applicable federal, state and local laws and regulations.
3. INSERT NAME OF ORGANIZATION may request to move or leave a specific INSERT NAME OF SCHOOL
campus due to a significant loss of funding, a significant change in demographics or decline in the percentage of
students considered at-risk on a specific INSERT NAME OF SCHOOL campus, or other persistent factors that
negatively impact INSERT NAME OF ORGANIZATION ability to effectively deliver services.

Time of Performance

This AGREEMENT shall be for a term of twelve months commencing on June 01. 2018 and
will renew automatically for another twelve-month period unless terminated by either party.
Compensation and Method of Payment

No fees will be charged to District. All dental services performed by INSERT NAME OF ORGANIZATION on campus
will be free of charge.
Additional Terms

1. Termination for Cause. Either party may terminate this Agreement anytime without cause.Either party may terminate
this Agreement anytime without cause.
2. INSERT NAME OF SCHOOL Not liable. INSERT NAME OF SCHOOL shall not be liable to INSERT NAME OF
ORGANIZATION or its employees, agents, invitees, licensees or visitors, or to any other person for injury to person or
damage to property on or about INSERT NAME OF SCHOOL premises caused by any act or omission of INSERT NAME
OF ORGANIZATION its agents, servants or employees, or of any other person entering upon INSERT NAME OF
SCHOOL premises under express or implied invitation by INSERT NAME OF ORGANIZATION

3 . 3. INSERT NAME OF ORGANIZATION Not liable. INSERT NAME OF ORGANIZATION shall not be liable to INSERT
NAME OF SCHOOL or its employees, agents, invitees, licenses or visitors, or to any other person for injury to person or
damage to property on or about INSERT NAME OF SCHOOL premises caused by any act or omission of INSERT NAME
OF SCHOOL, its agents, servants or employees, or of any other person entering upon INSERT NAME OF SCHOOL
premises under express or implied invitation by INSERT NAME OF SCHOOL.
4 . INSERT NAME OF ORGANIZATION's Indemnity. To the extent permitted by law. INSERT NAME OF
ORGANIZATION agrees to indemnify, defend and hold INSERT NAME OF SCHOOL harmless from and against any
claims by INSERT NAME OF ORGANIZATION its clients, employees, or agents, or causes of action for death or injury to
persons, or loss or damage to property arising out of or caused by INSERT NAME OF ORGANIZATION's maintenance,
use, or operation of INSERT NAME OF SCHOOL premises. Such duty to indemnify shall apply without regard to whether
the claim shall arise from the negligence of INSERT NAME OF ORGANIZATION ISO, or any combination thereof.

MOBILE HEALTHCARE ASSOCIATION 7 3