Caregiver Agreement - Template, Sample Form to Complete Pro · US-law

CAREGIVER SERVICES AGREEMENT

State of ________

This Caregiver Services Agreement (this “Agreement”) is entered into and made effective as of ________ (the “Effective Date”) by and between the following parties:

________ (the “Caregiver”), an individual having a primary address at:

________
Phone Number: ________
Email: ________

and ________ (the “Guardian”), an individual having a primary address at:

________
Phone Number: ________
Email: ________

The Guardian represents and warrants that the Guardian holds legal authority to contract on behalf of the following individual pursuant to ________ (e.g., letters of guardianship, durable power of attorney, or court order dated ________): ________ (the “Client”). The Client and the Guardian shall be collectively referred to throughout this Agreement as the “Client,” provided that all references to the Client shall be taken to refer to the Guardian’s contractual representation of the Client.

The Caregiver and the Client (acting through the Guardian) may be referred to individually as a “Party” and collectively as the “Parties.”

RECITALS

WHEREAS, the Guardian wishes to retain the Caregiver to provide certain Caregiving Services, described more fully below, to assist the following individual in continuing to live as independently as practicable: ________;

WHEREAS, the Caregiver represents that the Caregiver possesses the skills, qualifications, experience, and (where applicable) licensure or certification required to provide the Caregiving Services to the Client;

WHEREAS, the Caregiver wishes to render such Caregiving Services to the Client upon the terms and conditions set forth herein;

NOW, THEREFORE, in consideration of the mutual promises and covenants contained herein, and for other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the Parties agree as follows:

§ 1. DEFINITIONS

As used in this Agreement:

(A) “Caregiving Services” means the following specific non-medical caregiving services that the Caregiver will provide to the Client under the terms and conditions set forth herein:

________

(B) “Commencement Date” means the date on which the Caregiver begins providing the Caregiving Services, which shall be ________.

(C) “Completion Date” means the date on which the Caregiver will complete or cease the provision of the Caregiving Services, which shall be ________.

(D) “Fees” means the compensation the Client agrees to pay the Caregiver for the rendering of the Caregiving Services, as follows:

$________ (________), as a fixed fee for all Caregiving Services rendered.

(E) “Location” means the location identified in § 3 at which the Caregiving Services will be rendered.

§ 2. TERM AND COMPENSATION

(A) Term. This Agreement shall commence on the Commencement Date and shall continue through the Completion Date, unless earlier terminated in accordance with § 10.

(B) Fees. In consideration of the Caregiving Services to be rendered by the Caregiver, the Client agrees to pay the Caregiver the Fees set forth in § 1(D). Payment shall be made in accordance with the following schedule: ________.

(C) Taxes. The Caregiver shall be solely responsible for all federal, state, and local taxes, contributions, and assessments due on or arising from the Fees received under this Agreement, consistent with the Caregiver’s status as an independent contractor under § 5. The Caregiver shall provide the Client with a properly completed IRS Form W-9 upon execution of this Agreement, and the Client may issue an IRS Form 1099-NEC where required by law.

§ 3. LOCATION

The Caregiver will provide the Caregiving Services to the Client at the following Location:

________

§ 4. HOUSING

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§ 5. INDEPENDENT CONTRACTOR STATUS

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§ 6. EXPENSE REIMBURSEMENT

Except as otherwise expressly provided in this Agreement, the Caregiver shall be responsible for any and all expenses incurred in the performance of the Caregiving Services.

§ 7. SCHEDULE

The schedule for the Caregiving Services shall be as follows:

________

The Parties may modify or adjust the schedule by mutual agreement, as needed.

§ 8. VEHICLE

Where the Caregiving Services require transportation, the Caregiver will use the Caregiver’s own vehicle. The Caregiver shall maintain a valid driver’s license and the minimum automobile liability insurance required by applicable law. The Caregiver may submit actual mileage, supported by a detailed and contemporaneous mileage log, to the Client for reimbursement at the rate of $________ per mile.

§ 9. CONFIDENTIALITY

The Caregiver acknowledges that, in the course of providing the Caregiving Services, the Caregiver may have access to confidential and personal information concerning the Client, including health, financial, and personal information. The Caregiver shall hold all such information in strict confidence, shall use it solely for the purpose of providing the Caregiving Services, and shall not disclose it to any third party except as required by law or as authorized in writing by the Guardian. This obligation shall survive the termination of this Agreement.

§ 10. STANDARD OF CARE; LIABILITY; INDEMNIFICATION

(A) Standard of Care. The Caregiver shall perform the Caregiving Services with the reasonable care, skill, and diligence ordinarily exercised by qualified caregivers under similar circumstances, and in compliance with all applicable laws and regulations.

(B) Limitation of Liability. To the fullest extent permitted by applicable law, the Caregiver shall not be held liable for any injury, loss, or damage to the Client or the Client’s property arising in the ordinary course of the provision of the Caregiving Services, except to the extent that such injury, loss, or damage results from the gross negligence, recklessness, or willful misconduct of the Caregiver. Nothing in this Agreement shall limit or exclude any liability that may not lawfully be limited or excluded.

(C) Indemnification. Each Party shall indemnify, defend, and hold harmless the other Party from and against any claims, damages, liabilities, and reasonable expenses (including reasonable attorneys’ fees) arising out of the indemnifying Party’s gross negligence, willful misconduct, or material breach of this Agreement.

§ 11. TERMINATION

This Agreement may be terminated by either Party upon at least ________ days’ prior written notice to the other Party. Either Party may terminate this Agreement immediately upon written notice in the event of a material breach by the other Party, or where continuation would endanger the health or safety of the Client. Upon termination, the Client shall pay the Caregiver for all Caregiving Services properly rendered through the effective date of termination, and the Caregiver shall promptly vacate the Location as provided in § 4.

§ 12. GENERAL PROVISIONS

(A) GOVERNING LAW: This Agreement shall be governed by and construed in accordance with the laws of the State of ________, without regard to its conflict-of-laws principles, and any applicable federal law. The Parties consent to the exclusive jurisdiction and venue of the state and federal courts located in ________ County, State of ________, and agree that this choice of law, venue, and jurisdiction provision is mandatory and not permissive.

(B) LANGUAGE: All communications made or notices given pursuant to this Agreement shall be in the English language.

(C) ASSIGNMENT: This Agreement, and the rights and obligations hereunder, may not be assigned, sold, delegated, or otherwise transferred, in whole or in part, by either Party without the prior written consent of the other Party.

(D) AMENDMENTS: This Agreement may only be amended by a written instrument signed by both Parties.

(E) SEVERABILITY: If any provision or term of this Agreement is held to be invalid or unenforceable, then this Agreement shall be deemed amended to the extent necessary to render the otherwise unenforceable provision, and the remainder of this Agreement, valid and enforceable. If a court declines so to amend this Agreement, the invalidity or unenforceability of any provision shall not affect the validity or enforceability of the remaining terms and provisions, which shall be enforced as if the offending term or provision had not been included.

(F) WAIVER: The failure of either Party to enforce any provision of this Agreement shall not be construed as a waiver of that or any other provision, nor of any subsequent breach.

(G) NOTICES: All notices required or permitted under this Agreement shall be in writing and delivered to the addresses set forth above, or to such other address as a Party may designate in writing, and shall be deemed given upon personal delivery, upon confirmed electronic transmission, or three (3) business days after deposit in the mail, postage prepaid.

(H) ENTIRE AGREEMENT: This Agreement constitutes the entire agreement between the Parties and supersedes all prior or contemporaneous understandings, representations, and agreements, whether written or oral.

(I) HEADINGS: Headings in this Agreement are for convenience only and shall not be construed to limit or otherwise affect the terms of this Agreement.

(J) COUNTERPARTS: This Agreement may be executed in counterparts, including by electronic signature, each of which shall be deemed an original and all of which together shall constitute one and the same instrument.

EXECUTION

IN WITNESS WHEREOF, the Parties have executed this Agreement as of the dates set forth below.

CAREGIVER:

________

Signature: _________________________

Date: _____________________________

GUARDIAN, as legal guardian of and on behalf of ________:

________

Signature: _________________________

Date: _____________________________

ACKNOWLEDGMENT (Notary):

State of ________, County of ________.

On this ________, before me, the undersigned notary public, personally appeared ________, who is/are personally known to me or proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the foregoing instrument, and acknowledged that he/she/they executed the same for the purposes therein contained.

Notary Public Signature: _________________________

My commission expires: ________