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-,,.,.. -""'~ J Rider to MASTER SERVICES AGREEMENT between MAXIM HEALTH SYSTEMS, LLC and City of North Olmsted FOR FACILITY AND PUBLIC IMMUNIZATION THIS RIDER (this "Rider") TO THE MASTER SERVICES AGREEMENT (the "Agreement") is entered into as of the 17th day of February, 2009 (the "Effective Date"), by and between MAXIM and CLIENT referenced therein. WHEREAS, CLIENT desires to provide Services for members, residents, employees and/or the general public as identified by CLIENT (whether one or more, collectively, the "RECIPIENTS") at the CLIENT'S facility, and has entered into an Agreement with MAXIM to provide Services at CLIENT requested locations ("CLINIC(S)"); and WHEREAS, MAXIM employs Personnel and is willing to provide such Personnel to provide these Services at CLIENT'S CLINIC(S) according to the terms and conditions set forth herein. 1.1 Personnel. MAXIM will supply CLIENT with Personnel who meet the following criteria: 1) Possess current state license/registration and/or certification. 2) Possess CPR certification. 3) Possess proof of pre-employment screening, including, as required by state law, a physical and TB skin test, professional references, criminal background check(s) (and drug screenings as requested by CLIENT at CLIENT'S sole expense). 1.2 Promotional Materials. MAXIM shall provide reasonable quantities of promotional materials for CLINICS. 1.3 Consent Forms. RECIPIENTS will each be required to read and sign a consent form prior to receiving Services. MAXIM will provide consent forms to RECIPIENTS at the time Services are rendered. 1.4 Compensation. CLIENT to choose one of the following payment methods by initialing: a. MAXIM will bill Medicare Part B for RECIPIENTS that have coverage through Medicare Part B and who provide proper documentation prior to receiving Services as proof of such coverage. CLIENT will be responsible for payment for RECIPIENTS that do not have Medicare Part B coverage or who do not provide proper documentation of said coverage. Rates will be charged as set forth in Section 1.6 below. X MAXIM will bill Medicare Part B for RECIPIENTS that have coverage through Medicare Part B and who provide proper documentation prior to receiving Services as proof of such coverage. RECIPIENTS will be responsible for payment for Services if they are not covered by Medicare Part B or do not provide proper documentation of such coverage at the time of the CLINIC. Rates will be charged as set forth in Section 1.6 below. c. CLIENT will be responsible for payment for Services received by RECIPIENTS. Rates will be charged as set forth in Section 1.6 below. 1.5 Promotions. CLIENT shall promote CLINICS to RECIPIENTS. Promotions will include, but not be limited to, displaying promotional materials in highly visible settings at least two (2) weeks prior to the date of the CLINIC. Rev. 07/06 Copyright 2003-2006. MAXIM HEALTH SYSTEMS, LLC All rights reserved.