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eutilagn ‘Contract/Grant Agreement Checktst iste snl Peenmpleed hana ne coronene ee he Hse CLO sigan." fa ele ‘omplaal bythe pgm sper alia mega chest ecctaevae ape orn Ihe sen Die: Spm can hw CEO or appa. then 0 def PrennCEO' se over shee svat by, Se irndo . oes SUZ sin f= Fargo Elposwr gys.az ene, BODE ‘Areses Pia Copier fan Canned Ovi Rebnwediet Sue Goundvsen (Oar obs Lee Joi hn, peo el ae sxcuat: [Y] fonen’h Progmaney Center Gas HCiam agement wit Snowy Serie sor: 6220 pews Entve ake of Creel Agere ZAZE7 den GIS anil Stay peut Commer Agreement; Honey Ra SOM Of 2Morayemen Fl Mom yates eel Rik 0s Dreamz Reviews: Praga Dior mir Divs Diewor: Sin rot nna: (ste Con en acne sie Py ceo, Blef yr Bonnin abn “~ ECEN Dg! EGER 0) . AUG 28 208? ECONORNC ASSISTANCE Memorandum of Agreement ‘This Agraernent is entered batueen Women's Pregnancy Center (Agency Provider}, The Villago Tanily Sarvice Genter and the North Dckola Department cf Htuinan Servces {NDDHS). NDDMS je responsible far supervision of the Altematives te Aborion Program, Tha Village Family Service Conter wil administer the Alfernatves to Aborlton Program including marketing, updering and maintaining a lst of seruce providers, staking payments to sarcs providers and 4-800 senvce. ‘The program will provide positive outeome-based information, souneeling, and support services with the following requirements and expectations: 1. Provide sevuloas to pregnant wonten of women who bellave they may be pregnant, who reside In North Oakola. 2, Promate childbirth through information, ecunseling and education to assist pragnan! women to chease childbirth 3, Assist women in ‘iaking informed desisions sbaut adoption or parenting with Tespact to the child Alternatives ta Abortion services do not Include medicel services, ‘The Agenry Prouider desires to provide Alleratives to Abortion services nos stent with the requirements of he Alternatives to Abortions Program anc to meet the requirements O1N.D.G.. § 50-08-26 and thie Agreement. The Agency Prouldcr agrece to: 1. Scien excl polenlial client to esteblish that she is pregnant or reasonebly boleves she may be pregnant: 2, Invorm ach client that itis herright to secure Alternatives tc Abartians servicas from a provider of those services listed in the Alternatives ta Abortions hraghue, 3, Assist NDDHS and The Vilage Fatally Service Center in gathering data to fevalyata tha Altamatives te Abartions Program from the clas fist visit shrough birtn of the child; 4. Keep confifential the corr municallons hetweet.@ chid and provider or its employees and agents, except as permiied by faw or by the informed agreemant af the client, Submit tc NDDKS and The Vilage Family Servlae Center a copy of provicer’s Fabllty insurance polisy for approval befare raquasting payment; and 6. Maintain approved ahiliy coverage in effect at all tines services are being proviced under this Agreement, Agency Provider agrees nai to 1. Ceunsel for, refer for, ancourags, oF perform abortions, or knowingly rafer an Alternatives to Abortions ellent to another person or agency for the purpase of receiving caunsetiag for, referral for, encouragement for, ur fie oerfoimance of an aboation; of 2, Discriminate apalast Alernatives tp Abortions cliant on the basis of rligion, a religious belief, & refusal to hold a religious betel, or a rsfusal le actively patlicipate in a religious practice. Provdier for Attermafives to Abortions services will receive rsimbursenent (or services provided based on # “ate of $10.00 for each quarter haur of service furnished by a member of the clergy, a nurse lioonsed under N.D.S.C. ch. 23-12.1, a physician licensed under N.D.C.C. ch, 43-17, a psychologist censed unde N.D.C.C. ch, 49-2, & social worker lbensed uncer N.D.C.C. ch, 43-41 an adu/clion counselor lensed! under N.D.CC. ch. 43-45, a counselor licensed under N.D.C.C. 2h. $3-47, of a masriags and farniy therapist Boansad under M.D,C.C. ch. 43-53; and ata rate of $8.09 for each latter hour of service furnished by any cther individ, ‘This Agreement is effective July 2017 and remzing iv effect ull June 30, 2019, unless terminated by the Agency Provider, The Vilage Fantlly Service Center of NDOHS. ‘This Agreeent may be terminated at any time by mutuel consant of parties, oF upon 30-daye’ wikion notice by ether party, with or withcot cause. Failure by the Agency Provider to perform the terms ofthis Agresment may resu inthe immedkace tenmination af tre Agroament ‘Agency Provider: __ Women's Pregaanuy Center Signature: Anta TWO Tile: Rhy hit Mawar. ‘Tho Village Fami'y Service Center - Hb dria Date ong vg, PrestanTEEO The Vilage Family Service Center C: Carol Cartesge, Director Economic Assistance Potley Division Non Dakota Department of Hurnan Sovvlees