Purchase Order Midwife in United States Chicago –Free Word Template Download with AI
Midwife Professional Services Engagement
United States Chicago, Illinois 60601
PO No. CH-2025-04872 Vendor / Service Provider Information| Vendor Name: | Chicago Certified Midwife Collective, Inc. |
| Midwife Lead: | Ms. Angela Torres, CNM (Certified Nurse-Midwife), License No. IL-CNM-2019-4471 |
| Vendor Address: | 887 W. Madison Street, Floor 2, United States Chicago, IL 60607 |
| Vendor Contact: | (312) 555-0234 | [email protected] |
| State Licensure: | Illinois Department of Financial and Professional Regulation – Midwife License Active |
| Insurance: | Professional Liability Coverage – $2,000,000 per occurrence (Policy No. PL-88291) |
| Item # | Description of Midwife Service | Qty | Unit | Unit Price (USD) | Extended Price (USD) |
|---|---|---|---|---|---|
| 1 | Certified Midwife prenatal consultation and comprehensive obstetric assessment for high-risk and standard-risk patients at the Lakeview Maternal Health Services clinic in United States Chicago. Includes fetal monitoring, nutritional guidance, and birth planning sessions. | 40 | Sessions | $285.00 | $11,400.00 |
| 2 | Midwife-led labor and delivery support services, including continuous one-on-one Midwife attendance during the active labor phase, pain management guidance, and postpartum recovery monitoring for a minimum of four hours following delivery. | 12 | Deliveries | $1,850.00 | $22,200.00 |
| 3 | Postpartum Midwife home-visit program for new mothers residing in the United States Chicago metropolitan area. Includes newborn health screening, breastfeeding support, maternal wound assessment, and mental health check-ins over a 14-day period. | 12 | Visit Packages | $620.00 | $7,440.00 |
| 4 | Midwife emergency on-call retainer for the United States Chicago facility, ensuring a qualified Midwife is available within 30 minutes for obstetric emergencies, preterm labor interventions, and urgent maternal health concerns outside standard clinic hours. | 3 | Months | $2,400.00 | $7,200.00 |
| 5 | Midwife-led community education workshops on prenatal care, safe delivery practices, and postpartum wellness, to be conducted at the United States Chicago Public Health Center. Includes materials, venue coordination, and interpreter services for Spanish and Polish-speaking attendees. | 6 | Workshops | $950.00 | $5,700.00 |
| SUBTOTAL | $53,940.00 | ||||
| Illinois State Sales Tax (10.25%) | $5,528.85 | ||||
| TOTAL PURCHASE ORDER AMOUNT | $59,468.85 | ||||
- This Purchase Order constitutes a binding agreement between Lakeview Maternal Health Services LLC (hereinafter "Buyer") and Chicago Certified Midwife Collective, Inc. (hereinafter "Vendor") for the provision of Midwife professional services within the United States Chicago area. All services shall be rendered in compliance with Illinois state regulations governing midwifery practice as established by the Illinois Department of Financial and Professional Regulation.
- The Midwife and all supporting midwifery staff engaged under this Purchase Order must maintain active, unencumbered licensure in the State of Illinois throughout the duration of the contract. Any lapse in licensure shall constitute immediate grounds for termination of this Purchase Order without penalty to the Buyer.
- Payment shall be remitted via electronic funds transfer (EFT) to the Vendor's designated account within thirty (30) calendar days of receipt of a valid invoice. Invoices must reference Purchase Order number CH-2025-04872 and itemize services rendered under each line item.
- The Vendor shall maintain professional liability insurance with a minimum coverage of $2,000,000 per occurrence and $5,000,000 aggregate. Certificates of insurance naming Lakeview Maternal Health Services LLC as an additional insured party must be provided prior to the commencement of any Midwife services.
- All Midwife services shall be conducted in accordance with the American College of Nurse-Midwives (ACNM) standards of practice and the Illinois Midwifery Practice Act. The Midwife shall document all patient interactions in the Buyer's electronic health record system within twenty-four (24) hours of service delivery.
- The Vendor agrees to a minimum response time of fifteen (15) minutes for emergency Midwife dispatch within the United States Chicago city limits and thirty (30) minutes for the surrounding Cook County area. Failure to meet this response time on three or more occasions in a single calendar month shall result in a 5% service credit applied to the next invoice.
- This Purchase Order may be amended only by written mutual agreement signed by authorized representatives of both parties. No oral modifications shall be binding. Any scope changes affecting Midwife staffing levels, service hours, or geographic coverage within United States Chicago must be submitted as a formal change request at least ten (10) business days in advance.
- Confidentiality: All patient information accessed by the Midwife or any midwifery team member under this Purchase Order is protected under the Health Insurance Portability and Accountability Act (HIPAA) and the Illinois Personal Information Protection Act. The Vendor shall execute the Buyer's Business Associate Agreement prior to any patient data access.
- Termination: Either party may terminate this Purchase Order with thirty (30) days written notice. The Buyer may terminate immediately for material breach, including but not limited to the Midwife's failure to maintain required licensure, insurance, or adherence to clinical protocols. Upon termination, the Vendor shall be compensated for all Midwife services rendered through the effective date of termination.
- Governing Law: This Purchase Order shall be governed by and construed in accordance with the laws of the State of Illinois, United States. Any disputes arising hereunder shall be resolved through binding arbitration in United States Chicago, Cook County, in accordance with the rules of the American Arbitration Association.
For the Buyer:
Lakeview Maternal Health Services LLC
Title: Director of Clinical Operations
Signature: _________________________
Date: _________________________
For the Vendor:
Chicago Certified Midwife Collective, Inc.
Title: Lead Midwife / Authorized Representative
Signature: _________________________
Date: _________________________ ⬇️ Download as DOCX Edit online as DOCX
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