Purchase Order Midwife in United States Los Angeles –Free Word Template Download with AI
Midwife Professional Services — Los Angeles, California, United States
Document Reference: PO-LA-2025-04871
Buyer Information| Organization: | Westside Maternal & Child Health Center |
| Address: | 4820 Wilshire Boulevard, Suite 300, Los Angeles, California 90036, United States |
| Contact Person: | Dr. Elena Vasquez, Director of Obstetric Services |
| Phone: | (213) 555-0147 |
| Email: | [email protected] |
| Tax ID (EIN): | 82-4471903 |
| Provider Name: | Certified Midwife Associates of Southern California, LLC |
| Address: | 1200 S. Grand Avenue, Floor 5, Los Angeles, California 90015, United States |
| Contact Person: | Ms. Patricia Nguyen, CM, Lead Midwife & Business Manager |
| Phone: | (323) 555-0892 |
| Email: | [email protected] |
| License No.: | CA-CM-2019-00482 (California Board of Registered Midwives) |
| Insurance: | Professional Liability Coverage — Policy #PL-77821, $2,000,000 per occurrence |
| # | Description of Midwife Service | Qty | Unit Rate (USD) | Total (USD) | Service Period |
|---|---|---|---|---|---|
| 1 | Certified Midwife — Prenatal Care Consultations (comprehensive obstetric assessments, fetal monitoring, and patient education sessions conducted at the Westside Maternal & Child Health Center in Los Angeles, United States) | 48 | $185.00 | $8,880.00 | Jul 1 – Sep 30, 2025 |
| 2 | Certified Midwife — In-Labor Room Attendance and Delivery Support (one-on-one Midwife assistance during active labor, including pain management guidance, positioning support, and postpartum initial assessment at the Los Angeles facility) | 12 | $1,200.00 | $14,400.00 | Jul 1 – Sep 30, 2025 |
| 3 | Certified Midwife — Postpartum Home Visits (follow-up Midwife visits to patients residing in the greater Los Angeles metropolitan area, including newborn assessments, breastfeeding support, and maternal recovery evaluations) | 36 | $220.00 | $7,920.00 | Jul 1 – Sep 30, 2025 |
| 4 | Certified Midwife — Community Health Education Workshops (group Midwife-led sessions on prenatal nutrition, safe delivery practices, and newborn care, to be held at community centers throughout Los Angeles, United States) | 8 | $650.00 | $5,200.00 | Jul 1 – Sep 30, 2025 |
| 5 | Certified Midwife — On-Call Emergency Availability (24/7 Midwife on-call coverage for urgent obstetric consultations and emergency referrals within the Los Angeles service area) | 90 | $75.00 | $6,750.00 | Jul 1 – Sep 30, 2025 |
| SUBTOTAL | $43,150.00 | ||||
| Applicable Sales Tax (8.75% — Los Angeles County, CA) | $3,775.63 | ||||
| GRAND TOTAL (USD) | $46,925.63 | ||||
- This Purchase Order constitutes a binding agreement between Westside Maternal & Child Health Center (hereinafter referred to as the "Buyer") and Certified Midwife Associates of Southern California, LLC (hereinafter referred to as the "Provider") for the engagement of licensed Midwife professional services to be rendered in Los Angeles, California, United States.
- All Midwife services described in this Purchase Order shall be performed by individuals holding current, valid certification from the California Board of Registered Midwives and shall comply with all applicable federal, state, and local regulations governing midwifery practice in the State of California and the City of Los Angeles.
- The Provider shall maintain professional liability insurance with a minimum coverage of $2,000,000 per occurrence throughout the duration of this Purchase Order. Proof of insurance shall be provided to the Buyer prior to the commencement of services.
- Payment shall be made within thirty (30) calendar days of receipt of a valid invoice from the Provider. Invoices shall reference this Purchase Order number (PO-LA-2025-04871) and shall be submitted electronically to the Buyer's accounts payable department.
- The Provider agrees to maintain strict confidentiality of all patient medical records and personal health information in accordance with the Health Insurance Portability and Accountability Act (HIPAA) and all applicable California privacy statutes, including the California Confidentiality of Medical Information Act (CMIA).
- Any modifications, cancellations, or extensions to this Purchase Order must be made in writing and signed by authorized representatives of both parties. Verbal agreements shall not be binding.
- The Provider shall comply with all occupational safety standards set forth by the California Department of Industrial Relations and the Los Angeles County Department of Public Health during the performance of Midwife services on the Buyer's premises.
- In the event of a dispute arising from this Purchase Order, both parties agree to first attempt resolution through good-faith mediation in Los Angeles, California, United States, before pursuing any formal legal action in the Superior Court of California, County of Los Angeles.
- This Purchase Order shall remain in full force and effect from July 1, 2025, through September 30, 2025, unless terminated earlier by mutual written consent or in accordance with the termination provisions herein.
- The Provider warrants that all Midwife personnel assigned under this Purchase Order shall be free of any disciplinary actions, license suspensions, or malpractice findings that would impair their ability to deliver safe and competent obstetric care in the Los Angeles, United States, service area.
For the Buyer:
Westside Maternal & Child Health Center
Dr. Elena VasquezDirector of Obstetric Services
Date: ______________________
For the Provider:
Certified Midwife Associates of Southern California, LLC
Ms. Patricia Nguyen, CMLead Midwife & Business Manager
Date: ______________________ ⬇️ Download as DOCX Edit online as DOCX
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