Purchase Order Optometrist in United States San Francisco –Free Word Template Download with AI

Golden Gate Vision Care Group, LLC

1200 Market Street, Suite 450, United States San Francisco, CA 94102

Phone: (415) 555-0198 | Email: [email protected]

State of Incorporation: California, United States

FEIN: 94-XXXXXXX

Dr. Elena Vasquez, OD, FAAO

Bay Area Optometry & Vision Sciences

2847 Fillmore Street, United States San Francisco, CA 94115

Phone: (415) 555-0342 | Email: [email protected]

California Optometrist License No.: OD-2019-44871

Board Certified by the American Academy of Optometry

This Purchase Order is issued by Golden Gate Vision Care Group, LLC to formally request and authorize the procurement of comprehensive optometric services rendered by a licensed Optometrist operating within the jurisdiction of the United States San Francisco metropolitan area. This document serves as a binding commercial instrument establishing the terms, conditions, pricing, and delivery schedule for the professional services described herein. All parties acknowledge that this Purchase Order complies with the California Business and Professions Code, Chapter 659 (Optometrists), and all applicable federal regulations governing the provision of vision care services in the United States.

The Optometrist identified in Section 2 above is hereby engaged to provide a full suite of diagnostic, therapeutic, and corrective vision services to the employee population of the purchasing party. The services shall be performed at the Optometrist's clinical facility located in United States San Francisco, or at such other location within the city as mutually agreed upon in writing prior to the commencement of services.

5.1 This Purchase Order shall be governed by and construed in accordance with the laws of the State of California and the federal laws of the United States of America. Any disputes arising from this Purchase Order shall be resolved through binding arbitration in United States San Francisco, in accordance with the rules of the American Arbitration Association.

5.2 The Optometrist warrants that all services rendered under this Purchase Order shall be performed in full compliance with the California Optometry Practice Act, the standards of care established by the American Optometric Association, and all applicable health and safety regulations enforced by the San Francisco Department of Public Health.

5.3 Payment Terms: Net 30 days from the date of invoice submission. Invoices shall be submitted electronically to the purchasing party's accounts payable department. Late payments shall accrue interest at a rate of 1.5% per month, as permitted under California Civil Code Section 3289.

5.4 The Optometrist shall maintain professional liability insurance with a minimum coverage of $2,000,000 per occurrence and $5,000,000 in aggregate, naming Golden Gate Vision Care Group, LLC as an additional insured party. Certificates of insurance shall be provided prior to the commencement of services.

5.5 All patient records, diagnostic imaging, and clinical data generated in connection with this Purchase Order shall be maintained in strict accordance with the Health Insurance Portability and Accountability Act (HIPAA) and the California Confidentiality of Medical Information Act (CMIA). The Optometrist shall execute a Business Associate Agreement (BAA) prior to any exchange of protected health information.

5.6 The purchasing party reserves the right to audit the Optometrist's service delivery records, billing documentation, and compliance files upon thirty (30) days' written notice. Such audits shall be conducted during normal business hours at the Optometrist's facility in United States San Francisco.

5.7 This Purchase Order is valid for a period of twelve (12) months from the date of execution. Either party may terminate this Purchase Order with sixty (60) days' written notice. Upon termination, all services already rendered shall be invoiced and paid in full.

5.8 The Optometrist shall not subcontract or delegate any portion of the clinical services described in this Purchase Order without the prior written consent of the purchasing party. All services must be personally performed by the licensed Optometrist or by a credentialed associate under the direct supervision of the Optometrist.

Services under this Purchase Order shall commence on July 1, 2025, and shall be completed no later than June 30, 2026. The Optometrist shall provide a detailed service schedule within ten (10) business days of the execution of this Purchase Order. All on-site services in United States San Francisco shall be coordinated with the purchasing party's human resources department to minimize disruption to employee work schedules.

By signing below, both parties acknowledge that they have read, understood, and agree to all terms and conditions set forth in this Purchase Order. This document constitutes a complete and final agreement between the parties with respect to the procurement of optometric services in the United States San Francisco area.