Purchase Order Speech Therapist in United States San Francisco –Free Word Template Download with AI
Golden Gate Health & Wellness Services, Inc.
1200 Market Street, Suite 450, San Francisco, California 94102, United States
Tel: (415) 555-0187 | Email: [email protected]
PO NO. GGH-2025-04782
Buyer Information
Company: Golden Gate Health & Wellness Services, Inc.
Address: 1200 Market Street, Suite 450
City/State/ZIP: San Francisco, CA 94102
Country: United States
PO Date: June 12, 2025
Required By: July 1, 2025
Vendor / Service Provider
Company: Bay Area Speech & Language Therapy Group
Address: 845 Mission Street, Floor 3
City/State/ZIP: San Francisco, CA 94105
Country: United States
Vendor ID: V-2024-0091
Contact: Dr. Elena Vasquez, CCC-SLP
| # | Description of Service | Quantity | Unit | Unit Price | Extended Price | Location |
|---|---|---|---|---|---|---|
| 1 | Board-Certified Speech Therapist – Pediatric Articulation & Phonology Sessions (ages 3–12). Each session includes individualized assessment, therapeutic intervention, and progress documentation. The Speech Therapist must hold a current California license and CCC-SLP certification. | 120 | Sessions | $185.00 | $22,200.00 | San Francisco, CA |
| 2 | Board-Certified Speech Therapist – Adult Neurogenic Communication Disorders (post-stroke, TBI, ALS). Includes comprehensive evaluation, treatment planning, and family caregiver training. The Speech Therapist shall provide weekly progress reports to the referring physician. | 80 | Sessions | $210.00 | $16,800.00 | San Francisco, CA |
| 3 | Speech Therapist – Fluency & Stuttering Intervention Program (ages 5–18). Group-based therapy with a maximum of 6 participants per group. The Speech Therapist will coordinate with school district IEP teams in the San Francisco Unified School District. | 40 | Group Sessions | $320.00 | $12,800.00 | San Francisco, CA |
| 4 | Speech Therapist – Telehealth Consultation & Remote Monitoring. Virtual follow-up sessions for patients residing in the broader San Francisco Bay Area. The Speech Therapist will utilize HIPAA-compliant telehealth platforms approved by the vendor. | 60 | Virtual Sessions | $140.00 | $8,400.00 | Remote / SF Bay Area |
| 5 | Speech Therapist – Initial Comprehensive Evaluation & Treatment Plan Development. Includes standardized testing (CELF-5, PPVT-IV, or equivalent), oral-motor examination, and a written treatment plan delivered within 5 business days of the initial session. | 50 | Evaluations | $350.00 | $17,500.00 | San Francisco, CA |
| Subtotal | $77,700.00 |
| California Sales Tax (8.5% on applicable items) | $0.00 (Exempt – Medical Services) |
| Administrative & Coordination Fee | $2,331.00 |
| TOTAL PURCHASE ORDER AMOUNT | $80,031.00 |
- Scope of Services: This Purchase Order authorizes the procurement of Speech Therapist services as itemized above. All Speech Therapist personnel assigned to this contract must be licensed by the California Board of Registered Nursing or the California Commission on Speech-Language-Hearing Pathology, and must maintain active certification from the American Speech-Language-Hearing Association (ASHA).
- Service Location: All in-person Speech Therapist sessions shall be conducted at the buyer's facility located at 1200 Market Street, San Francisco, California 94102, United States, or at the patient's residence within the City and County of San Francisco as pre-approved in writing by the buyer's clinical director.
- Compliance: The vendor and all assigned Speech Therapist staff shall comply with all applicable federal, state, and local regulations in the United States, including but not limited to HIPAA (Health Insurance Portability and Accountability Act), the Americans with Disabilities Act (ADA), California Health and Safety Code, and San Francisco Municipal Code provisions governing healthcare service providers.
- Payment Terms: Net 30 days from the date of invoice receipt. Invoices shall be submitted monthly and must include detailed session logs, patient identifiers (de-identified per HIPAA), and the Speech Therapist's signature and license number for each service rendered.
- Performance Standards: The Speech Therapist shall maintain a minimum patient satisfaction rating of 4.2 out of 5.0 as measured by quarterly surveys. Failure to meet this standard for two consecutive quarters shall constitute grounds for termination of this Purchase Order with 30 days' written notice.
- Insurance & Liability: The vendor shall maintain professional liability insurance of no less than $1,000,000 per occurrence and $2,000,000 aggregate, as well as workers' compensation coverage as required by the State of California. Certificates of insurance shall be provided prior to the commencement of services.
- Confidentiality: All patient records, clinical notes, and progress reports generated by the Speech Therapist in connection with this Purchase Order shall remain the property of the buyer. The vendor shall execute a Business Associate Agreement (BAA) prior to any access to protected health information.
- Termination: Either party may terminate this Purchase Order with 60 days' written notice. In the event of termination, the vendor shall complete all scheduled Speech Therapist sessions already booked and provide a comprehensive transition plan for affected patients within the City of San Francisco.
- Governing Law: This Purchase Order shall be governed by and construed in accordance with the laws of the State of California, United States. Any disputes shall be resolved through binding arbitration in San Francisco, California, in accordance with the rules of the American Arbitration Association.
- Background Checks: All Speech Therapist personnel shall undergo a criminal background check through the California Department of Justice and the FBI, as well as a check of the California Child Abuse Central Index, prior to their first session with any patient under this Purchase Order.
Authorized by (Buyer):
Michael T. Okafor, Director of Procurement
Golden Gate Health & Wellness Services, Inc.
Date: ______________________
Accepted by (Vendor):
Dr. Elena Vasquez, CCC-SLP, Owner
Bay Area Speech & Language Therapy Group
Date: ______________________
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