Contract Title:
Vendor:
Vendor Contact & Phone:
Contract Originator:
Department:
Approximate Value:

The following process is required before any new contract is entered into on behalf of [AGENCY NAME].

  1. Contract Originator ([AGENCY NAME] contact: e.g., manager/administrative assistant/associate/director) fills out New Contract Checklist.
  2. Contract Originator sends contract and completed checklist to Compliance Director for review.
  3. If there are changes, Compliance Director will send edits back to Contract Originator for contract negotiation. A confidentiality agreement (CA) or business associate agreement (BAA) may need to be sent to vendor/contractor.
  4. If there are no changes, Compliance Director will send to appropriate [AGENCY NAME] leadership for signature.
  5. Once contract is signed, contract is returned to Contract Originator to send to the vendor. After sending, Contract Originator must send a copy of the executed contract, approval letter, and contract checklist, all with appropriate signatures to Executive Assistant.

  1. Contract

This is a new vendor for [AGENCY NAME]. / YES □ / NO □
This contract renews automatically. / YES □ / NO □
If contract renews automatically, it renews on this date:
This contract expires on (date):
This contract includes all pages, addenda and attachments, including any referenced documents that are available on the vendor’s website. / YES □ / NO □
This contract shows our correct legal name. / YES □ / NO □
The contract clearly spells out the effective date. / YES □ / NO □
All costs are clearly itemized and acceptable. / YES □ / NO □
The payment method and schedule are clear and acceptable. / YES □ / NO □
The responsibility for any cost increases is clear and assigned appropriately. / YES □ / NO □
Charges for late payments are clear and reasonable. / YES □ / NO □
Location(s) for service are clear and acceptable. / YES □ / NO □
The method for delivery of service is clear and acceptable. / YES □ / NO □
Description of issues:
  1. Vendor

Vendor is reputable. / YES □ / NO □
Vendor is adequately insured. / YES □ / NO □
Vendor does not have an unlimited claim to research results (if applicable). / YES □ / NO □
Vendor does not have access to PHI. / YES □ / NO □
If vendor does have access to PHI, a BAA has been sent to the Privacy Officer for review/approval. / YES □
Vendor’s performance expectations are clear. / YES □ / NO □
Vendor does not have access to the [AGENCY NAME] logo or trade name. / YES □ / NO □
Description of issues:
  1. [AGENCY NAME]

[AGENCY NAME] will retain exclusive ownership of that data shared. / YES □ / NO □
If not, [AGENCY NAME] and vendor will share ownership of the data shared. / YES □ / NO □
[AGENCY NAME]’s tax exemption status is observed. / YES □ / NO □
Description of issues:
  1. Indemnification and Liability

There is a clause that will hold the vendor harmless for negligence, damages, etc. / YES □ / NO □
There is a clause that will hold [AGENCY NAME] harmless for negligence, damages, etc. / YES □ / NO □
It is clear that any damages to [AGENCY NAME]’s property by vendor is the responsibility of the vendor. / YES □ / NO □
Description of issues:
  1. Performance

A clear timeline for the performance of service is included and acceptable. / YES □ / NO □
Location(s) for service are clear and acceptable. / YES □ / NO □
The expected quality of services is clearly defined. / YES □ / NO □
It is clear how quality will be determined. / YES □ / NO □
It is clear how long [AGENCY NAME] has to assess quality. / YES □ / NO □
[AGENCY NAME]’s rights and remedies if services do not meet expectations are clearly defined and acceptable. / YES □ / NO □
Description of issues:
  1. Termination

[AGENCY NAME] may terminate the contract without the approval of the vendor. / YES □ / NO □
[AGENCY NAME] may terminate the contract for “no cause.” / YES □ / NO □
It is clear how much notice must be given before a termination. This period of time is acceptable to [AGENCY NAME]. / YES □ / NO □
All fees and penalties for termination are clear and acceptable. / YES □ / NO □
Description of issues:
  1. Confidentiality

Vendor may have access to donor information. / YES □ / NO □
Vendor may have access to [AGENCY NAME] operation information (Compliance Director will determine if CA is required.) / YES □ / NO □
Vendor may be able to view PHI, either intentionally or unintentionally (Compliance Director will determine if BAA is required). / YES □ / NO □
Description of issues:

Signature of Contract Originator

I certify that I have reviewed the contract in question and have completed the above checklist. I have done due diligence to ensure that the contract and vendor meet [AGENCY NAME]’s requirements.

Signature of Contract Originator / Date