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In this SOP video for Managed Service Providers, Karl emphasizes the necessity of signing contracts for all services. He clarifies that a service agreement is not solely about the statement of work (SOW), which should be appended to it. Instead, the service agreement serves as a foundational document that outlines the overall client relationship, detailing billing frequency, advance billing, and rates, which can be adjusted outside the contract. It also establishes important parameters relevant to both parties' insurance companies and tax implications. Overall, Karl highlights the importance of having a comprehensive service agreement to protect and clarify the professional relationship.