Adult Family Home AFH Services Agreement - La Crosse County 2025

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The document is an agreement between La Crosse County and a service provider for the purchase of Adult Family Home and Respite Services. It outlines the terms of service, payment procedures, provider responsibilities, client eligibility, dispute resolution, and conditions for termination. The agreement emphasizes compliance with state and federal regulations, indemnification clauses, insurance requirements, and prohibits conflicts of interest. It also includes provisions for inspections and modifications to the agreement.
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  1. Click ‘Get Form’ to open the Adult Family Home AFH Services Agreement in the editor.
  2. Begin by entering the Agreement number and effective date at the top of the form. Ensure these details are accurate as they are crucial for identification.
  3. In Section I, provide the name and address of the Provider. Make sure to fill in all fields completely, including service descriptions and payment amounts.
  4. Proceed to Section II, where you will need to detail indemnity and insurance information. This includes entering coverage limits for homeowners' or renters' insurance and automobile liability insurance.
  5. Continue through Sections III to IX, ensuring that you comply with all requirements outlined regarding provider responsibilities, client eligibility, and prohibited practices.
  6. Finally, review all entered information for accuracy before signing. Use our platform’s signature feature to sign electronically at the designated areas.

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