Service Agreement

About You:

Which best describes you: *

I am engaging Alyv to provide services to meI am engaging Alyv to provide services to someone I care forI have legal authority to Engage Services for another person

Your Details:

First Name *

Last Name *

Preferred Pronouns

Phone Number *

Email Address *

Best Method To Communicate

Text MessageEmailPhone

Please provide any information regarding communications ie. Font size for emails, printed copies needed etc.

NDIS Number *

Residential Address *

Street address *

City *

State *

Postcode *

Current Plan Start Date *

Current Plan End Date *

Details of the Person Receiving Services:

Full Name *

Address (Residential) *

Street address *

City *

Postcode *

Contact Number

Contact Email

Contact Method *

TextPhoneEmailOther

Please give any specific details about communicating with this person ie. text message only, large font needed for emails etc.

NDIS # *

Age: *

Plan Start Date *

Plan End Date *

Legal Authority

What legal authority do you have *

Please upload your authority to Act for this person *

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The Agreement

This service agreement is made between the above mentioned person, who is a participant in the National Disability Insurance Scheme, and The Trustee for Sarahs Family Trust, Trading as Alyv (TM), ABN: 31 891 008 162

This agreement will start on:

and shall continue for the duration of the persons plan as specified above. Both parties agree that should the NDIS plan roll over, extend, be reviewed or renewed this agreement and all its terms and conditions will extend beyond the expiry date in the previous plan by mutual agreement.

Alyv Agrees To:

Review this agreement as required or when requested by the Participant
Provide services that meet the Participants needs at the Participants preferred times
Be transparent and honest in all dealings with the Participant
Communicate effectively in a manner stated by the Participant
Treat the Participant with respect and courtesy
Seek instruction and direction from the Participant regarding all aspects of their support
Give the Participant information about managing complaints and concerns
Listen to any feedback from the Participant and resolve any issues quickly
Give the Participant a minimum of 24 hours notice if Alyv has to amend any booking.
Give the Participant the required notice if Alyv needs to end this agreement (see “Ending this Service Agreement” below for more information)
Protect the Participants privacy and confidentiality
Keep accurate records of any services provided to the Participant
Issue invoices and statements as soon as practical to the Participant
Give a minimum of two weeks notice in writing with any changes to the terms in this agreement

The Person(s) Above Agree To:

Inform Alyv how they wish the services to be delivered to meet their needs
Treat the Provider with courtesy and respect
Communicate to the Provider if the Participant has and concerns about the services being provided
Give the Provider a minimum of one clear business day notice if the Participant cannot make a scheduled appointment; should notice be given within one clear business day of the booking then the Alyv cancellation policy will apply
Give Alyv the required notice if the Participant needs to end the Agreement (see “Ending this Service Agreement” below for more information); and
Let the Provider know immediately if the Participants NDIS Plan is suspended or replaced by a new plan or if the Participant stops being a Participant of the NDIS

Agree *

Costs and Pricing

Please select the applicable categories for the supports you need: *

Core Supports (In Home or Community)High Intensity Core Supports (In Home or Community)Gardening, Cleaning and Home MaintenanceCB Social & Community (ie. Mentoring, Peer Support, Individual Skill Development, Life Transition Planning, Daily Living Skill Building)CB Daily Living (ie. Assistance with Decision Making, Budgeting, Daily Planning, Skill Development or Public Transport Training)Other

Core Supports (In Home and Community) (Hourly Rates)

Weekdays (booking finished before 8pm)	$62.22
Weekday Evenings (booking finished after 8pm)	$68.55
Weekday Nights (bookings that start before 6am or finish after 12am)	$69.75
Saturdays	$87.58
Sundays	$111.38
Public Holidays	$138.65
Transport (With or on behalf of the service recipient)	$0.90 per km plus costs (parking etc)

High Intensity Core Supports (In Home or Community) (Hourly Rates)

Weekdays (booking finished before 8pm)	$67.22
Weekday Evenings (booking finished after 8pm)	$73.55
Weekday Nights (bookings that start before 6am or finish after 12am)	$74.75
Saturdays	$95.13
Sundays	$123.89
Public Holidays	$153.88
Transport (with or on behalf of the service recipient)	$0.90 per km plus costs (parking etc)

CB - Increased Social and Community Participation (Hourly Rate)

Individual Skill Development (Life Transition Planning)	$72.00
Skill Development and Training	$72.00
Community Participation Activities	As Quoted

CB - Improved Daily Living (seven years or older)

Skill Development and Public Transport Training	$63.00
Daily Planning, Budgeting and Supported Decision Making	$63.00
Reporting on Request	As Quoted

Gardening and Home Maintenance (Hourly Rate)

Cleaning (Domestic)	$52.00
Gardening	$52.00
Home Maintenance	$52.00

Consumables

Visual charts, guides, check lists etc	As Quoted
Flash cards and communication cards	As Quoted
Social stories	As Quoted

Activity Based Transport (with you or on your behalf) $0.90 per km paid directly to your worker.

If reports are required to assist with a plan review, please advise us with at least six weeks notice and we will arrange a quote based on the kind of reporting needed. There is no charge to supply general information such as your roster of supports or other documents we have on file regarding your services with us.

Alyv does NOT charge for Provider travel (to get to and from your home).

Alyv does NOT charge for any establishment or set up costs.

Agree *

Cancellations, Bookings and Ending This Agreement

The Alyv cancellation policy required you to give one clear business day notice for cancellations in order to not inccur a cancellation fee.

If a cancellation is made with less than one clear business days notice, Alyv will charge 100% of the agreed booking value.

For example, if you wish to cancel a booking on a Friday, we will need notice of this within business hours on the preceding Wednesday.

Our business days are Monday through Friday, 9am to 5pm excluding public holidays.

Alyv will work with you to minimise late cancellations and we will offer you alternatives where possible. We will also take all efforts to ensure your wellbeing in the event that you don't attend a booking and have not given us any notice. This may include calling you, your emergency contacts or other people you have nominated.

We promise to make every effort to reallocate your worker and will only charge for a late cancellation where we have exhausted these avenues and are obligated to pay the worker for their missed hours.

Agree *

Alyv will work with you to develop a roster of supports. This roster is how we will plan your services and staff availability.

Should you need any one off changes, please contact Alyv as soon as possible so we can plan for additional supports. We recommend at least two weeks notice so we can plan for one of your preferred staff members to be available to you. Changes and additions to the roster with less than two weeks notice cant be guaranteed but we will always try our best.

Should you need to permenantly change your bookings, please provide two weeks notice, although we will always try to facilitate these changes much sooner.

Agree *

Should any changes to this agreement be needed, Alyv will discuss these in an open and transparent way to ensure your needs are met.

Should you wish to cancell this agreement we are happy to negotiate the cancellation period. If you are no longer needing our services you can cancel future bookings as per our cancellation policy and we can end services immediately.

Alternatively you can choose a future date, and we can work with your new supports to hand over and train them up until this time.

Agree *

Invoicing and Payments

Tick here if you are Plan Managed

All parties agree that Alyv is an independent provider and will make invoices for services to be sent to self managed and plan managed participants and/or their nominees.

We can not claim funds directly from NDIA for Agency Managed participants.

Agree *

Alyv will be responsible for creating accurate invoices on a weekly or fortnightly basis and the participant will be responsible for the payment of these invoices. All claims with the NDIA are the Participant's responsibility and, should the NDIA reject a claim for services, the Participant would be responsible for the payment of any invoices outstanding.

Alyv will make all efforts to ensure invoices are acceptable by the NDIA, and Plan Managers, Participants and their nominees are responsible for managing their NDIA budgets and advising us if any changes to services are needed due to funding.

Agree *

Plan Manager Name *

Plan Manager Email *

Goods and Services Tax

For the purposes of GST legislation, the Parties confirm that:

A supply of Services under this Agreement is a supply of one or more of the reasonable and necessary Services specified in the statement included, under subsection 33(2) of the National Disability Insurance Scheme Act 2013 (NDIS Act), in the Participant’s NDIS Plan currently in effect under section 37 of the NDIS Act;
The Participant’s NDIS Plan is expected to remain in effect during the period the Services are provided; and
The Participant/Participant’s Representative will immediately notify the Provider if the Participant’s NDIS Plan is replaced by a new Plan or the Participant stops being a participant in the NDIS.

Agree *

Consent

This section talks about how Alyv can gather, share and manage your information. This consent is optional and can be changed at any time, there will be no need for a new service agreement to be made in the event that you wish to change, modify or withdraw your consent. Please contact us and notify us of any changes to your consent as soon as is practical.

Participant's full name: *

Date of birth: *

Participant's representative/nominee/parent (if applicable):

Representative's full name: *

Date of birth: *

I consent to Alyv gathering and sharing information about me (or the participant/applicant I am representing who is identified in this form), with the following people and/or organisations:

Please include as much detail as possible so we can ensure we are speaking to the right person, especially where you would like us to communicate with your Support Coordinator, Plan Manager or PBS clinician, other allied health practitioner or your other support staff and informal supports.

We will only communicate with the people/organisations named here and will seek your consent should we need to speak to anyone not named here. Click "Add Item" to add more people or organisations to the list.

Name of Provider

Contact Person:

Phone or email

I DO NOT consent to Alyv gathering and sharing information about me (or the participant/applicant I am representing who is identified in this form)

Thank you, we confirm that you have asked we do not share your information or have any authority to gather information from any other prople or providers. This means that we will keep your information private and uphold your request, however, there may be times where Alyv is required by law to share your information. This includes:

Receiving a subpoena lawfully requiring us to provide information
Receiving a lawful FOI request from you or a person otherwise legally entitled to access this information
In circumstances where there is a risk of harm to yourself, our workers or the community
Other legislated reasons as set out in shedule 16A of the Australian Privacy Principals or otherwise specified in the Privacy Act 1988

If we do need to or are obligated to share or disclose your information for any reason under Australian law, we will notify you and communicate this to you as soon as practical after identifying that this will be lawfully required.

Consent signature *

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This signature is only relevant to the "Consent" portion of this document

Date of signing: *

Signatures

By signing this you agree to all the terms and conditions in this agreement and confirm you have read and understood your obligations and your rights when dealing with Alyv.

Your Signature *

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Date *

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