Requester Information

Your First Name *

Your Last Name *

Your Email Address *

Building/Location *

Professional Services Agreement

This agreement is entered into the date listed below written between the Des Moines Public Schools (District) and (Provider):

Provider (Company) name:

Is the provider a current DMPS employee? *

Provider First name:

Provider Last name:

Is the provider a former DMPS employee? *

How long has the former employee been separated from DMPS?
Please enter the date of separation. *

Provider Street Address *

Provider City *

Provider State *

Provider Zip Code *

Provider Email Address

Fax Number

Phone Number

Did the provider submit documentation? *

Upload documentation submitted by provider

Agreement Information

Only the sections requiring possible inputs are included below. Once this form is submitted, you will receive the entire document via email.

Will you need the comprehensive document or the basic document? *

Comprehensive

Basic

*Comprehensive: A more detailed agreement allowing the user to enter the number of hours required, cost per hour, down payment, etc.

*Basic: A single, flat fee, simple transaction contract.

2. PAYMENT

A. Payment Terms: The District shall pay the Provider as detailed in the Scope of Work stated below:

Provider shall submit a request for payment upon completion of the project, including an invoice which details work completed and reimbursable costs for any applicable travel and lodging.

$___(1)___ is due upon signing of the agreement. The remaining amount will be due upon receipt of

Provider’s final invoice to the District when the day(s) are completed. The Provider will include itemized

support of costs incurred for travel and lodging with final invoice. The District will process the request

for payment and request approval at the first regularly scheduled Board of Education meeting.

Enter Amount Due at signing (1)

13. SCOPE OF WORK

Per previous discussions, the Provider and the District agree on the following terms for the Provider to deliver. This section will change to reflect the required service

The District wishes to receive _(1)_ day(s) of ________(2)_______service
The service will be delivered on ___(3)_____ by the Provider.
The Provider and District will determined who is responsible for equipment and materials as needed based on requests received in advanced and mutually agreed upon by both parties.
The service fee is $__(4)_______ for a full day plus any other actual expense for travel and lodging limited to a maximum reimbursement of $__(5)_____. If the District cancels after the Provider is in transit, the District will pay the cost of transportation and teaching fee. Cancellations after flights are booked, but before the Provider transit, the District will pay for the flight.

Enter items to be included in final document.
Numbers reference blank spaces listed above. They are also color coded.

Number of Days (1)

Service Provided (2)

Date of Delivery (3) +

Daily Amount (4)

Max Reimbursement (5)

13. SCOPE OF WORK

Per previous discussions, the Provider and the District agree on the following terms for the Provider to deliver the following services:

.

Enter items to be included in final document.
Numbers reference blank spaces listed above. They are also color coded.

The District agrees to pay the Provider $__(1)____ by the terms defined in section two (2) above.

Amount Due (1)