Business Associate Agreement Template - 2017 Page 9
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917.
Counterparts. This Agreement may be executed in multiple counterparts, with each of the
counterparts, taken together, deemed to be an original. Facsimiles and photocopies of this Agreement
shall have the same force and effect as an original.
Executed in Culver City, California as of the date first written above.
“SUBCONTRACTOR”
“BUSINESS ASSOCIATE”
__________________________________
WESTSIDE REGIONAL CENTER
A California (corporation, limited liability
California nonprofit corporation
Corporation, etc.
By:
By:
Signed
Carmine Manicone, Executive Director
Printed Name & Title
Vendor number: ________________________________
Vendor number: ________________________________
Vendor number: ________________________________
Vendor number: ________________________________
Vendor number: ________________________________
Vendor number: ________________________________
Vendor number: ________________________________
Vendor number: ________________________________
Vendor number: ________________________________
Page 9 of 9
July 2017
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Parent category: Medical