MEMORANDUM OF AGREEMENT

KNOW ALL MEN BY THESE PRESENTS:

This Memorandum of Agreement (“Agreement”) is entered into this

___ day of ___________ 2019, in _________________ by and between:

BERNARDINO GENERAL HOSPITAL ,

a_________________________________________________________
-and-

The LOCAL GOVERNMENT OF QUEZON CITY, a political

entity created and existing under the laws of the Republic of the
Philippines, with principal office at Elliptical Road, Diliman Central,
Quezon City, duly represented by HON. HON. MA. JOSEFINA G.
BELMONTE, in his capacity as its City Mayor, herein referred as the
“THIRD PARTY”.

-and-

NOVALICHES DISTRICT HOSPITAL, a medical and corporate

entity duly organized and existing under and by virtue of the laws of
the Republic of the Philippines with address at 680 Quirino Highway,
Novaliches Quezon City, represented herein by its City Mayor, Dr.
EDUARDO ALDANA, hereinafter referred to as “Hospital”.

WITNESSETH

WHEREAS, cognizant of the pressing concern vi-a-vis the

government’s obligation to prioritize the health and well-being of the
Filipinos, President Rodrigo Duterte has allocated [ ]
(P .00) from the Presidential Social Fund to provide medical
services to those in need for free.
 WHEREAS, the funds for the medical services shall be
disbursed under the program called “Malasakit Program”

WHEREAS, the President has tasked Malasakit Center to be the

implementing agency of the Malasakit Program.

WHEREAS, the Malasakit Center, given its limitations,

recognizes and acknowledges the importance of other institution,
private and government entities to be its partned and ally in carrying
out its mandate of providing free medical services to the Filipinos;

WHEREAS, the Malasakit Program shall be implemented by

providing funding to local government units, which will in turn
allocate said funds to identified hospitals, such as NOVALICHES
DISTRICT HOSPITAL, where patients needing prescription
medicines, assistive devices, laboratory procedures and other
medical needs will be assessed and provided assistance by the
identified hospitals.

WHEREAS, the Service Provider has signified its intent and

willingness to support Malasakit Center in its mission by way of
offering their health facilities, health programs and services to
NOVALICHES DISTRICT HOSPITAL, including its medical personal
to attend to the patients who are eligible to avail of benefits under the
Malasakit Programs.

I. TARGET BENEFICIARIES
1. The target beneficiaries are Filipinos in need of diagnostic
laboratory and imaging services that are either confined or
receiving out-patient treatment from the Hospital.

2. Priority shall be given to the following:

II. OBLIGATIONS AND RESPONSIBILITY OF HOSPITAL:
1. Determine and authorize official signatories, as set forth in
Annex A, who will represent the Hospital to request and
authorized the availment of services of the qualified
beneficiaries from the Service Provider.
2. Identify, assess and recommend patients for provision of
assistance.
3. Coordinate with the Service Provider to ensure the
availability of services requested.
4. Provide guarantee letter (“GL”), as set forth in Annex B, to the
patients which will be hand carried together with its valid
identification to the Service Provider for availment of services
corresponding the recommended amount of assistance.
5. Report any error to the Service Provider within five (5) days
upon receipt of the statement of account. If no error is
reported, the statement of account shall be considered
correct and final.

That in case an error has been found on the submitted

statement of account, within the aforementioned period,
Hospital must still process and settle remaining account
without errors. Those accounts found with error shall be
reconciled by both parties and resubmitted on the next
billing.

III. OBLICATIONS AND RESPONSIBILITIES OF SERVICE

PROVIDER:

1. Provide a credit line to the Hospital with a credit limit of

__________________ upon which the cost of services shall be
charged.
2. Allow withdrawals/services request to be made from the
credit facility upon presentation of the valid identification of
the qualified beneficiary and GI as approved by the hospital’
3. Provide service to qualified patients up to an amount which
shall not exceed the recommended amount indicated in the
GL. Any amount in excess of the said recommended amount
shall be paid in cash by the said patients.
4. Allow patients with disabilities and are senior citizens to avail
of necessary discount and privileges in accordance with RA
10754 or the Magna Carta for Persons with Disability and RA
9994 or the Expanded Senior Citizens Act of 2010.
5. Each transaction of the eligible patients shall be covered by
the Service Provider’s charge invoice and the terms thereof
shall form part of this Agreement.
6. Bill the LGU with notice to the Hospital on a bi-monthly basis
or whenever the amount of the credit line is nearly to be
reached, i.e. when the amount consumed has reached 80% of
the credit line, or whichever comes first, on the actual cost of
services availed by qualified patients.
7. Submit to the Hospital the summary of 1) statement of
account together with the 2) original copy of charge invoice
and 3) Guarantee Letter based on the below schedule of
submission (bi-monthly) of statement of account and release
of payment.

a. Invoices from 1st – 15th day of the month will billed on

the 16th day of the same month. Payment shall be made
on or before 16th day of the following.
b. Invoices from 16th–31st day of the month will billed on
the 1stday of the same month. Payment shall be made on
or before 30th of the same month.
c. Should the credit line be nearly reached prior to the set
bi-monthly schedule of billing, the Service Provider
 may already bill the Hospital and shall submit Invoices
covering the 1st day succeeding its last submitted bill up
to the actual billing day.
8. Shall inform the Hospital within five (5) working days, if the
80% of the credit limit has been reached, and should not stop
providing and/or refuse provision of services to the clients
until the credit limit has been reached. When the credit limit
has been reached, Service Provider shall immediately inform
Hospital that it shall suspend services and await further
instructions from the Hospital.

IV. OBLICATIONS AND RESPONSIBILITIES OF LOCAL

GOVERNMENT OF QUEZON CITY:

1. Secure a credit line from the Service Provider with a credit

limit of Five Hundred Thousand Pesos (P500,000.00) upon
which the services availed by qualified beneficiaries shall be
charged.
2. Settle with or pay in full its accountabilities within thirty (30)
days from receipt of the statement of account from the
Service Provider. The LGU undertakes that non-remittance
or untimely remittance of funds under the Malasakit
Program to the Hospital shall not cause non-payment to the
Service Provider for service rendered.
3. In the event that the Hospital shall be required to withhold
taxes on its payments to the Service Provider, the LGU shall
submit to the service Provider the corresponding Certificate
Tax Withheld at Source upon issuance of payment. In case
the Certificate of Creditable Tax Withheld at Source is not
submitted, the amount withheld shall automatically be part
Hospital’s outstanding account.
V. RESERVATION CLAUSE

Service Provider reserves the right to suspend this Agreement

without prior notice, in the event the LGU fails to settle its overdue
accounts with the Service Provider and resumes or reinstates the
credit line upon the complete and total settlement of the accounts
payable by the LGU.

VI. CONFIDENTIALITY

Except as specified herein or permitted in writing signed by the

parties or for the compliance with the Data Privacy Act, and laws or
regulations governing trust, banking, insurance, securities and
exchange or any other law or lawful order, all Confidential
Information of any party, which shall come to the knowledge of the
other party during the term of this Agreement shall not be disclosed,
directly or indirectly, to any third party, except with prior written
consent of the Disclosing Party. Any violation of this duty even after
termination of this Agreement shall give the party the right to sue for
injunction and/or damages.

The term “Confidential Information” shall _____ any and all

kinds of information

VII. DATA PRIVACY

Both parties shall comply with the provisions of Republic Act

No. 10173, otherwise known as the “Data Privacy Act of 2012” and its
Implementing Rules and Regulations. Each party undertakes to
obtain the prior informed written consent of the data subject whose
personal information and sensitive personal information
(collectively referred to as “Information”) shall be collected and
processed before Information may be disclosed, stored or processed.
The terms “data subject,” “personal information” and “sensitive
personal information” shall have the definitions provided under the
Data Privacy Act of 2012 and its Implementing Rules and Regulations,
which are as follows:

a. Personal Information refers to any information wether

recorded in a materials form or not, from which the identity
of an individual is apparent or can be reasonably and directly
ascertained with other information would directly and
certainly identify an individual.
b. Sensitive personal information refers to personal
information:
1) About an individual’s health race, ethnic origin, marital
status, age, color and religious, philosophical or
political affiliations;
2) About an individual’s health, education, genetic or
sexual life of a person, to any proceeding for any offense
committed or alleged to have been committed by such
person, the disposal of such proceedings, or the
sentence of any court in such proceedings;
3) Issued by government agencies peculiar to an individual
which includes, but not limited to, social security
numbers, previous or revocation or current health
records, licenses or its denials, suspension or
revocation, and tax returns; and
4) Specifically established by an executive order or an act
of Congress to be kept classified.
c. Data subject refers to an individual whose personal
information, whether sensitive or not, is processed.

Moreover, a party shall have the right to refuse the performance

of any of its obligations in case a data subject withholds consent to
the collection, processing, and disclosure of his Information without
incurring any liability under this Agreement, it being understood
that the collection, processing, and disclosure of the data subject’s
Information is absolutely necessary for the performance of the
Service herein.

d. Data Sharing

The Personal data collected by the Hospital from its

qualified patient regarding the needed data shall be
processed in order to facilitate the availment of credit
facility.

In accordance with the Data Privacy Act and during the

effectivity of this Agreement, both parties have a limited,
non-transferable, and revocable access to the Personal Data
collected by the other party to copy, use and share the same
pursuant to this Agreement.

VIII. AMENDMENT/REVISION

Any amendment or modification of the provisions of this

Agreement should be in mutual written consent of ALL PARTIES’
duly authorized representatives.

Days prior to the expiration thereof, provided, that in the absence of

a written advice from either party, it would be deemed renewed.

IX. PENALTY CLAUSE

 This agreement shall be implemented in accordance with the
terms and conditions herein stipulated. Failure on the part of any
party to comply with any provision of this Agreement shall warrant
its revocation and shall give rise to the filing of appropriate
administrative, civil and criminal case against the errings party.

The parties hereto agree that the venue for any action arising
out of this Agreement shall be in any of the proper courts in the
Quezon City.

X. ACKNOWLEDGMENT

The Parties acknowledge that the Service Provider does not

provide any service or good to the Hospital; that Hospital holds in
trust for beneficiaries of the Malasakit Program grants to these
beneficiaries; and that amounts delivered under the Malasakit
Program to the Hospital are held in trust, to be applied as payment
for the service or goods rendered by the Service Provider to the
beneficiaries.

XI. EFFECTIVITY

This Agreement shall take effect upon signing and approval of

the both parties.

Service Provider
Josefina G. Belmonte
City Mayor
Quezon City Government

Eduardo F. Aldana, MD
Hospital Director
Novaliches District Hospita

Ruby G. Manangu
OIC – Accounting
Quezon City Government