Enter Basic Contract Information
Administrative Information
Basic Contract Details
| Vendor Name |
Being Alive
|
| Vendor Number (3____ for AP and 00___ for AR) |
302271
|
| Vendor Contact Name |
Jamie Baker
|
| Vendor Contact Email |
[email protected]
|
| Contract / Amendment Title |
Contract for HIV services
|
| Contract / Amendment Amount |
$137,719.00
|
| Is this a new agreement or an amendment to an existing agreement? |
New Agreement
|
| Supplemental Insurance (for Risk team only) |
---
|
Upload Contract Documents
Upload Documents
| Upload Contract or Amendment Authorization Form |
Contract Auth.pdf
|
| Upload Agreement or Amendment |
Being Alive2.pdf
|
| Describe changes to Insurance Requirements, if any (if no insurance is required, type "None required") |
---
|
| Describe changes to Contract Template, if any (If none, type "None required") |
---
|
| Upload other supporting documents here, if necessary (e.g. staff reports, etc.) |
BA Budget.pdf, BA Scope.pdf
|
Supplemental Risk Information
Upload Additional Insurance Files Here
General Liability Details
| Policy Effective Date |
10/1/2021
|
| Policy Expiration Date |
10/1/2022
|
| Policy Amount |
$1,000,000.00
|
| Endorsements |
PNC, AI, WOS
|
Automobile Policy Details
| Effective Date |
10/1/2021
|
| Expiration Date |
10/1/2022
|
| Policy Amount |
$1,000,000.00
|
Workers Comp Policy Details
| Effective Date |
08/01/2022
|
| Expiration Date |
08/01/2023
|
| Policy Amount |
$1,000,000.00
|
| Endorsements |
WOS
|
| Waived |
PENDING
|
Professional Liability Policy Details
| Effective Date |
10/1/2021
|
| Expiration Date |
10/1/2022
|
| Policy Amount |
$1,000,000.00
|
| Endorsements |
Prof Liab; Sexual Misconduct
|
Other Policy Details
| Other Policy Name 1 |
Crime
|
| Effective Date 1 |
10/1/1021
|
| Expiration Date 1 |
10/1/2022
|
| Policy Amount 1 |
$25,000.00
|
