Enter Basic Contract Information
Administrative Information
Basic Contract Details
| Vendor Name |
Tarzana Treatment
|
| Vendor Number (3____ for AP and 00___ for AR) |
323128
|
| Vendor Contact Name |
Albert Senella
|
| Vendor Contact Email |
[email protected]
|
| Contract / Amendment Title |
Contract for substance abuse treatment services
|
| Contract / Amendment Amount |
$93,467.00
|
| Is this a new agreement or an amendment to an existing agreement? |
New Agreement
|
| Supplemental Insurance (for Risk team only) |
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|
Upload Contract Documents
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Supplemental Risk Information
General Liability Details
| Policy Effective Date |
03/10/2022
|
| Policy Expiration Date |
03/10/2023
|
| Policy Amount |
$1,000,000.00
|
| Endorsements |
PNC, AI, WOS
|
Automobile Policy Details
| Effective Date |
03/10/2022
|
| Expiration Date |
03/10/2023
|
| Policy Amount |
$1,000,000.00
|
Workers Comp Policy Details
| Effective Date |
11/26/2021
|
| Expiration Date |
11/26/2022
|
| Policy Amount |
$1,000,000.00
|
| Endorsements |
WOS
|
Professional Liability Policy Details
| Effective Date |
03/10/2022
|
| Expiration Date |
03/10/2023
|
| Policy Amount |
$1,000,000.00
|
| Endorsements |
SA & Molestation
|
Other Policy Details
| Other Policy Name 1 |
Crime
|
| Effective Date 1 |
03/10/2022
|
| Expiration Date 1 |
03/10/2023
|
| Policy Amount 1 |
$1,000,000.00
|
