Enter Basic Contract Information
Administrative Information
Basic Contract Details
| Vendor Name |
Brentview Medical
|
| Vendor Number (3____ for AP and 00___ for AR) |
324140
|
| Vendor Contact Name |
Amanda Pagliari
|
| Vendor Contact Email |
[email protected]
|
| Contract / Amendment Title |
AMENDMENT NO. 1 TO AGREEMENT FOR SERVICES
|
| Contract / Amendment Amount |
$0.00
|
| Is this a new agreement or an amendment to an existing agreement? |
Amendment
|
| If this is if a Contract Amendment, what is the Contract Number? |
9736
|
| Supplemental Insurance (for Risk team only) |
---
|
Upload Contract Documents
Upload Documents
Supplemental Risk Information
General Liability Details
| Policy Effective Date |
4/15/21
|
| Policy Expiration Date |
4/15/22
|
| Policy Amount |
$1,000,000.00
|
| Endorsements |
PNC, AI, WOS
|
Automobile Policy Details
| Effective Date |
4/15/21
|
| Expiration Date |
4/15/22
|
| Policy Amount |
$1,000,000.00
|
Workers Comp Policy Details
| Effective Date |
3/9/21
|
| Expiration Date |
3/9/22
|
| Policy Amount |
$1,000,000.00
|
Professional Liability Policy Details
