Enter Basic Contract Information
Administrative Information
Basic Contract Details
| Vendor Name |
HEALTH MANAGEMENT ASSOCIATES
|
| Vendor Number (3____ for AP and 00___ for AR) |
327318
|
| Vendor Contact Name |
John O’Connor
|
| Vendor Contact Email |
[email protected]
|
| Contract / Amendment Title |
Amendment No. 5
|
| Contract / Amendment Amount |
$6,870.00
|
| 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? |
008157
|
| Supplemental Insurance (for Risk team only) |
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|
Upload Contract Documents
Upload Documents
| Upload Contract or Amendment Authorization Form |
Contract_Amendment_Form_-_HMA.docx.pdf
|
| Upload Agreement or Amendment |
Amendment_No._5_-_HMA_-_FY22.docx.pdf
|
| Upload Docusign "Certificate(s) of Completion" |
Summary.pdf
|
| Describe changes to Insurance Requirements, if any (if no insurance is required, type "None required") |
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|
| Describe changes to Contract Template, if any (If none, type "None required") |
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|
| Add any notes you may have for Finance and Risk Review teams. |
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|
| Add name of RFP / RFQ / RFB, if issued |
none
|
Supplemental Risk Information
General Liability Details
| Policy Effective Date |
04/15/2021
|
| Policy Expiration Date |
04/15/2022
|
| Policy Amount |
$1,000,000.00
|
| Endorsements |
PNC, AI, WOS
|
Automobile Policy Details
| Effective Date |
04/15/2021
|
| Expiration Date |
04/15/2022
|
| Policy Amount |
$100,000.00
|
Workers Comp Policy Details
| Effective Date |
04/15/2021
|
| Expiration Date |
04/15/2022
|
| Policy Amount |
$1,000,000.00
|
| Endorsements |
WOS
|
Professional Liability Policy Details
| Effective Date |
01/13/2021
|
| Expiration Date |
01/13/2022
|
| Policy Amount |
$1,000,000.00
|
Other Policy Details
| Other Policy Name 1 |
Cyber Professional
|
| Effective Date 1 |
01/13/2021
|
| Expiration Date 1 |
01/13/2022
|
| Policy Amount 1 |
$5,000,000.00
|
| Other Policy Name 2 |
Excess Cyber
|
| Effective Date 2 |
01/13/2021
|
| Expiration Date 2 |
01/13/2022
|
| Policy Amount 2 |
$5,000,000.00
|
