Enter Basic Contract Information
Administrative Information
Basic Contract Details
| Vendor Name |
Awakening Recovery
|
| Vendor Number (3____ for AP and 00___ for AR) |
328503
|
| Vendor Contact Name |
Greg Gelber
|
| Vendor Contact Email |
[email protected]
|
| Contract / Amendment Title |
Agreement for Services
|
| Contract / Amendment Amount |
$25,000.00
|
| 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? |
009605
|
| Supplemental Insurance (for Risk team only) |
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|
Upload Contract Documents
Upload Documents
| Upload Contract or Amendment Authorization Form |
autho.pdf
|
| Upload Agreement or Amendment |
amend 2 corrected.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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|
Supplemental Risk Information
General Liability Details
| Policy Effective Date |
policy renewals pending
|
Automobile Policy Details
| Effective Date |
policy renewals pending
|
Workers Comp Policy Details
| Effective Date |
policy renewals pending
|
Professional Liability Policy Details
| Effective Date |
policy renewals pending
|
Other Policy Details
| Other Policy Name 1 |
policy renewals pending
|
