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2018-336-E Health - Advanced Dental Associates dental services
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2018-336-E Health - Advanced Dental Associates dental services
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Entry Properties
Last modified
8/2/2018 4:48:01 PM
Creation date
8/2/2018 4:38:02 PM
Metadata
Fields
Template:
Contract
Date
7/1/2018
Contract Starting Date
7/1/2018
Contract Ending Date
6/30/2019
Contract Document Type
Agreement - Services
Amount
$2,000.00
Document Relationships
R 2018-336 Health - Advanced Dental Associates referral agreement
(Attachment)
Path:
\Board of County Commissioners\Contracts and Agreements\Contract Routing Sheets\Routing Sheets\2018
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InsuredName:AdvancedDentalAssociatesInc. <br />PolicyNumber:Q971310636 <br />PolicyPeriod:06/02/2018to06/02/2019Page4of6 <br />ProcessedOn:03/19/2018 57 <br />ScheduleofStaticForms-(continued) <br />FormNumberEditionDateDescription <br />CG210605/14EXCL-ACCESSORDISCLOSUREOFCONFIDENTORPERSINFOAND <br />DATA-RELATEDLIAB-WITHLIMITBODINJEXCEP <br />CG210906/15EXCLUSION-UNMANNEDAIRCRAFT <br />IL001711/98COMMONPOLICYCONDITIONS <br />IL002109/08NUCLEARENERGYLIABILITYEXCLUSIONENDORSEMENT(BROADFORM) <br />IL026909/08NORTHCAROLINACHANGES-CANCELLATIONANDNONRENEWAL <br />IL095201/15CAPONLOSSESFROMCERTIFIEDACTSOFTERRORISM <br />IL985F01/15*DISCLOSUREPURSUANTTOTERRORISMRISKINSURANCEACT <br />PKMJ01/10EXCLUSION-LEADLIABILITY <br />PKMN01/10EXCLUSION-PERSONALACTIVITYLIABILITY <br />PKMD01/10EXCLUSION-ASBESTOS <br />PKMQ12/14EXCLUSION-PROFESSIONALLIABILITY <br />PKRO01/10AMENDMENTOFPOLICY-TWOORMORECOVERAGEPARTS <br />DocuSign Envelope ID: 9F2C2FF6-C184-4821-B124-5C284105DD0A
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