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2019-643-E Health - Patagonia Health software amendment
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2019-643-E Health - Patagonia Health software amendment
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Entry Properties
Last modified
9/19/2019 9:08:14 AM
Creation date
9/19/2019 8:48:33 AM
Metadata
Fields
Template:
Contract
Date
8/7/2019
Contract Starting Date
10/1/2019
Contract Ending Date
12/31/2019
Contract Document Type
Contract Amendment
Amount
$22,155.00
Document Relationships
R 2019-643 Health - Patagonia Health software amendment
(Attachment)
Path:
\Board of County Commissioners\Contracts and Agreements\Contract Routing Sheets\Routing Sheets\2019
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DocuSign Envelope ID:881484B7-44A8-4DD9-9947-6209CB23CD79 <br /> r,2/15/2019 <br /> TE(MM/DD/YYYY) <br /> A�" CERTIFICATE OF LIABILITY INSURANCE <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to <br /> the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br /> certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT MeliSSa Streeter <br /> NAME: <br /> Tompkins Insurance Agencies, Inc. VHCONNo Ext: (215)274-7408 F IC No;688-339-6337 <br /> 1240 Broadcasting Road ADDRESS:mstreeter@tompkinsfinancial.com <br /> P.O. Box 6707 INSURER(S)AFFORDING COVERAGE NAIC# <br /> Wyomissing PA 19610 INSURERA:Sentinel Iris CO LTD 11000 <br /> INSURED INSURER B:Hartford Fire Insurance Co. 19682 <br /> PATAGONIA HEALTH INC. INSURER C: <br /> 15100 Weston Parkway INSURERD: <br /> Suite 204 INSURERE: <br /> Cary NC 27513 INSURERF: <br /> COVERAGES CERTIFICATE NUMBER:18-19 MASTER REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS <br /> LTR SD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY <br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> DA AGE To RENTE <br /> A CLAIMS-MADE FX7 OCCUR PRE M <br /> IS <br /> ES Ea occur ence $ 50,000 <br /> 39SBMUQ5601 6/17/2018 6/17/2019 MED EXP(Anyone person) $ 10,000 <br /> PERSONAL&ADV INJURY $ 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> X POLICY PRO- <br /> JECT ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000 <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY (COMBINEDEa accidentS INGLE LIMIT $ 1,000,000 <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> A ALL OWNED SCHEDULED <br /> AUTOS AUTOS 39SBMUQ5601 6/17/2018 6/17/2019 BODILY INJURY(Per accident) $ <br /> NON-OWNED Pera ciT DAMAGE <br /> HIRED AUTOS AUTOS <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION $ <br /> WORKERS COMPENSATION PER OTH- <br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER <br /> ANY PROPRIETOR/PARTNER/EXECU I— E.L.EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? ❑ N/A <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> B Technology E&O/Cyber 39TE033492319 2/13/2019 2/13/2020 Each Wrongful Act $5,000,000 <br /> Aggregate $5,0 0 0,0 0 0 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> David Boyce/MNS s_ -�J`'? <br /> ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD <br /> INS025rgmami <br />
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