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2022-593-E-Health-Awakenings Counseling-Amendment to Service Agreement EMDR Therapy Facilliation
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2022-593-E-Health-Awakenings Counseling-Amendment to Service Agreement EMDR Therapy Facilliation
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Last modified
11/14/2022 3:25:14 PM
Creation date
11/14/2022 3:25:07 PM
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Template:
Contract
Date
11/10/2022
Contract Starting Date
11/10/2022
Contract Ending Date
11/13/2022
Contract Document Type
Contract
Amount
$0.00
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�m ALLI ED ALLTEU WORLD INSURANCE COMPANY O 23 WOR LC A stock insurance company, incorporated under the laws or New Hampshire • ......,..,_ 1690 New Britain Al'enoe, Suite 101, Farmington, CT 06032 (1-800-421-6694) <br />2 / O,.AIMS-MADE MENTAL REAL. TB COUNSELORS' PROFF.SSIONAL AND BUSINES� LIABILITY POU CV 1 l5/21 - A 'DDSlSACLAIMSMADEPOLlCY-PLUSt:READCAREFULLY RENEWA L� <br />NOTICE: A LOWER l.Thtn' OF LlABII.JTV APPLIES TO JUDGEMENTS OR SETTLEMENTS WIIFJ'ITHERE ARE ALI.EOATIONS OF SEXUAL MISmNDUcr <br />(SEE THE SPECIALPROVlSlO!ol'SEXUAL MISCONDIJCI"' INTIIE POLICY). <br />D RATION <br />POLICY N O: 5003-6071 ACCOUNTNO: AZ-AWAK515-0 0570442R ITEM I. (•) NMIBAND ADDRESS OF INSURED: ITEM I. (b) ADDIDONAL NAMFD INSUREDS: <br />ITEM 2. <br />ITEM3. <br />ITEM4. <br />JTEM5 <br />ITEM6 <br />ITl!M7. <br />ITEMS. <br />AWAKENINGS COUNSELING LLC 5151 N ORACLE RD STE 118C TUCSON, AZ 85704 <br />ADDmONAL JNSIJREDS: <br />TYPEOF ORG: <br />LINDA C. OUELLETTE <br />LLC/LLP <br />POLICY PERIOD: FROM: . 02/01/22 TO: 02/01/23 <br />12:0lA.M. STANDARD TIME ATTIIE AODRESS OF THE INSURED AS STATED HEREIN: <br />LIMITS OF UABO..ITY: <br />(aJS, ___ l....:....' _0_0_0.:..,_0_0_0_ PER-CLAIM'-1NSURING AGREEMENT A.(c)$ <br />(bJs, __ ..... 1..,._.o'-'o'-'o"'"._,.o"'o"'o_ PER-CLAIM-INSURING AGREEMENT 8.0) and 8.(2) (d) S PREMIUM SOIEDULE: CLASSIFlCATION NUMBER RATE <br />COONSELOR <br />3,000,000 'AGGREGATE <br />50.000 PER PROCEllDING <br />ANNUAL PREMIUM <br />SELF-EMPLOYED PROFESSIONAL 1 DEFENSE LIMIT . <br />RETROACTIVE DA TE: 02/01/14 TOT AL PREMIUM: <br />EXTENDED REPORTING PERIOD <br />ADDIDONAL PREMIUM r,r eurciscd):S, ___L--- <br />POLICY FORMS AND ENDORSEMEN'IS A TT ACHED TO THIS POLICY <br />APA-MH 00002 00 (06/14) APA 00127 02 (06/14) <br />APA-MH 00001 00 (06/14) <br />T8IS rs NOT A BILL PRF.�nul\l HAS DEEN PAID. AUTHORJZEO COMPANY REPRESENTATIVE <br />A.mcqan Professinn31 Ageocy • 95 Bro.:u:IWG)', Amityville. NY t l?OI <br />DocuSign Envelope ID: B2566E80-2C07-49D8-B7AF-8975E30F7430
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