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2023-474-E-Health Dept-Awakenings Counseling-Facilitate participation in EDMR therapy consultation
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2023-474-E-Health Dept-Awakenings Counseling-Facilitate participation in EDMR therapy consultation
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Last modified
9/7/2023 1:43:42 PM
Creation date
9/7/2023 1:43:34 PM
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Template:
Contract
Date
8/20/2023
Contract Starting Date
8/20/2023
Contract Ending Date
9/5/2023
Contract Document Type
Contract
Amount
$1,050.00
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Account Number: AZ AWAK 5150 Date: 1/12 /23 Initials: LPD <br />CERTIFICATE OF IN SURANCE <br />ALLIED WORLD INSURANCE COMPANY <br />C/0 : American Profess ional Agency, Inc. <br />95 Broadway, Amityville, NY 11701 <br />800-421-6694 <br />This is to certify that the insurance policies specified below have been issued by the company <br />indicated above to the insured named herein and that, subject to their provisions and conditions, <br />such policies afford the coverages indicated insofar as such coverages apply to the occupation <br />or busines s of the Named Insured (s) as stated. <br />THIS CERTIFICATE OF INSIJWICE NEITHER AFFIRMATIVELY Im NEGATIVELY AMENJS, EXTEN'.lS 00 ALTERS <br />THE COVERAGE(S) AFFOODED BY THE POLICY(IES) LISTED ON THIS CERTIFICATE. <br />Name and Address of Named Insured : <br />AWAKENINGS COUNSELING LLC <br />5151 N ORACLE RD STE 118C <br />TUCSON AZ 85704 <br />Type of Work Covered: MENTAL HEALTH COUNSELOR <br />Location of Operations: N/A <br />(If d.if.fer&nt than .tdd:ress listed .above) <br />Claim History: None <br />Ret roactive date is 0 2 /01/20 14 <br />Policy Effective <br />Coverages Number Date <br />PROFESSIONAL/ <br />LIABILITY 5003-6071 2 /01/2023 <br />Additional Named Insureds: <br />LINDA C. OUELLETTE <br />Expiration Limits of <br />Date Liability <br />2/01/2024 <br />1,000,000 <br />3.000.000 <br />NOTICE OF CANCELLATION WILL ONLY BE GIVEN TO THE FIRST NAMED INSURED, WHO SHALL <br />ACT ON BEHALF OF ALL INSUREDS WITH RESPECT TO GIVING OR RECEIVING NOTICE OF <br />CANCELLATION. <br />Colllnents: Defense Reimbursement Proceedings Limit is $50,000. <br />Th j s Certifjcate Issued to: <br />Name: AWAKENINGS COUNSELING LLC <br />5151 N ORACLE RD STE 118C <br />Address: <br />TUCSON AZ 85704 <br />APA 00138 00 (06/2014) <br />DocuSign Envelope ID: 9E456A85-891D-4238-BD70-9597FDB02780
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