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Lynn Shatz 12/3/2019
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6 Years Then Destroy
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Lynn Shatz 12/3/2019
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Last modified
12/10/2019 11:31:07 AM
Creation date
12/10/2019 11:29:44 AM
Metadata
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Contracts
Contractor's Name
Lynn Shatz
Approval Date
12/3/2019
End Date
12/31/2020
Department
Senior Center
Department Project Manager
Bob Dvorak
Subject / Project Title
Dental Hygiene Services
Tracking Number
0002100
Total Compensation
$4,500.00
Contract Type
Agreement
Contract Subtype
Professional Services
Retention Period
6 Years Then Destroy
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1%4,, Liberty_ <br /> o International <br /> Iladtxtvritum. <br /> Healthcare Professional Liability <br /> LIBERTY INSURANCE UNDERWRITERS INC. <br /> (A Stock Insurance Company,hereinafter the"Company") <br /> ENDORSEMENT NO. [ ] <br /> Effective Date: 07/01/2019 <br /> Policy Number: AHY-630201008 <br /> Issued To: Lynn D Shatz <br /> Return Premium 0 $ <br /> Additional Premium 0 <br /> THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br /> This endorsement modifies insurance provided under the following: <br /> MEDICAL PROFESSIONAL LIABILITY OCCURRENCE INSURANCE POLICY <br /> MEDICAL PROFESSIONAL LIABILITY OCCURRENCE INSURANCE POLICY—INDIVIDUAL <br /> INTRAOPERATIVE NEUROPHYSIOLOGICAL MONITORING PROCEDURE <br /> EXCLUSION ENDORSEMENT <br /> In consideration of the premium charged, the following is added to SECTION VI,EXCLUSIONS: <br /> to Bodily Injury arising out of any: <br /> a. intraoperative neurophysiological monitoring services;or <br /> b. supervision of intraoperative neurophysiological monitoring services provided by the Insured. <br /> ALL OTHER PERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. <br /> 1 1 <br /> HCPL-8320(01/15) <br />
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