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Lynn Shatz 12/3/2019
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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
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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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14, Liberty <br /> Io t International <br /> Underwriters.. <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 /> STUDENT PROFESSIONAL LIABILITY OCCURRENCE INSURANCE POLICY <br /> SPECIFIED MEDICAL PROFESSIONAL LIABILITY OCCURRENCE INSURANCE POLICY— <br /> STUDENT INDIVIDUAL <br /> MEDICAL PROFESSIONAL LIABILITY OCCURRENCE INSURANCE POLICY <br /> MEDICAL PROFESSIONAL LIABILITY OCCURRENCE INSURANCE POLICY—INDIVIDUAL <br /> EXCLUSION OF SPECIFIED ACTIVITIES—REUSE OF PARENTERAL DEVICES <br /> AND SUPPLIES <br /> In consideration of the premium charged, this policy shall not apply to Bodily Injury or Property <br /> Damage for, based upon, arising out of or related to any acts, errors or omissions involving Reuse <br /> of: <br /> 1. needles or syringes; <br /> 2. catheters or ports,including implanted ports; <br /> 3. intravenous solution, whether intended for direct intravenous administration or as a source of <br /> diluent for medication or any other substance to be administered parenterally; <br /> 4. intravenous medications intended for direct intravenous administration, including heparin or <br /> sodium chloride used for flushing venous access devices; <br /> 5. lines,including intravenous lines, tubing and any connectors thereto;or <br /> 6. any other types of parenteral device or supply used to inject medications,administer parenteral <br /> substances or withdraw blood samples; <br /> in contravention of the instructions, warnings or recommendations of the manufacturer of such <br /> parenteral device or supply, or any standards regarding safe injection practices, intravenous therapy <br /> guidelines, infection control or any other pertinent recommendations or guidelines promulgated by <br /> 1 2 <br /> HCPL-8321 (01/15) <br />
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