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Dear Prospective Healthways Provider: <br />Healthways is pleased to present you with the attached Healthways Agreement, providing an opportunity for you <br />to participate in the Healthways fitness provider network. Please note that the terms and conditions of the <br />agreement, including payment, are to remain strictly confidential. Healthways' execution of your submitted <br />agreement will be contingent on acceptance of your location into the Healthways network. Following receipt of <br />the signed agreement, Healthways will contact you regarding your opportunity to join the provider network. <br />Please scan the entire signed agreement, W -9, and a copy of your location's certificate of insurance, and then <br />email the documents as an attached file to your contact at Healthways. To confirm receipt, please follow up <br />with your contact at Healthways. We look forward to receiving your agreement application. <br />Yes, I am interested in participating in the Healthways provider network. I am attaching the following documents <br />for consideration: <br />✓ Entire signed, completed contract agreement <br />• Sign and date the agreement <br />• Complete one Exhibit A -] for each location covered under the agreement (you may make copies of <br />the exhibit if necessary) <br />• Complete Exhibit A -2 <br />• Completed W -9 <br />✓ Certificate of insurance evidencing a minimum of $l M general liability insurance <br />(Must show current policy number, expiration date, limits of liability and insured premises) <br />Comments: <br />JI / <br />� f <br />r: <br />f <br />