Enter Basic Contract Information
Administrative Information
Basic Contract Details
| Vendor Name |
Elio Palacios Jr.
|
| Vendor Number (3____ for AP and 00___ for AR) |
330053
|
| Vendor Contact Name |
Elio Palacios Jr.
|
| Vendor Contact Email |
[email protected]
|
| Contract / Amendment Title |
Administrative hearing officer services
|
| Contract / Amendment Amount |
$50,000.00
|
| Is this a new agreement or an amendment to an existing agreement? |
New Agreement
|
| Supplemental Insurance (for Risk team only) |
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|
Upload Contract Documents
Upload Documents
| Upload Contract or Amendment Authorization Form |
Elio Palacios Jr. Authorization.pdf
|
| Upload Agreement or Amendment |
Elio Palacios Jr. Agreement - FY23 hearing officer services.pdf
|
| Upload Docusign "Certificate(s) of Completion" |
Elio Palacios Jr. Agreement - FY23 hearing officer services - DocuSign summary.pdf, Elio Palacios Jr. Authorization - DocuSign summary.pdf
|
| Upload Insurance Documents (COI, Endorsements, WOS, etc.) |
Elio Palacios Jr - Professional COI exp. 2.1.23.pdf, Elio Palacios Jr - General COI exp. 6.28.23.pdf, Elio Palacios Jr - Evidence of Driver's Insurance 5.29.22.pdf
|
| Describe changes to Insurance Requirements, if any (if no insurance is required, type "None required") |
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|
| Describe changes to Contract Template, if any (If none, type "None required") |
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|
| Upload approval for contract template changes (e.g., email from Finance or City Attorney) |
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|
| Add name of RFP / RFQ / RFB, if issued |
Administrative hearing officer services
|
| - or add weblink to RFP / RFQ / RFB, if issued |
https://www.weho.org/home/showpublisheddocument/53339/637896707960870000
|
Supplemental Risk Information
General Liability Details
| Policy Effective Date |
06/28/2022
|
| Policy Expiration Date |
06/28/2023
|
| Policy Amount |
$1,000,000.00
|
| Endorsements |
PNC, AI, WOS
|
Automobile Policy Details
| Effective Date |
05/29/2022
|
| Expiration Date |
05/29/2023
|
| Policy Amount |
|
Workers Comp Policy Details
| Endorsements |
Exempt
|
| Waived |
No employees
|
Professional Liability Policy Details
| Effective Date |
02/01/2022
|
| Expiration Date |
02/1/2023
|
| Policy Amount |
$1,000,000.00
|
