Enter Basic Contract Information
Administrative Information
| Contract Manager Name (City Staff) |
Helen Collins
|
| Contract Manager Email ([email protected]) |
[email protected]
|
| Department |
08 - DPW
|
| Division |
55 - Facilities & Field Services
|
Basic Contract Details
| Vendor Name |
Aqua Source
|
| Vendor Number (3____ for AP and 00___ for AR) |
330048
|
| Vendor Contact Name |
Ron Ybarra
|
| Vendor Contact Email |
[email protected]
|
| Contract / Amendment Title |
Pool Chemical Systems
|
| Contract / Amendment Amount |
$75,000.00
|
| 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 |
Please_DocuSign_EdenContractAuthorizationFor 3.pdf
|
| Upload Agreement or Amendment |
Signed Agreement Aquasource.pdf
|
| Upload Docusign "Certificate(s) of Completion" |
|
| Upload Insurance Documents (COI, Endorsements, WOS, etc.) |
WAIVER_109145_.PDF, PRIMARY WORDING- aqua_109147_.PDF, City of West Hollywood_109144_.pdf, AQUA SOURCE COML POOL SERVICES WOS WC040306 9-7-22_109116_.pdf, AQUA SOURCE COML POOL SERVICES NOC WC 331-0342 9-7-22_109115_.pdf, AQUA SOURCE COML POOL SER_CityOfWestHollywood_9-7_109114_.pdf, ADDITIONAL INSURED_109146_.PDF, ACORD Forms_109039_.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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|
Supplemental Risk Information
General Liability Details
| Policy Effective Date |
01/25/2022
|
| Policy Expiration Date |
01/25/2023
|
| Policy Amount |
$1,000,000.00
|
| Endorsements |
PNC, AI, WOS
|
Automobile Policy Details
| Effective Date |
09/15/2022
|
| Expiration Date |
19/15/2023
|
| Policy Amount |
$1,000,000.00
|
Workers Comp Policy Details
| Effective Date |
04/01/2022
|
| Expiration Date |
04/01/2023
|
| Policy Amount |
$1,000,000.00
|
| Endorsements |
WOS
|
Professional Liability Policy Details
