Enter Basic Contract Information
Administrative Information
Basic Contract Details
| Vendor Name |
REGENTS UCLA/SANTA MONICA UCLA
|
| Vendor Number (3____ for AP and 00___ for AR) |
329977
|
| Vendor Contact Name |
Brian P. Zunner-Keating
|
| Vendor Contact Email |
[email protected]
|
| Contract / Amendment Title |
mou
|
| Contract / Amendment Amount |
$0.00
|
| 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 |
EdenContractAuthorizationFormUCLA Homeless Healthcare Collaborative.pdf
|
| Upload Agreement or Amendment |
UCLA Homeless Healthcare Collaborative MOU Final.pdf
|
| Upload Docusign "Certificate(s) of Completion" |
Summary.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 any notes you may have for Finance and Risk Review teams. |
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|
| Add name of RFP / RFQ / RFB, if issued |
none
|
| - or add weblink to RFP / RFQ / RFB, if issued |
none
|
Supplemental Risk Information
General Liability Details
| Waived |
Ins documents pending execution of MOU
|
Automobile Policy Details
| Endorsements |
Ins documents pending execution of MOU
|
Workers Comp Policy Details
| Waived |
Ins documents pending execution of MOU
|
Professional Liability Policy Details
| Waived |
Ins documents pending execution of MOU
|
