Enter Basic Contract Information
Administrative Information
| Contract Manager Name (City Staff) |
Clarice Kokubun
|
| Contract Manager Email ([email protected]) |
[email protected]
|
| Administrator completing this workflow, if different (City staff) |
|
| Department |
03 - FIN
|
| Division |
03 - FIN Administration
|
Basic Contract Details
| Vendor Name |
ICMA-RC
|
| Vendor Number (3____ for AP and 00___ for AR) |
304648
|
| Vendor Contact Name |
Tom Axline
|
| Vendor Contact Email |
[email protected]
|
| Contract / Amendment Title |
Amendment to the Administrative Services Agreement for Plan Numbers 800075, 800680
|
| Contract / Amendment Amount |
$0.00
|
| Is this a new agreement or an amendment to an existing agreement? |
Amendment
|
| If this is if a Contract Amendment, what is the Contract Number? |
9212
|
| Supplemental Insurance (for Risk team only) |
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|
Upload Contract Documents
Upload Documents
| Upload Contract or Amendment Authorization Form |
ICMA-RC 800075 Contract Authorization (_9673 Amendment 1) 08-31-20 (signed).pdf, ICMA-RC 800680 Contract Authorization (_9212 Amendment 1) 08-31-20 (signed).pdf
|
| Upload Agreement or Amendment |
ICMA-RC RHS 800075 - Contract _9673 Amendment 1 08-31-20 (signed).pdf, ICMA-RC RHS 800680 - Contract _9212 Amendment 1 08-31-20 (signed).pdf
|
| Upload Insurance Documents (COI, Endorsements, WOS, etc.) |
COI 20-21 City of West Hollywood.pdf
|
| Describe changes to Insurance Requirements, if any (if no insurance is required, type "None required") |
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|
| Upload approval for insurance changes, if any (e.g., email from Risk) |
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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
|
Supplemental Risk Information
General Liability Details
| Policy Effective Date |
08/01/20
|
| Policy Expiration Date |
08/01/21
|
| Policy Amount |
$1,000,000.00
|
| Endorsements |
PNC, AI, WOS
|
Automobile Policy Details
| Effective Date |
08/01/20
|
| Expiration Date |
08/01/21
|
| Policy Amount |
$1,000,000.00
|
Workers Comp Policy Details
| Effective Date |
08/01/20
|
| Expiration Date |
08/01/21
|
| Policy Amount |
$1,000,000.00
|
| Endorsements |
WOS
|
Professional Liability Policy Details
| Effective Date |
06/30/20
|
| Expiration Date |
06/30/21
|
| Policy Amount |
$12,500,000.00
|
Other Policy Details
| Other Policy Name 1 |
Crime Liability
|
| Effective Date 1 |
06/30/20
|
| Expiration Date 1 |
06/30/21
|
| Policy Amount 1 |
$25,000,000.00
|
| Other Policy Name 2 |
Cyber Liability
|
| Effective Date 2 |
06/30/20
|
| Expiration Date 2 |
06/30/21
|
| Policy Amount 2 |
$5,000,000.00
|
