Enter Basic Contract Information
Administrative Information
Basic Contract Details
| Vendor Name |
Alan Seltzer
|
| Vendor Number (3____ for AP and 00___ for AR) |
329149
|
| Vendor Contact Name |
Alan Seltzer
|
| Vendor Contact Email |
[email protected]
|
| Contract / Amendment Title |
Agreement for Hearing Officer Services
|
| Contract / Amendment Amount |
$12,500.00
|
| 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 |
EdenContractAuthorizationForm_Fillable-A._Seltzer - CS.pdf
|
| Upload Agreement or Amendment |
Hearing_Officer_Services_Agreement_-_A._Seltzer - CS -dated.pdf
|
| Upload Docusign "Certificate(s) of Completion" |
Summary - CS.pdf, Summary.pdf
|
| Upload Insurance Documents (COI, Endorsements, WOS, etc.) |
Seltzer_11LPL10608904_pdf_107651636.pdf, Cert. of Bus. Owner's Ins.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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|
Supplemental Risk Information
General Liability Details
| Waived |
No Required for this Contract
|
Automobile Policy Details
| Effective Date |
11/01/20
|
| Expiration Date |
11/01/21
|
Workers Comp Policy Details
Professional Liability Policy Details
| Effective Date |
01/01/21
|
| Expiration Date |
01/01/22
|
| Policy Amount |
$1,000,000.00
|
