Contract Review Process
Feb 02, 2021
submission
#659
Enter Basic Contract Information
Administrative Information
| Contract Manager Name (City Staff) | Susan Schumacher |
| Contract Manager Email ([email protected]) | [email protected] |
| Administrator completing this workflow, if different (City staff) | Clarice Kokubun |
| Administrator email ([email protected]) | [email protected] |
| Department | 02 - ASD |
| Division | 27 - Human Resources |
Basic Contract Details
| Vendor Name | Delta Dental |
| Vendor Number (3____ for AP and 00___ for AR) | 30717 |
| Vendor Contact Name | Noriko Cowles (USI Insurance Services) |
| Vendor Contact Email | [email protected] |
| Contract / Amendment Title | Amendment No. 13 to Agreement Renewal Group #03067 |
| Contract / Amendment Amount | $0.00 |
| Is this a new agreement or an amendment to an existing agreement? | Amendment |
| Supplemental Insurance (for Risk team only) | --- |
Upload Contract Documents
Upload Documents
| Upload Contract or Amendment Authorization Form | Memo to Finance - Delta Dental Amendment No. 13 2-2-21.pdf |
| Upload Agreement or Amendment | Plan _03067 PPO EOC (01-01-21).pdf, 2021 Plan _03067 Renewal Amendment _13 (01-01-21).pdf |
| Describe changes to Insurance Requirements, if any (if no insurance is required, type "None required") | --- |
| Describe changes to Contract Template, if any (If none, type "None required") | --- |
| Add any notes you may have for Finance and Risk Review teams. | --- |
| Add name of RFP / RFQ / RFB, if issued |
Supplemental Risk Information
General Liability Details
| Waived | No Insurance Required |
Automobile Policy Details
| Waived | No Insurance Required |
Workers Comp Policy Details
| Waived | No Insurance Required |