Enter Basic Contract Information
Administrative Information
| Contract Manager Name (City Staff) |
Jonathan Holub
|
| Contract Manager Email ([email protected]) |
[email protected]
|
| Department |
05 - HSRS
|
| Division |
62 - Rent Stabilization & Housing
|
Basic Contract Details
| Vendor Name |
DG Mediation, Inc.
|
| Vendor Number (3____ for AP and 00___ for AR) |
329307
|
| Vendor Contact Name |
Dina Glouberman
|
| Vendor Contact Email |
[email protected]
|
| Contract / Amendment Title |
Agreement for Mediator Services
|
| 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 |
_Mediator_Contract_Authorization_JH_CS.pdf
|
| Upload Agreement or Amendment |
Mediator_Services_Agreement_DG_CS.pdf
|
| Upload Insurance Documents (COI, Endorsements, WOS, etc.) |
POI-Auto-Glouberman.pdf, Insurance Verification 03.2021.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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|
Supplemental Risk Information
General Liability Details
| Policy Expiration Date |
Waived due to Covid-19
|
Automobile Policy Details
| Effective Date |
04/06/21
|
| Expiration Date |
10/06/21
|
| Policy Amount |
$1,000,000.00
|
Workers Comp Policy Details
Professional Liability Policy Details
| Effective Date |
3/22/21
|
| Expiration Date |
3/22/22
|
| Policy Amount |
$1,000,000.00
|
