Enter Basic Contract Information
Administrative Information
Basic Contract Details
| Vendor Name |
Robert Snider
|
| Vendor Number (3____ for AP and 00___ for AR) |
328348
|
| Vendor Contact Name |
Robert Snider
|
| Vendor Contact Email |
[email protected]
|
| Contract / Amendment Title |
Amendment 1 to Agreement for Hearing Officer Services
|
| Contract / Amendment Amount |
$150,000.00
|
| 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? |
9496
|
| Supplemental Insurance (for Risk team only) |
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Upload Contract Documents
Upload Documents
| Upload Contract or Amendment Authorization Form |
Snider_K_Amend_Auth_Form_Signed.pdf
|
| Upload Agreement or Amendment |
Amendment_2_Snider_A.pdf
|
| Upload Insurance Documents (COI, Endorsements, WOS, etc.) |
2021 umbrella coverage.pdf, 2021 malpractice insurance.pdf, 2021 auto insurance.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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| Add any notes you may have for Finance and Risk Review teams. |
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|
| Upload other supporting documents here, if necessary (e.g. staff reports, etc.) |
Staff Report - Snider HO Services Contract_Amend 2_June 21, 2021_DRAFT.docx
|
Supplemental Risk Information
Automobile Policy Details
| Effective Date |
11/12/20
|
| Expiration Date |
11/12/21
|
Professional Liability Policy Details
| Effective Date |
12/1/20
|
| Expiration Date |
12/1/21
|
| Policy Amount |
$500,000.00
|
