Contract Review Process
Oct 11, 2021
submission
#1160
Enter Basic Contract Information
Administrative Information
| Contract Manager Name (City Staff) | Kristin Cook |
| Contract Manager Email ([email protected]) | [email protected] |
| Administrator completing this workflow, if different (City staff) | Margarita Kustanovich |
| Administrator email ([email protected]) | [email protected] |
| Department | 04 - PSD |
| Division | 04 - Sheriff/Protective Services |
Basic Contract Details
| Vendor Name | LA CO/ DEPT. OF HEALTH SRVS. |
| Vendor Number (3____ for AP and 00___ for AR) | 309214 |
| Vendor Contact Name | Rich Jurado |
| Vendor Contact Email | [email protected] |
| Contract / Amendment Title | MOU for Medical Alert Center Staffing for Halloween 2021 |
| Contract / Amendment Amount | $4,228.00 |
| Is this a new agreement or an amendment to an existing agreement? | New Agreement |
| Supplemental Insurance (for Risk team only) | --- |
Upload Contract Documents
Upload Documents
| Upload Contract or Amendment Authorization Form | EdenContractAuthorizationForm_309214-LA_CO_DEP._of_Health_Srvs._Hween_2021.pdf |
| Upload Agreement or Amendment | LA_County_EMS_Agency_-_MOU_-_Halloween_Weekend.pdf |
| Upload Docusign "Certificate(s) of Completion" | Summary.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. | --- |
Supplemental Risk Information
General Liability Details
| Waived | No insurance is required for this MOU agreement |
Automobile Policy Details
| Endorsements | No insurance is required for this MOU agreement |
Workers Comp Policy Details
| Expiration Date | No insurance is required for this MOU agreement |