Enter Basic Contract Information
Administrative Information
Basic Contract Details
| Vendor Name |
Sajji Lazarus
|
| Vendor Number (3____ for AP and 00___ for AR) |
329310
|
| Vendor Contact Name |
Sajji Lazarus
|
| Vendor Contact Email |
[email protected]
|
| Contract / Amendment Title |
DESIGN EXCELLENCE SCREENING EVALUATION COMMITTEE
|
| Contract / Amendment Amount |
$50,000.00
|
| 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 |
Authorization_Form_Sajji_Lazarus.pdf
|
| Upload Agreement or Amendment |
Sunset_Signage_-_Design_Excellence_Screening_Committee_Contract_-_Sajji_Lazarus_1_.pdf
|
| Upload Docusign "Certificate(s) of Completion" |
Summary_1_.pdf
|
| Upload Insurance Documents (COI, Endorsements, WOS, etc.) |
SLazarus_auto insurance.pdf, Additional Insured - Automatic Status.pdf, COI - City of West Hollywood.pdf, Auto COI_4047360740.pdf, 4976296_1_EO_Acord25_1.pdf, 4976294_1_CGL_Acord25_1.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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|
| Upload approval for contract template changes (e.g., email from Finance or City Attorney) |
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|
Supplemental Risk Information
General Liability Details
| Policy Effective Date |
104/2021
|
| Policy Expiration Date |
10/4/2022
|
| Policy Amount |
$1,000,000.00
|
| Endorsements |
AI
|
| Waived |
Waived out wos; pnc - Hiscox Placement
|
Automobile Policy Details
| Expiration Date |
11/17/2021
|
| Policy Amount |
$100,000.00
|
Workers Comp Policy Details
Professional Liability Policy Details
| Effective Date |
10/4/2021
|
| Expiration Date |
10/4/2022
|
| Policy Amount |
$1,000,000.00
|
