Enter Basic Contract Information
Administrative Information
Basic Contract Details
| Vendor Name |
Caltrans
|
| Vendor Number (3____ for AP and 00___ for AR) |
003194
|
| Vendor Contact Name |
Irene Dong
|
| Vendor Contact Email |
[email protected]
|
| Contract / Amendment Title |
Program Supplement - LRSP
|
| Contract / Amendment Amount |
$40,000.00
|
| 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 |
LRSP PSA Auth Form (Signed 2).pdf
|
| Upload Agreement or Amendment |
LRSP PSA (Draft).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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|
Supplemental Risk Information
General Liability Details
| Waived |
no ins req'd for this PSA
|
Automobile Policy Details
| Endorsements |
no ins req'd for this PSA
|
Workers Comp Policy Details
| Waived |
no ins req'd for this PSA
|
