Enter Basic Contract Information
Administrative Information
Basic Contract Details
| Vendor Name |
Trustees of the University of Pennsylvania
|
| Vendor Number (3____ for AP and 00___ for AR) |
329591
|
| Vendor Contact Name |
Yolanda S Green
|
| Vendor Contact Email |
[email protected]
|
| Contract / Amendment Title |
Contract
|
| Contract / Amendment Amount |
$86,236.00
|
| 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 |
Contract Authorization_Form Trustees_of_the_University_of_Pennsylvania.pdf
|
| Upload Agreement or Amendment |
10086527_Contract_Over_25K_-_Guaranteed_Income_Micro-Pilot-Trustees_of_the_University_of_Pennsylvani.pdf
|
| Upload Docusign "Certificate(s) of Completion" |
Summary.pdf, Summary-Authorization.pdf
|
| Upload Insurance Documents (COI, Endorsements, WOS, etc.) |
WC Self-Insurance Permit 2021.pdf, COI for City of West Hollywood.pdf, 2021 Excess WC & EL Certificate.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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|
| Add any notes you may have for Finance and Risk Review teams. |
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|
| Add name of RFP / RFQ / RFB, if issued |
None
|
Supplemental Risk Information
Upload Additional Insurance Files Here
General Liability Details
| Policy Effective Date |
07/01/2021
|
| Policy Expiration Date |
07/01/2022
|
| Policy Amount |
$3,000,000.00
|
| Endorsements |
PNC, AI, WOS
|
| Waived |
endorsements pending
|
Automobile Policy Details
| Effective Date |
07/01/2021
|
| Expiration Date |
07/01/2022
|
| Policy Amount |
$1,000,000.00
|
Workers Comp Policy Details
| Effective Date |
04/01/2021
|
| Expiration Date |
04/01/2022
|
| Policy Amount |
$2,000,000.00
|
| Endorsements |
WOS
|
| Waived |
Permissibly self insured
|
Professional Liability Policy Details
| Effective Date |
11/5/2021
|
| Expiration Date |
11/5/2022
|
| Policy Amount |
$10,000,000.00
|
| Endorsements |
Cyber / Technology coverages here
|
