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2022-252-E-County Mgr-Travelers Insurance-Work comp coverage
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2022-252-E-County Mgr-Travelers Insurance-Work comp coverage
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Last modified
7/5/2022 10:14:29 AM
Creation date
7/5/2022 10:14:12 AM
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Template:
Contract
Date
6/30/2022
Contract Starting Date
6/30/2022
Contract Ending Date
7/1/2022
Contract Document Type
Contract
Amount
$227,358.00
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Revised 06/21 <br />ORANGE COUNTY—DEPARTMENT USE ONLY <br />______________________________________________________________________________ <br /> <br />Party/Vendor Name: Travelers Insurance Party/Vendor Contact Person: Tiffany Allen Contact Phone: 704-544-3520 <br />Party/Vendor Address: 1440 Carmel Commons Blvd. City Charlotte State: NC Zip: 28226 Department: County <br />Manager- Risk Mgmt Amount: $227,358. Purpose: Work Comp Coverage Budget Code(s): 10230220 641000 <br />Vendor # (N/A if new vendor) Vendor is a BOCC consultant? Yes No Contract Type: (Check one) <br />New Renewal Amendment Effective Date Approved by Board Yes No Agenda Date: <br />--- For Section XIV. c. contracts only, Approved by Board in Current FY Budget Yes No <br /> <br />This agreement is approved as to technical form and content and I as Department Director affirmatively state work on <br />this project has not been initiated prior to execution of the agreement: <br /> <br />Department Director’s Signature ________________________________________ Date: ________ <br />Agreements for emergency services or repair are not subject to the above affirmation. If services related to this <br />agreement have already begun or been completed please briefly describe the nature of the emergency condition that <br />was addressed: <br /> <br />Information Technologies <br /> <br />(Applicable only to hardware/software purchases or related services) This agreement has been reviewed and is <br />approved as to information technology content and specifications: <br /> <br />Office of the Chief Information Officer___________________________________ Date: ________ <br /> <br />Risk Management <br /> <br />This agreement is approved for sufficiency of insurance standards, specifications, and requirements: <br /> <br />Office of the Risk Management Officer___________________________________ Date: _________ <br /> <br />Financial Services <br /> <br />This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br /> <br />Office of the Chief Financial Officer ____________________________________ Date: _________ <br /> <br />Legal Services <br /> <br />This agreement is approved as to legal form and sufficiency: <br /> <br />Office of the County Attorney __________________________________________Date: ________ <br /> <br />Clerk to the Board <br /> <br />Received for record retention: <br />All Docusign contracts must be copied to the Clerk upon completion: occlerkdocs@orangecountync.gov <br />The following signature block is for hard copies only and is not required for Docusign contracts: <br /> <br />Office of the Clerk to the Board __________________________________________Date:_________ <br />DocuSign Envelope ID: FCD9FE56-CF01-4E96-B983-B8E8DFE6811C <br />6/30/2022 <br />6/30/2022 <br />6/30/2022 <br />7/1/2022
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