City of Rancho Cordova Contract and Agreement Routing and Approval Form
CONTRACTOR/COMPANY INFORMATION
Email
Phone
Contractor Name
Contact Person
Address
REQUESTING CITY DEPARTMENT
Phone
Department Name
City Contact
CONTRACT DESCRIPTION/INFORMATION
Contract #
Amount
Expiration
Cumulative
Amount
Original
Amendment 1
Amendment 2
Amendment 3
Resolution # (attach Resolution)
Bid information
Not required
Purpose of Contract: (brief description)
Contract Template Used (use dropdown)
Budget Expense Acct No.
Select one.
Project/Grant No.
INSURANCE REQUIREMENTS
All Insurance Certificates must include the corresponding Contract No.
Is Endorsement included? ☐
Is Waiver of Subrogation attached? ☐
Any modifications/waivers to insurance requirements? Select one.
If yes, what was modified/waived? ___________________________________________________________
In the section below, please provide insurance amounts as required in the contract.
☐ General______________
☐ Auto ________________
☐ Professional_________________
☐ Sexual Molestation Abuse ______________
☐ Workers’ Compensation ______________
☐ Other _______________
NOTES/SPECIAL INSTRUCTIONS
PO Number
To Be Completed By Finance Department
Vendor ID
CONTRACT CERTIFICATION & APPROVALS
Department Head
Date
City Attorney
Date
Risk Manager
Date
City Clerk
Date
For questions regarding contracts or insurance requirements, contact the City Clerk’s office (916) 851-8720.