HomeMy WebLinkAboutHR14-327 - Extension - VSP - Group Vision Care Plan Number 12229020 - 01/01/2014 cords Ma?aA,-g'-'-ernd1t
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CONTRACT COVER SHEET
This is to be completed by the Contract Manager prior to submission
to City Clerks Office. All portions are to be completed.
If you have questions, please contact City Clerk's Office.
Vendor Name: � dllc� W �ci2�l Irs�t1 �� `�71
Vendor Number: nq
JD Edwards Number
Contract Number: '
This is assigned by City Clerk's Office
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Project Name: Cx,Ll (A CC'_. a i, x �A,I
Description: ❑ Interlocal Agreement O Change Order ❑ Amendment Contract
❑ Other:
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Contract Effective Date: - C.( Termination Date: i � ..L�J i
Contract Renewal Notice (Days):
Number of days required notice for termination or renewal or amendment
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Contract Manager:�t,e-Kl i zZ)JJP partment: Pl-
Contract Amount:
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Approval Authority: ❑ Department Director ❑Mayor City Council
Detail: (i.e. address, location, parcel number, tax id, etc.):
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REQUEST FOR MAYOR'S SIGNATURE
T Please Fill in All Applicable Boxes
Reviewed by Director
Ori inator's Name: .. av r 2 De t/Div. Extension: r
Date Sent: t ' - t r`,; ° L Date Required: E .{
Return to: ,v z _ CONTRACT TERMINATION DATE: -
VENDOR: 11 ` %' DATE OF COUNCIL APPROVAL: t ? #4
ATTACH THE COUNCIL MOTION SHEET FOR THE MAYOR - if ap licable
Brief Explanation of Document:
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All Contracts Must Be Routed Through The Law Department
(This area to be completed by the Law Department)
Received:
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Approval of Law Dept.: i t .:,
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Law Dept. Comments: 1 J �h
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Date Forwarded to Mayor: -- r
Shaded Areas To Be Completed By Administration Staff
Received:
ED
Recommendations and Comments:
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� Disposition f . r t r G- `�� � � j< -� 17jF
Date Returned:
VISION SERVICE PLAN
PLEASE ATTACH TO YOUR
GROUP VISION CARE PLAN
AMENDMENT TO GROUP VISION CARE PLAN
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To be attached to and made part of Group Vision Care Plan Number 12229020, issued to CITY OF KENT.
EXCEPT as specifically amended herein, said Plan shall remain in full force and effect.
IT IS HEREBY AGREED that effective January 1, 2014 the Plan Term shall be changed to forty-eight(48)
months.
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SIGNATURE , ;, -
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9t30t14jxj VSP/AMENDTERM.DOG
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