AI- 30294
14.F.
CC CONSENT
- Meeting Date:
- 12/29/2011
- Submitted For:
- Martha Salazar
- Submitted By:
- Vangie Garcia, PURCHASING DEPT.
- Department:
- PURCHASING DEPT.
Information
CAPTION
1. Acceptance and approval of the "Designation Of Insurance Carrier's Austin Representative Form (DWC-027)" as submitted by TriStar in connection to Contract #C-10-266-12-13 (aka E-11-272-09-27 as it was extended and approved for an additional year on 09/27/11) as it is related to the legal portion of the agreement, more specifically, 2.3 of Article 2: Definitions; and
2. The approval for County Judge, Elected Official, Executive Officer and or an authorized County Representative to sign the document.
2. The approval for County Judge, Elected Official, Executive Officer and or an authorized County Representative to sign the document.
BACKGROUND
Tristar Risk Management being the County's Workers Comp. Insurance Carrier has sent notification that the attached form designating Thornton, Biechlin, Segrato, Reynolds & Guerra, L.C. as the County's Austin Workers' Comp. needs to be signed and filed with the Tx. Dept. Of Insurance, Division Of WC by a County Representative. In addition for clarification purposes, this law firm's information was included and submitted in the RFP's response from TriStar Risk Management.
Fiscal Impact
- FISCAL YEAR:
- ACCT. #:
- FUNDS AVAILABLE Y/N?:
- MATCHING FUNDS Y/N?:
BUDGETARY IMPACT:
No fiscal impact. Signature of form is required only.Attachments
Form Review
| Inbox | Reviewed By | Date |
|---|---|---|
| Purchasing / Internal | msalazar | 12/21/2011 03:56 PM |
| Budget and Management | mmunoz | 12/21/2011 04:31 PM |
| Auditor's Office | Alejandro Garcia | 12/22/2011 04:42 PM |
- Form Started By:
- vgarcia
- Started On:
- 12/21/2011 11:40 AM
- Final Approval Date:
- 12/22/2011