Fillable Agreement Routing Form 01 2016 (California State University Channel Islands)

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Agreement Routing Form 01 2016 (California State University Channel Islands)

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File type: PDF

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CHANNEL

ISLANDS~

AGREEMENTROUTING

FORM



Attachthisroutingformtoallagreementsand

contracts.



REQUESTFORFINALSIGNATUREMUSTBEMADE14CALENDARDAYSPRIORTOAGREEMENTSTART

DATE.



*Ifthisisan

amendment

orchangeorder,pleaseprovideoriginalagreementnumber:



Agreement

Purpose/Summary:

SpecialInstructions:



Reviewers



Indicate i

abl

DateReceived



ReviewerSignature



DateForwarded



Vendor/EntityAgreementReceived(Signed)

 

Agreementissigned



EventsandConferencingOffice

  

ProcurementandLogisticalServices

  

AVP,StudentAffairsorDesignee

  

Exec.Director,HousingandResidentialEducation

  

Director,ProcurementandLogisticalServices

  

RiskManager

  

VicePresidentofBusiness&FinancialAffairsorDesignee

(

Transactionsof$100Kormore

MOUs

MOAs

FUAs

SFLAs

)



  

President

(

Transactions

of$ 300Kormore)



  

Reviewer

Comments:

FORBFAUSEO

NLY



Verificationo

A

reementCom

onents

INDICATE Yes, No or N/A

Agreementcontainsscopeofworkandmaximumdollarlimit(includingmiscellaneo usexpenses)

YesNoN/A

Priceandratesareinaccordancewithlaw,policiesandguidelines YesNoN/A

RFP/IFB#orStatutoryAuthorityreference,asapplicable

YesNoN/A

SpecificPaymentSchedule&Instructionsareincluded

YesNoN/A

EffectiveDateofAgreement &EndingDateofAgreementarespecified

YesNoN/A

W‐9or204FormcompletedbyVendorisonfilew/PLSOffice?

YesNoN/A

GeneralProvisionsareattachedifneeded

YesNoN/A

InsuranceProvisions,RequirementsandIndemnification (RequiresCSUStandardsorRiskMgmt.review)

YesNoN/A

C.I.AgreementRoutingFormINTERNALDOCUMENTRevised1/2016 

Date:

Dept.OriginatingAgreement:



PONumber#

(WillbeassignedbyPLS)

OriginatingDept.Co ntact:  Phone:

Vendor/ContractingAgencyName:

 

Phone:



Vendor/AgencyContact:

AgreementTransactionAmount:



TermStartDate:



Fax:

TermEndDate:

NewStandard Amendment* ChangeOrder* MOU/MOA



StudentPlacement

ServiceAgreement ESA

TOSA

 JOC



Lease



PublicWorksAgreement

ProjectArchitect/EngineerAgreement InteragencyAgreement



Grant



SummerFacilitiesLicensingAgreement

FUA Other

REV 1-2016

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Agreement Routing Form 01 2016 (California State University Channel Islands)

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Completed 21 July 2020

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