Fillable BOARD.AGENDA.REQUEST.MEMO Example for Board Agenda request

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BOARD.AGENDA.REQUEST.MEMO Example for Board Agenda request

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Page 1 of 2
Board Agenda Item Request Memo (2/19/08)
(Rev: 9/17/10, 1/1/12) Business Services Division
EL CAMINO COMMUNITY COLLEGE DISTRICT
BOARD AGENDA ITEM REQUEST/INFORMATION SHEET
To: Business Services Division
Date:
Subj: Board Agenda Item for:
(Board Meeting Date)
From:
Ext.:
Area Vice President (Initial Here)
Ext.:
(Initial Here)
Division Manager:
Division Office:
Contract Coordinator/Dept. Contact:
(Initial Here)
Please Check One: CONTRACT:
PSA:
Insurance Required?: Yes
NO
CONTRACTOR NAME:
Date(s) of service:
Contract Amount $
Requisition No.
/PO #
Account No. (s)
/
FOR NON-PO DRIVEN Contracts (Please complete the following)
Check one: Income Generating
OR
No Cost:
Projected Gross Income: $
Projected Expenses: $
Projected Net:
Source of funding (i.e., Grant, Partnership, Agreement, etc.):
Note: Contracts valued at the threshold amount or higher, non-PO driven, and “No Costs”
contracts will be distributed after Board approval.
PLEASE COMPLETE THE FOLLOWING FOR ALL AGREEMENTS
Description of Division/Dept. Program:
Description of Services: (Note: Provide a detailed description of the services/work. What is the
benefit to the District resulting from entering into this agreement?)
Page 2 of 2
Board Agenda Item Request Memo (2/19/08)
(Rev: 9/17/10, 1/1/12) Business Services Division
INSTRUCTION PAGE ONLY (Do not attach this page when forwarding)
REQUIRED DOCUMENTS FOR PROCESSING:
(1) Board Agenda Item Request/Information Memo per contract agreement (set)
(1) original and 2 copies of each Agreement (minimum 3 copies – this makes a set)
(1 original agreement will be kept in the Purchasing Office/AP files as appropriate.
The remaining copies will be returned to the department after the Board Meeting)
(1) W-9 (required each calendar/Fiscal Year) for ALL CONTRACTORS
(1) Form 590 annually (Each FY) for ALL CONTRACTORS
Affirmative Action Status Form (once time DURING THE HISTORY of business
relationship, unless their status changes)
---------------------------------------------------------------------------------------------------------------------
1. For “NO COST”AND “INCOME GENERATING” AGREEMENTS
a. Complete the Board Agenda Item Request/Information Sheet and attach to set.
b. Send the agreement (set) to the Area Vice President for approval and initials
2. PO/BPO DRIVEN CONTRACTS/PERSONAL SERVICE AGREEMENTS
UNDER THE THRESHOLD Dollar Amount will be appear in the Board Agenda
under the PO/BPO List for ratification by the Board.
a. PERSONAL SERVICE AGREEMENTS (PSAs)
1) Complete the IRS Checklist
2) Create Requisition
3) Place Requisition # On Checklist – send directly to Human Resources
only. Do Not Send to Purchasing
4) Complete and attach the Board Agenda Request/Information Memo to the
agreement packet and forward to your Area Vice President
b. CONTRACTS:
1) Complete and attach the Board Agenda Request/Information Sheet
2) Forward the agreement packet to the Area Vice President
(BOARD APPROVAL IS REQUIRED BEFORE SERVICES START ON
CONTRACTS VALUED AT THRESHOLD DOLLAR AMOUNT OR HIGHER.
(This amount changes EVERY JANUARY- watch for notification)
ALL AGREEMENTS ARE TO BE PROCESSED THROUGH THE APPROPRIATE
AREA VICE PRESIDENT’S OFFICE, WHO, IN TURN, WILL FORWARD THEM ON
TO THE PURCHASING & BUSINESS SERVICES DIVISION OFFICE.
DO NOT TAKE OR SEND CONTRACTS DIRECTLY TO THE OFFICE OF THE VICE
PRESIDENT OF ADMINISTRATIVE SERVICES. THEY WILL BE RETURNED TO
YOU WITHOUT ACTION.
Contact Your Division Office or Purchasing Office for Assistance.
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BOARD.AGENDA.REQUEST.MEMO Example for Board Agenda request

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Completed 1 November 2019

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