Rev – 06/01/2016
Fairleigh Dickinson University
Contract Routing Form
Deadline for contract approval
Requesting Department Information
Department Name: Department Mail Stop:
Department Contact: Contact email address:
Vendor/Contractor Information
Businesses’ Name: Approved Vendor: Yes □ No □
Vendor Contact: Vendor Telephone:
Vendor email address:
Vendor’s Mailing Address
Vendor’s ‘Pay To’ Address
Contract Information
Purpose of Contract:
Contract Amount $ over _____ months Sole Source (No-Bid) Contract: No □ Yes □ (attach justification)
Other reviews: In accordance with the University’s Purchasing Policies and Procedures, the Contract Approval and Signatory Authority Policy and
Fairleigh Dickinson University Contract Procedures certain University transactions require review and approval from other departments. Please have
the appropriate person sign below indicating their review and/or approval.
□ For Capital Funding & Financing (VP, Finance)
□ For Computer Hardware, Software, and Related (VP, OIRT)
□ For Employment Services, including temp agencies (AVP, Human Resources)
□ For Construction, Machinery, Hazardous Materials, Safety (VP, Facilities & Auxiliary Services)
I acknowledge that I have read and understand the attached contract/agreement and that upon contract execution I will comply with all its
requirements and am responsible for: (a) monitoring compliance, expiration, and payment; and (b) ensuring that none of the University's policies are
violated in connection with this contract, including the University's Code of Conduct and Conflict of Interest and Nepotism policies.
Requesting Department (Responsible Officer or authorized Date
delegate must sign)
