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Get File Group Id 63286.html (California Maritime Academy)

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Date Requested:
Originator:
Department:
Phone:
Phone:
Fax:
E-Mail:
E-Mail:
Risk Analysis:
Warranty (if applicable)
:
Services Dates:
List of Deliverables:
% $ Amount
SERVICE Requisition
V
E
N
D
O
R
Project Contact:
Vendor #:
PO #:
Scope of Work / Specifications
Dept Approval
Project IDFund Dept ID ClassAccount
If yes, Scope of Work for Services
Over 100k Attached
Name and Address:
$NTE:
End Date:
I certify that the goods & services requested are necessary for the operation of the department, that there are sufficient funds to cover the expense, and that I am
authorized to approve such expenses.
Payment Terms:
Cal Maritime Project Contact:
Procurement Office Use Only
REQUIRED FOR ALL REQUISITIONS:
Date Received:
Start Date:
Split
204 Form
BLANKET
CHANGE ORDER
In Arrears
Schedule of Payments - detailed breakdown attached
Advance - Justification attached
Work Performed on Campus
Work Performed off Campus
SPONSORED PROGRAMS
Are any deliverables taxable?
Debarment Documentation (Visual
Compliance and SAM) if over 25K:
Yes
No
Authorized Dept/Unit Head Signature
VP Approval (as needed)
IT Approval (as needed)
Sponsored Programs Review
Commodity Requisition $10,000 - $49,999.99:
Commodity Requisition $50,000 - $100,000:
Commodity Requisition Over $100,000.01:
Abstract of Quotes or 2 Quotes Attached
3 Quotes
Attached
RFP or RFQ R
equired
Revised 08/08/2018 T. Price
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Completed 16 July 2020

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