Contractor/Consultant Information:
Name of Contractor:
Business License No.:
Tax ID Number:
Vendor Number:
Contract Information: Please attach a cover memo attention to the Chancellor
ICC #
(Please attach a copy of the original ICC and previous addendums)
Purchase Order #
Contract Start Date: End:
New Contract End Date:
(Extension Request Only)
Original/Previous Contract Amount:
Request to Increase/Decrease the Contract By:
Total Contract Amount:
Board Approval Date(s):
(if applicable)
Accounting Codes: (additional lines are provided for split funding only)
LOC FUND
COST
CTR
OBJECT PR
ACTIVITY
& SUFF
SPPJ LN
PREVIOUS
AMOUNT
ADDENDUM
+ / -
TOTAL
GRAND TOTAL
Funds Verified by Business Manager
Approval Routing:
College President/ Vice Chancellor
Vice Chancellor, Financial Services
Chancellor
Updated July 17, 2013
PERALTA COMMUNITY COLLEGE DISTRICT
INDEPENDENT CONTRACTOR & ORIGINAL CONTRACT
ADDENDUM FORM #
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00