UAA Representational (Rep) Expense Allowance Form
Representational expenses are defined in UA BOR R05.02.070
Representational (Rep) Allowance forms must be completed for all activities that fall into the following categories. These types of
expenditures most typically include entertainment (8115) or commodity or gift (4008/4018)
type expenses. It may also
include catered events, meals provided during a work session (3008/3018), or catered fundraising events (3038/4038). See Rep
Allowance Guidelines for details.
Any 8115 expense over $200, and any gifts or “other discretionary expenditures” expense, requires the signature of the Rep
Allowance designee (assigned by the Chancellor). Any non-8115 entertainment-like expenses, or any 8115 expense under $200
can
be approved by the fiscal or account manager, with the exception of gifts and “other discretionary expenditures.” The purchase of
gifts costing more than $100 requires approval of the VC Administrative Services.
Event: _________________________________________________ Date of Event: __________________________
Vendor Name: __________________________________________ Location of Event: _______________________
Method of Payment: PO JV LPO
Reimbursement Procard
Does this event include alcohol?: No Yes**
**If yes, please break out the alcohol amount (including bartender and liquor license fees), indicate an allowable non-
public funding source, and attach a copy of the approved Request for Beer and Wine
Does
this request include gifts:? No Yes**
**If yes, please provide the name of the recipient(s) and all other required documentation as per BOR R05.02.070(F)(5).
Attach additional pages if necessary.
Provi
de the fund/org/acct for event (provide grant number, if restricted funds will be used):
Fund:_______________ Org:______________ Account:_________ Amount: $_____________ Grant #:________________
Fund:_______________ Org:______________ Account:_________ Amount: $_____________ Grant #:________________
Business reason and benefit gained or expected to be gained by UAA. Include an activity description or nature of business
discussion to occur: ______________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
List of attendees including business relationship (role/title) and names of any UA employees to be present for
meal/entertainment. Identify groups if applicable. Attach agenda/list if applicable: ________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Certif
ication of benefit to the university and appropriateness of expenditure:
I certify that the expense(s) included in this request for reimbursement or payment are incurred for the benefit of the university
or the respective funding agency in connection with the performance of the official duties and obligations, and that, in my
opinion, such expenditure(s) represent(s) an appropriate use of public or other funds used to support the expenditure.
(Print Name) Designated Signature Authority (if 8115 over $200): _______________________________________________
(Print Name) Fiscal Signature Authority (if 8115 under $200, or non-8115):________________________________________
(Signature) Certified and approved:_____________________________________________ Date:______________________
UHDCS waiver approval**: ____________________________________________________Date :_____________________
Reason for waiver request: ______________________________________________________________________________
**Waiver must be obtained if self-catering an on-campus event costing $500 or more.
Rev. Sep 2017
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