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VehicleAcquisitionRequest UNIVERSITY OF HAWAI’I –AUXILIARY ENTERPRISES

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UNIVERSITY OF HAWAI‘I @ HILO
Auxiliary Services
VEHICLE ACQUISITION FORM
Type of Acquisition:
New Purchase * Replacement * Surplus/Donation * Lease
(more than 12 months)
*Vehicle acquisitions must comply with the Federal Alternative Fuel Transportation Program [10 CFR Part 490] Energy Policy Act of 1992
Requesting Department:
____________________________________________________________________________________
Date of Request:
___________________________ Address: _____________________________________________________
Contact Person:
______________________________________________________________ Phone Number: ___________________
Type of Vehicle Requested:
Sub-Compact Compact Larger than compact or specialized vehicle (provide a justification):
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
Number of Vehicle Units Requested:
_______________________
Special Requirements:
1. Air Conditioning: YES NO (IF YES, provide justification below)
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
Assignment and Storage:
Vehicle will be assigned to: _________________________________________________________________ (Department/Program Name)
Vehicle will be stored at: _______________________________________________________________________ (Island and Address)
Application/Purpose:
1. Intended use of vehicle: __________________________________________________________________________________
2. Number of passengers to be transported: ____________________________________________________________________
3. Type of cargo to be transported: ___________________________________________________________________________
4. Type of terrain to be traveled: __________________________________________________________________________________
5. Reference the attached “New/Replacement Vehicle Acquisition Eligibility Criteria” for the following:
a. What User Group do you belong to? Specialized Vehicle Daily User
Facilities, Grounds, Safety, & Service Off-campus Commuter Federal/Private Grant Funding
6. How many miles on average do you anticipate traveling annually?
Over 10,000 miles/year Between 8,500-10,000 miles/year Under 8,500 per year
Funding Authorization:
If the vehicle will be acquired with funds appropriated by the State Legislature, complete Item No. 1. If not, proceed to Item No. 2.
1. Vehicle will be acquired with funds appropriated by the State Legislature:
a. Means of financing
General Special Federal Revolving
Clear Form
b. Are funds budgeted and allocated to your program for vehicle acquisition?
YES NO
2. If sponsored research or training funds will be used, does the proposed vehicle acquisition comply with applicable sponsor terms or
conditions?
YES NO
VALIDATION:
I verify the accuracy of the information provided on this form and certify that sufficient funds are available in this account for this acquisition
and that this acquisition is in accordance with applicable Transportation Services and University of Hawai‘i policies and procedures.
________________________________________________________________________________________ ____________________
Fiscal Officer Typed Name FO Code Date
APPROVAL/DISAPPROVAL:
APPROVED This acquisition is approved in accordance with applicable Transportation Services and University of Hawai‘i policies
and procedures.
NOT APPROVED This acquisition is not approved.
_________________________________________________________________________________________ ____________________
Dean/Director Typed Name Date
EVALUATION by Auxiliary Services:
The vehicle(s) on this acquisition form has been evaluated for appropriateness for the stated intended use and purpose and deemed as follows.
APPROPRIATE INAPPROPRIATE
COMMENTS: _________________________________________________________________________________
___________________________ ___________________ OR _________________________________ _________________
Auxiliary Service Director Date Vice Chancellor of Administrative Affairs Date
_________________________________________________________________________________________________________________
FOR AUXILIARY SERVICES USE ONLY
Trade-in Information:
____________________________________________________________________________________
____________________________________________________________________________________
Year Make Model License Number
Reassessment Information:
Ending Mileage/Odometer Reading: ______________________________________________________
Mechanical and Body Condition: ____________________________________________________________________________________
Cost Analysis of Vehicle:
Estimated Acquisition Cost: $___________________________ Estimated Insurance Costs: $_______________________________
Annual FMP fee (if applicable): $________________________ Annual R&M Costs: $____________________________________
Total Acquisition and Operating Cost: $_______________per year $__________________________________for the life of the vehicle
Other:
Specs prep by:__________________________ Sent to:____________________________ Date:______________
UH IFB No:____________________________ UH Contract No: ________________________________________
AUX/VEHIC Revised 04/08
UNIVERSITY OF HAWAI‘I @ HILO
Auxiliary Services
REQUEST FOR APPROVAL OF VEHICLE ACQUISITION(S)
(Attachment to Vehicle Acquisition Form)
Type of Vehicle Requested: ______________________________________________________________________
Source of Funds and Account Code: ______________________________________________________________
Purpose and Justification for Vehicle Acquisition:
How will this vehicle support the University’s missions, goals and objectives?
Impact if Deferred:
Explain why the alternatives listed in the “Eligibility Criteria” cannot meet the organization’s transportation
needs (also include a cost analysis/comparison of each alternative):
VALIDATION:
I verify the accuracy of the above information and certify that this acquisition supports the University Program indicated in the Source of
funds and Account Code section.
________________________________________________________________________________________ ____________________
Approving Authority Typed Name Title Date
AUX/VEHIC Revised 04/08
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VehicleAcquisitionRequest UNIVERSITY OF HAWAII AUXILIARY ENTERPRISES

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Completed 23 February 2020

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