CHANNEL
ISLANDS ~
AGREEMENT ROUTING
FORM Rev’d 8/2014
Attach this routing form to all agreements and
contracts.
REQUEST FOR FINAL SIGNATURE MUST BE MADE 14 CALENDAR DAYS PRIOR TO AGREEMENT START
DATE.
* If this is an
amendment
or change order, please provide original agreement number:
Agreement
Purpose/Summary:
Special Instructions:
Reviewers
Indicate if no
t
Date Received
Reviewer Signature
Date Forwarded
Vendor/Entity Agreement Received (Signed)
Agreement is signed
Summer Conferencing Specialist
Exec. Director, Housing and Residential Education
Vice President of Student Affairs or Designee
Buyer, Procurement and Logistical Services
Director, Procurement and Logistical Services
Risk Manager
Vice President of Business & Financial Affairs or Designee
(Transactions of $100K or more, MOUs, MOAs, FUAs, SFLAs)
Transactions
Reviewer
Comments:
FOR BFA USE O
NLY
Verification of Agreement Components
INDICATE Yes, No or N/A
Agreement contains scope of work and maximum dollar limit (including miscellaneous expenses)
Yes No N/A
Price and rates are in accordance with law, policies and guidelines Yes No N/A
RFP/IFB # or Statutory Authority reference, as applicable
Yes No N/A
Specific Payment Schedule & Instructions are included
Yes No N/A
Effective Date of Agreement & Ending Date of Agreement are specified
Yes No N/A
W-9 or 204 Form completed by Vendor is on file w/ PLS Office?
Yes No N/A
General Provisions are attached if needed
Yes No N/A
Insurance Provisions, Requirements and Indemnification
(Requires CSU Standards or Risk Mgmt. review)
Yes No N/A
C.I. Agreement Routing Form INTERNAL DOCUMENT Revised 8/
2014
Date:
Dept. Originating Agreement:
PO Number #
(Will be assigned by PLS)
Originating Dept. Contact: Phone:
Vendor/Contracting Agency Name:
Phone:
Vendor/Agency Contact:
Agreement Transaction Amount:
Term Start Date:
Fax:
Term End Date:
New Standard Amendment*
Change Order*
MOU/MOA
Student Placement
Service Agreement ESA
TOSA
JOC
Lease
Public Works Agreement
Project Architect/Engineer Agreement
Interagency Agreement
Grant
Summer Facilities Licensing Agreement
FUA Other
