Email to: ______________________________
Reminder: Checklist must be completed in its entirety for prompt processing; standard review is within 30 days
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CONTRACT OWNER NAME |
VENDOR NAME | |||
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DEPARTMENT AND COST CENTER |
CONTRACT TYPE | |||
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Dept: |
CC: |
_____ Service _____ Product ____ Consultant (SOW only) | ||
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REQUEST LEVEL |
VERSION | |||
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_____ Regular _____ Urgent – Rationale: |
_____ New _____ Renewal _____ Amendment _____ Checklist Resubmission | |||
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Contract Reference #: ______________________________ (if new, N/A) | ||||
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CONTRACT AMOUNT[1] |
DATES | |||
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$ _____ /year |
$ _____ total |
BEGIN |
END | |
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_____ /_____ /_____ |
_____ /_____ /_____ | |||
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LEGAL REVIEW REQUESTED[2] |
_____ Begin on date of execution | |||
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_____ No _____ Yes – Rationale: |
_____ One-time purchase (no dates) | |||
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Term ____ 1 year _____ Other: ______________________________ | ||||
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Auto Renew: _____ Yes ____ No | ||||
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CONTRACT DESCRIPTION & NOTES[3] |
CONTRACTING PARTY | |||
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_____ OHMC _____ OMC _____ OSC _____ EHN | ||||