Section I To be completed by Originating Department

Submitted by: ____________________ Department: _________________ Extension ______

Today’s Date: ___________ Needed-by-date ____________ Contract Start date __________

1. Purpose of contract/lease: o property lease o auto lease

o campus performance o sports camp

Other: ______________________________________

2. Length of contract/lease o single event o monthly o annual o other _______________

3. RHIT commitment: $ __________ 4. Name of business ___________________________

5. Contact Information:

Name Address Phone

__________________ _______________________________

_______________________________ _____________

6. Does this contract involve any hosted or web-based service (internet) ___ yes ___ no

7. Have bid processes in the Purchasing Guide been followed? o yes o no

If no, please explain _______________________________________________________

8. Does the awarding of this contract/lease involve any potential conflict of interest issues,

such as involvement by board members, employees, family members, etc? If so, explain. ________________________________________________________________________

________________________________________________________________________

9. Are there any provisions which you feel need special attention in the review process? If so, please indicate which ones.

________________________________________________________________________

10. As the proponent of this contract, I certify that I have read all documents being submitted and feel that this legal commitment is in the best interests of my department and the Institute.

Signed: _______________________________ Dated: ______________

Any exhibits or other documentation should be attached to a printed copy of this form.

Form should be forwarded to Dan Wells in Administrative Services, CM25.