The University of Memphis

Contract/Agreement Routing Form
Please click here for form Information & help: Contract Review and Approval Process Summary (opens in a new window)
 

Requesting Department
Department Name Room/Building
Contact Person Telephone
E-Mail Address Fax
Are stimulus funds being used? Yes  No
 

Contractor Information
Contractor Name Telephone
Contact Person
Address Fax
E-Mail Address
 

Contract Description
Purpose of Contract:
Contract Amount: Start Date:
mm/dd/yyyy 		End Date:
mm/dd/yyyy
Requisition Number (Required for Expenditure Contracts)
Is this a "Sole Source" contract? No  Yes   If yes, justification must be provided
Is your Attestation Re Personnel Used in Contract Performance attached? (Required for Personal Service, Processional Service, Consultant Service Contracts, and all contracts for acquisition of hardware, software and related services) No  Yes
Will any student information be released as result of the contract? No  Yes
What other departments are affected by this contract?
Specify the individual in your department (Contract Monitor) responsible for ensuring receipt of goods/services contracted for under this agreement:
Frequency of monitoring (less than monthly, monthly, quarterly):
 
I certify that I have read the attached contract/agreement and that the requesting department will comply with all its requirements and have notified any other departments affected by this contract/agreement. I recognize that while the Procurement and Contract Services, Business Services, or the Office of Legal Counsel may analyze the contract from a legal or policy perspective, it is the requesting department's responsibility to (a) ensure the specifications are sufficient and/or practical for department need; (b) funds are available; (c) monitor compliance, expiration, and payment; and (d) ensure no violation of University policies and procedures in connection with this contract, including the policy on Conflict of Interest.
Requesting Department:
__________________________________________
Department Contact/Contract Monitor
______________
Date
Approved By:
__________________________________________
Financial Manager / Directror / Department Chair
______________
Date
Approved By:
__________________________________________
Dean/Assistant Vice President (If $50,000 or more)
______________
Date
Approved By:
__________________________________________
Vice President / Provost (If $250,000 or more)
______________
Date
 

Contract Routing and Approvals
Type of Contract (Select One) Routing Sequence Approvals Date
A. Standard Contracts and Vendor-Generated Contracts
Banking
Clinical Affiliation
Computer Hardware, Software, and Related
Services
Continuing Education
Dual Service
Facilities Use
Personal, Professional, and Consultant Services		 1. Procurement and Contract Services (678-2265)

2. Legal Counsel (if applicable)

3. Business Services (if applicable)







B. Specific Non-Standard Contracts
Music Performance License
Partnership
Performance
Real Property Lease
1. Business Services (678-2307)

2. Legal Counsel (if applicable)




C. All Other Non-Standard Contracts
 1. Legal Counsel (678-2155)

2. Business Services (if applicable)




 
For Office Use Only: Contract Number______________ Purchase Order Number______________