(Including Grants and related Proposals)
00/font> District 00/b> Cuyamaca 00/b> Grossmont 00/b> New Contract No.
Date 00/b> New Proposal No.
Initiator Phone 00/b> New Master Fixed Form Agreement
Title 00/b> Amend Contract No.
Division/Department 00/b> Renew Contract No.
Site Contact Person Phone 00/b> Cancel Contract No.
CONTRACTOR:Address
City/State/Zip TIN/SSN
Phone Fax Contact
00/b> INCOME CONTRACT (Including Grants and Proposals) SOURCE 00/font> Grant Specify 00/font> Participant 00/font> Contract Education 00/font> General Fund 00/font> State Program 00/font> Other BUDGET EXPENSE DETAIL 1000: 2000: 3000: 4000: 5000: 6000: 7000: Total: TOTAL Total Object 1000-7000 $ Indirect Costs $ Total Contract cost $ District Match $ Notes: 00/b> EXPENDITURE ONLY CONTRACT IFAS ENCUMBRANCE No. .CHECK ALL BOXES THAT APPLY AND ATTACH REQUIRED DOCUMENTS
00/font> Construction 00/font> Lease/Rental 00/font> Maintenance 00/font> Workshop/Seminar
00/font> Fixed Form Master 00/font> License 00/font> Professional Service 00/font> Other
CONTRACT INFORMATIONA. Contract Period: From: to inclusive.
B. Cost: $ / 00/font> Day 00/font> Month 00/font> Year 00/font> Other
Delivery: $ Installation: $ Total Cost for Contract Period: $
C. Invoiced: 00/font> Monthly 00/font> Quarterly 00/font> Yearly 00/font> Contract Period 00/font> Other (specify)
D. Budget Detail: Account # Account #
SPECIFIC DESCRIPTION, PURPOSE, AND JUSTIFICATION/BACKGROUND (Describe each in full; use separate sheet if needed.) APPROVALS FOR DISTRICT OFFICE USE ONLY:Construction Projects
Initiator Date Facilities Review/Approval
Vice President/Executive Dean Date Date
President/Vice Chancellor Date 00/font> Requires Certificate of Insurance
Business Office/Budget Date Certificate Received
Vice Chancellor00usiness Services Date 00/font> Approved 00/font> Ratified
CO01.F1 3/02 by Governing Board on:
