CONTRACT COVER SHEET
(Type or Print all information with the exception of Signatures and Signature Dates)
Signature Approval and Date Required to Process Contract Cover Sheet for Academic Division
Provost Office: / ______/ Date: / ______
College Dean: / ______/ Date: / ______
Department Chair: / ______/ Date: / ______
Originating Unit
UHD Contract Contact / UHD Person Responsible for Ensuring Contract TermsUHD Department: / English / Name: / Kathryn Laity
Contact Name: / Kathryn Laity / Title: / Chair/Women's Month
Contact Phone #: / 713.222.5372 / Date: / March 9, 2005
Contact Room #: / 1050S / Signature:
Contractor/ Vendor Information
Contractor/Vendor: / Special Speaker
Address: / Street Name
City: / City / State: / NY / Zip: / 00022
Contact Name: / Special Speaker
Contract Signatory: / Special Speaker / Title:
Phone #: / Fax #: / Tax ID #: / 555-55-5555
Contract Information
Brief Description of Goods or Services or arrangements covered by the terms of the contract:
**** is invited to campus by UHD Women's Month to present the [fill in name of event]
Effective Date: / Upon Execution by Authorized Signatories, or / Other (Specify Date):
Termination Date: / Notice To Proceed + / (Specify # of Days), or / Other (Specify Date): / March 9, 2005
Financial Information
People Soft
Cost Center: / Account Code: / 5205 / Amount: Not To Exceed: / $200
Will Contract Generate Income: / Click Here to Select OneNoYes / Will Contract Be Paid From Grant Funds: Click Here to Select OneNoYes-Verify Availability of Funds with Allen Turner
Contract Form and UHD Signatory
Contract: / Click Here to Select OneGeneral Agreement (S-98-5)Speaker Agreement (S-2000-3) $250 or BelowPerformer Agreement (S-98-8)Independent Contractor Agreement (S-98-7)Letter of Contract (S-99-22)Job Order (S-2004-1)Professional Services (S-99-23)Consulting Agreement (S-98-6)Grant-Sponsored Project (S-99-13)(Copy A. Sherman)English Language Institute (S-2000-12)Vendor Contract/DocumentNon Standard UHD Contract (Requires OGC Review) / Signatory: / Click Here to Select OneMax Castillo - President UHDT. Chaney Anderson - V. P. for AdministrationMolly Woods - Vice President for Academic AffairsDavid Bradley - Assistant V. P. for AdministrationChristopher G. McCall - Facilities Mgnt. DirectorHossein Shahrokhi-Information Tech. Exec. DirectorIvonne Montalbano - Exec. Assist. to the PresidentRichard Sebastiani-Director of Sports and Fitness
Contract Checklist
1. Has this individual or owner of this business been an employee of the University of Houston system in the past 12 months? Click Here to Select OneYes - SEE NOTENo[Note: If Yes, state law does not allow us to write a contract for this individual/vendor.] (If unsure, check PeopleSoft or contact Human Resources at (713) 221-8072.)
2. Are all documents in order and submitted at least 5 business days prior to the start date for services for OGC standard contracts or at least 20 business days prior to start date for services if using a non-standard contract? Click Here to Select OneContract will begin "Date of Full Execution"YesNo - SEE NOTE
[Note: If No, and not associated with a building repair, complete a “Justification for Untimely Contract Submittal” form.]
3. Does the contract, Licensing Agreement, insurance or other document requiring UHD signature originate from the vendor, has the OGS standard contract been altered, or is this a non-standard UHD contract? Click Here to Select OneYes - SEE NOTENo
[Note: If Yes, must be reviewed by the Office of General Counsel. Forward to Contract Administrator.]
4. Is the product or service available through the Building and Procurement Commission? Click Here to Select OneRevenue Contract-Questions 5 to 13 Not ApplicableYes - SEE NOTENo
[Note: If Yes, no contract needed.)] (If Unsure, contact Purchasing at (713) 221-8062.)
5. Does the purchase involve HEAF funds, the purchase of software or a state contract item? Click Here to Select OneRevenue Contract -Questions 6 to 13 Not ApplicableYes - SEE NOTENo
[Note: If Yes, A Purchase Requisition is required. Contact Purchasing at (713) 221-8062.]
6. Is the purchase valued at $2,500 or more ($5,000 for Facilities Management and Information Technology)? Click Here to Select OneRevenue Contract-Questions 7 to 13 Not ApplicableYes - SEE NOTENo
[Note: If Yes, A Purchase Requisition is required. Contact Purchasing at (713) 221-8062.]
7. Is the purchase for printing services paid with state funds or valued at $5,000 or more? Click Here to Select OneProfessional Services - Not ApplicableConsulting Contract - Not ApplicableRevenue Contract-Questions 8 to 13 Not ApplicableGrant Related Contract - Skip to 13Interagency Agreement -Skip to 13License Agreement Renewal - Skip to 10Hotel for Special Event - Skip to 11Yes - SEE NOTEYes, I will attach a Sole Source in lieu of bidNo - Skip to number 11
[Note: If Yes, Competitive bidding is required. Contact Purchasing at (713) 221-8062.]
8. Does this contract involve Consulting Services valued at $15,000 or more? Click Here to Select OneRevenue Contract-Questions 9 to 13 Not ApplicableGrant Related Contract - Skip to 10Interagency Arrangement - Skip to 10Hotel for Special Event - Skip to 10Yes - SEE NOTENo
[Note: If Yes, requires notification of Legislative Board and Governor’s Office of Budget and Planning as well as 30 day publication on Texas Register. Contact Contract Administrator (713) 222-5340.]
9. Is this purchase valued at $25,000 or more? Click Here to Select OneRevenue Contract-Questions 10 - 13 Not ApplicableGrant Related Contract - Not ApplicableInteragency Arrangement - Not ApplicableHotel for Special Event - Not ApplicableYes - SEE NOTEYes, but I will attach a Sole Source JustificationNo - Skip to number 11
[Note: If Yes, UHD has elected to post on the Texas Electronic Marketplace for 14 or 21 days. Contact Purchasing at (713) 221-8062. Requires Payment Bond if this involves facilities repair or improvement.]
10. Is this purchase valued at $100,000 or more? Click Here to Select OneRevenue Contract-Questions 11 to 13 Not ApplicableYes - SEE NOTENo
[Note: If Yes, requires Information Sheet for Purchase Requisition Exceeding $100,000. Contact Purchasing at (713) 221-8062. Requires Performance Bond if this involves facilities repair or improvement. LBB report required for IT purchases (AM # 03.A.05 paragraph 7.6]
11. Does the contract include language for Alternative Dispute Resolution[1]? Click Here to Select OneRevenue Contract-Questions 12 - 13 Not ApplicableGrant Related Contract - Skip to 13Interagency Arrangement - Not ApplicableInsurance - Questions 12 - 13 Not ApplicableYesNo - SEE NOTE
[Note: If No, Be sure the Alternative Dispute Resolution Clause form OGC-S-99-24 is attached to your contract.]
12. Does the contract include language for Child Support[2] certification? Click Here to Select OneRevenue Contract - Question 13 Not ApplicableGrant Related Contract - Not ApplicableInteragency Arrangement - Not ApplicableInsurance - Question 13 Not ApplicableYesNo - SEE NOTE
[Note: If No, attach Child Support Certification, form (OGC-S-99-25).]
13. Does the contract involve the purchase of hardware, software, firmware or computer component acquisition using State Appropriated Funds? Click Here to Select OneYes - SEE NOTENo
[Note: If Yes, attach Technology Access Clause, form S-99-26)]
[1] The Alternative Dispute Resolution clause must be added to the following contracts if they involve the expenditure of University funds:
General Agreement (S-98-5), Performer Agreement (S-98-8), Independent Contractor Agreement (S-98-7), and Consulting Agreement (S-98-6)
[2] The contracts listed above under footnote 1 already contain language for Child Support certification and.