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<br />STATE OFCO,LORjlDl), "
<br />Ct.... "ACT ROUTING / DOCUMENTATION Fl".
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<br />1~f:SECiFjQN,)jRil
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<br />CONTRACT INfORMATION/; ENClJMBRANCE REQUEST
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<br />. I cOFR.f;; AGENCY 10 (ALPHA) .:' .
<br />I ' ' P{)r~ "
<br />I (Optiina') I AMENDS ROUTING NUMBER
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<br />I DIVISION OR PROGRAM (lorcontracl reVIeW aro::l billing purpos&S)"~ .
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<br />I NUMBER O:~OPIES ATTACHED
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<br />-=0
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<br />AGENCY NAME
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<br />ROUTI~,G NUMBER .- (~~~I Year),
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<br />RETURN CONTRACT TO
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<br />AGENC:I.OiVIS1?N PR?GRAM CONTACT
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<br />AGENCY ENCUMBRANCE CONTACT
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<br />~II (~r;Nr~r)1 .
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<br />PHONE
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<br />FAX
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<br />PHONE
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<br />PHONE
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<br />FAX
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<br />~I { .', 7' I
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<br />CONTRACT INFORMATION,
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<br />Statewide Master Contract Log (SMCL) Type '. Multi-Year Contract 0 Yes 0 No
<br />o DelegatedContract..-Q.Non~Delegated.Contrad..- _.__d,~ ',,-~,';'-M~G.End.Date-.. . --,...... .,.._."._
<br />o Original Contract @Amendmerit 0 Change/Order 0 Supplement" 0 Lease ....".." ,. -, --
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<br />Vendor Name (As Entered on VendorFile) ,.~." '0:"" ,. n. I j ;.1.1 (, Vendor Code ~ (I, ~ li',<n ,;-
<br />Contract Encumbrance Amount $ /,/..- /"' ') 77 N",i,'/~;'" ,?,F'i
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<br />If Amendment, Change Order, or Supplement, is thi,s an.., 0 Increase OR [;}-Decrease
<br />Appropriation Information:'bL6ng ~iii" D's~~6i~1 Bill State Fisc;{YeQ;
<br />Comments:
<br />(For DOAC use only)
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<br />'Bill Number
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<br />I F;i"..,;(,,;.,~>>i':> "'#W;":<AA,:,,~C\:iW~
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<br />METHOD OF PROCUREMENT
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<br />o Formal RFP 0 Informal RFP '. 0 Sealed Bid RFP/Bid Number
<br />o Sole Source 0 Emergency 0 Special Circumstance
<br />LfR~ie~to Pre-Appro~-ed Justiiication Attached 0 Other (Identify)
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<br />Approval is dependent upon adherence to State Procurement Rules. Failure to reference the RFP/Bid number or to include a pre-approved justification for'
<br />Sole Source. Emergency, or Sped.al Circumstance procurement will cause delays in obtaining a contract approval. .
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<br />IIt;gsEcn6i.3@:1
<br />',,<'<,"',;''''''- ~":",-,:~"",;;:"":,, ."'.,,
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<br />Agency Release Date
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<br />ROUTING SEQUENCE
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<br />Signature f'-;:;':,
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<br />SIGNATURE"
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<br />,DIVISION.OF- F.!URCf.lASING. "
<br />RETURNED TO DIVISION OF PURCHASING
<br />DEPARTMENT OF ADMINISTRATION
<br />DEPARTMENT OF PERSONNEL
<br />RETURNED TO DEPARTMENT OF PERSONNEL
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<br />STATE BUILDINGS DIVISION
<br />r-:o ATTORNEY GENERAL
<br />RETURNED TO THE ATTORNEY GENERAL
<br />I '" DIVISION OF ACCOUNTS AND CONTROL ,'..
<br />'RETURNED TO ACCOUNTS AND CONTROL I j'\
<br />AGENCY , , 'f / A /; IIA ,/
<br />I QT.hIER ~c.1 ~ I, ".c..1, /,1/;/,;-"" 'lUFi;<.V,:7#t~:<,.,
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<br />NOTE: Contracts must be in compliancs rith the State Controller's Fiscal Rules (Chapter 3); the Colorado Procurement code and rules, and the Department of Personnel Statutes and rules. The above routing blocks
<br />must indicate the numeric routil'lll seQuence for the attached contract. The Agency Release Dale and Signature are to be completed by the agency representative initiating the CONTRACT/ROUTING
<br />OOCUMENTATIONFORM. '
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<br />DATE RECEIVED
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<br />DATE FORWARDED
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<br />SIGNATURE
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<br />ORIGINAL CONTRACTS and AMENDMENTS: ATTACH the white and yellow copies to the contract or amendment being routed. SEND the goldenrod copy to the agency accounting office. RETAIN the pink copy tor
<br />your records.
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<br />395-53-07.0085 (R 12/92)
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