1995-08-22_GENERAL DOCUMENTS - C1981048 (2)

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STATE OF COLORADO CONTRACT ROUTING/DOCUMENTATION FORM 11 SECTION 1 CONTRAC INFORMATION/ENCUMBRANCE REQUEST AGENCY NA E ,/ COFRS AGENCY ID(ALPHA) DIVISION OR PROGRAM(for contract review and billing purposes) ROUTING NUMBER (Fiscal Year) (Corwact Number) (Optional) AMENDS ROUTING NUMBER NUMBER OF COPIES ATTACHED RETURN CONTRACT TO �� l I j PHONE FAX AGENCY/DIVISION PROGRAK CONTACT PHONE . � f 7/P 4 Ililll AGENCY ENCUMBRANCECONT,ACT PHONE FAX CONTRACT INFORMATION Statewide Master Contract Log (SMCL) Type I �r Multi-Year Contract ❑Yes ❑No ❑Delegated Contract ❑Non-Delegated Col I ntract MYC End Date ❑Original Contract ❑Amendment ❑"Change/Orde//r ❑ Supplement ❑ Lease Vendor Name (As Entered on Vendor File) I ..t. 1 Vendor Code Contract Encumbrance Amount$ r If Amendment, Change Order, or Supplement, is this an...❑ Increase OR ❑ Decrease Appropriation Information: ❑ Long Bill ❑ Special Bill State Fiscal Year Bill Number Comments: (For DOAC use only) SECTION 2 METHOD OF PROCUREMENT ❑ Formal RFP ❑ Informal RFP ❑ Sealed Bid RFP/Bid Number ❑ Sole Source ❑ Emergency ❑ Special Circumstance ❑ Refer to Pre-Approved Justification Attached ❑Other(Identify) Approval is dependent upon adherence to State Procurement Rules. Failure to reference the RFP/Bid number or to include a re-approved justification for Sole Source, Emergency,or Special Circumstance procurement will cause delays in obtaining a contract approval. SECTION 3 ROUTING SEQUENCE _ Agency Release Date Signature DIVISION OF PURCHASING (DATE RECEIVED SIGNATURE DATE FORWARDED SIGNATURE RETURNED TO DIVISION OF PURCHASING DEPARTMENT OF ADMINISTRATION DEPARTMENT OF PERSONNEL RETURNED TO DEPARTMENT OF PERSONNEL STATE BUILDINGS DIVISION ATTORNEY GENERAL RETURNED TO THE ATTORNEY GENERAL l DIVISION OF ACCOUNTS AND CONTROL RETURNED TO ACCOUNTS AND CONTROL AGENCY OTHER r's Fiscal Rules(Chapter 3);the Colorado Procurement code and rules and the De partment of Personnel Statutes and rules.The above routing blocks NOTE: Contracts must be in compliance with the State Controlle 11 must indicate the numeric routing sequence for the attached contract.The Agency Release Date and Signature are to be completed by the agency representative initiating the CONTRACT/ROUTING DOCUMENTATION FORM. ORIGINAL CONTRACTS and AMENDMENTS: ATTACH the white and yellow copies to the contractor amendment being routed.SEND the goldenrod copy to the agency accounting office.RETAIN the pink copy for your records. 395-53-07-0085(191 12/92)