Revenue Contract Coversheet And Approval Form - University Of Houston
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1Revenue Contract Coversheet and Approval Form
General Information
UHCL Department:
_____________________________________________________________________________________
Contact Person:
_________________________________Title: _______________________________________________
Campus Mail Code:
________ Telephone: ___________________Email: ________________________________________
Business Coordinator: ___________________________________________
Campus Mail Code:
________ Telephone: ___________________Email: ________________________________________
Summary of Contract Terms
Contract with: _____________________________________________________________________________________________
Federal Tax ID: ____________________________________ Contractor Contact Person: ____________________________
Contractor Address:
_____________________________________________________________________________________
Contractor Phone:
______________________________ Contractor Email: _____________________________________
Contract Description: _______________________________________________ ______________________________________
Provide a clear synopsis of the services/events/etc. that will result by entering into this agreement
Contract Term: Start ________________________________ End __________________________________________________
Total Amount of Contract:
$ _________________________________
Source of Funds
(If multiple cost centers are being utilized, please attach a supplemental page listing the appropriate codes.)
Revenue Cost Center:
Fund__________ Dept ID___________ Prog__________ Proj__________ Acct__________ Amt $___________________
Official Authorized to Sign__________________________________________________________________________________
Identify by name and title, the official authorized to sign the contract on behalf of the University of Houston System pursuant to
SAM, and Board Policies – NOTE the OGC must have a delegation of signature authority on file. (Name & Title)
Certification of University Employee(s) With Responsibility for Ensuring Contract Terms and Conditions are Met
I have read this contract entirely. I am satisfied with its description of the goods and/or services to be provided to the University
(including, for example, warranties, delivery terms, acceptance period, and maintenance terms). I am also satisfied with the
description of the University’s obligations (including, for example, scope of work, payment due dates, late charges, tax,
charges, insurance, and confidentiality requirements) and all other provisions of this contract, except as noted in any
attached memorandum. A memorandum ___ is, ___ is not, (select one) attached. I acknowledge responsibility to ensure that
all good faith efforts are employed in seeing that all terms, conditions and responsibilities of the contract are met.
Name: ______________________________________Signature: _______________________________________ Date: _________________
(Dean, Department Head or designee of area originating the contract who certifies that the requirements listed on agreement are to be met)
Title__________________________________________________________________________________________________________________
Name: _____________________________________Signature: _________________________________________Date: _________________
(UHCL Contract Administration)
Title___________________________________________________________________________________________________________________
Name: _____________________________________Signature: ________________________________________ Date: _________________
(Associate Vice President, Finance or Director, General Accounting)
Title __________________________________________________________________________________________________________________
Name: _____________________________________ Signature: ________________________________________ Date: _________________
(UH Tax Director)
Title __________________________________________________________________________________________________________________
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