Short Term Limited Scope Service Agreement And Express Invoice Template - California State University

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Short Term Limited Scope
Service Agreement and Express Invoice
 
            (Use only for services up to $5000 provided by an individual/sole proprietor)
 
For use for the following services only, check appropriate box: 
Accompanists
Art Model
Guest Artist
Honorarium
Sign Language Interpreter
Guest Lecturer
Notetaker
Payee Information:           
Name:   ___________________________________________ 
                                                           Address:___________________________________________ 
 
                                                           City, State, Zip: _____________________________________
On File
Attached
    
Vendor Data Record Form: 
TAX PAYOR ID #________________________ 
 
 
Department Name:    _________________________________ 
Check Delivery Instructions:
Department Contact: _________________________________ 
 
Contact Phone #:        _________________________________     
Mail to Payee    
Pick up in AP, date needed_______ 
 
Account 
Fund 
Dept ID 
Program  
Class 
Project/Grant 
Total Due 
 
 
 
 
 
 
Description of Service:  
Provide dates, hours, detail of service, including in the description any equipment, furniture or other 
 
pertinent information that fully describes the service being provided.
__________________________________________________________________________________________________ 
_____________________________________________________________________________ 
__________________________________________________________________________________________________ 
 
RELEASE OF LIABILITY:  
For the aforementioned services, I assume all liability for any damage or injuries accruing 
thereof,  and that further,  in consideration for being allowed to provide this service hereafter referred to as the 
Activity, I release from liability and waive my right to sue the State of California, the Trustees of the California State 
University, which own and operate California State University, East Bay and their employees, officers, volunteers and 
agents (collectively “University”) from any and all claims, including  illness , injuries, death or economic loss that I may 
suffer because of my involvement in this Activity, including any travel to and from the Activity. I will hold the 
University harmless from any and all claims, loss or damage to my personal property, liabilities and costs, including 
attorney’s fees, as a result of my involvement in this Activity.  It is further agreed that this waiver, release and 
assumption of risk is to be binding on my heirs and assigns.   
 
I understand that this document is written to be as broad and inclusive as legally permitted by the State of California. I 
agree that if any portion is held invalid or unenforceable, I will continue to be bound by the remaining terms. 
 
Name:_________________________________________________ Date: ________________  
 
Signature: ___________________________________________________________________
 
This is the sole binding contract for this service with the University; other contractual documents will not be accepted. 
 
I certify that the Contractor is acting in an independent capacity and not as an officer or employee or agent of the State of California. I also certify that the above 
services have been satisfactorily performed or are to be performed as stated. 
 
____________________________________________     ____________        
 
Purchasing Review ___________  Date_______ 
Approval of Department Chair or Administrative Unit   Date
 
  
 
 
 
 
 
 
 
 
 
 
 
 
(Revised 6‐20‐12) 
 

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