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