Form Bao-Pur403b - Miscellaneous Personal Property Loan Agreement
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2MISCELLANEOUS PERSONAL PROPERTY LOAN AGREEMENT
Contract # _____________________
This agreement is entered into on the latest date accompanying the signatures below, by and between
___________________________________________________, hereinafter called the LENDER, and the State of
Oregon, acting by and through the State Board of Higher Education on behalf of Portland State University for the
following department, ___________________________, hereinafter called PSU.
Whereas, the LENDER will loan certain items listed below, and PSU will use, exhibit, or consider the
items, the LENDER agrees to lend during the period ___________________, 20___, through ________
____________, 20____, inclusive, the items listed below. The terms on the reverse of this contract are made a part
of this agreement.
LOANED ITEMS
*CONDITION
INVENTORY
DESCRIPTION
VALUE
ON ARRIVAL
NUMBER
PSU FACULTY/STAFF INDIVIDUAL RESPONSIBLE FOR LOANED PROPERTY:
NAME
SIGNATURE _________________________________________
DEPARTMENT
EXTENSION
DATE ___________________
*ITEMS EXAMINED BY
TITLE _______________________________
ACCOUNT TO BE INVENTORIED
DATE EXAMINED ___________________
:
IN WITNESS WHEREOF, BOTH PARTIES HAVE EXECUTED THIS AGREEMENT AS OF THE LAST DAY AND YEAR WRITTEN BELOW
LENDER _________________________________
STATE OF OREGON ACTING BY AND
THROUGH THE STATE BOARD OF HIGHER
SIGNATURE ______________________________
EDUCATION ON BEHALF OF PORTLAND
STATE UNIVERSITY
TITLE _____________________ DATE________
BY _______________________________________
Contract Officer
Date
ADDRESS ________________________________
and approves Insurance Fund Coverage
Subject to conditions on reverse:
________________________________
____(yes)
____(no)
________________________________
Telephone Number __________________________
BAO-PUR403b (revised 02/06)
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