Cancel Contract Template - DOC by cry21048

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									(Please type or Print)                                   REQUEST FOR CONTRACT
                                                              (Including Grants and related Proposals)
     District            Cuyamaca      Grossmont                                                                               New Contract No.
Date                                                                                                                           New Proposal No.
Initiator                                                                     Phone                                            New Master Fixed Form Agreement
Title                                                                                                                          Amend Contract No.
Division/Department                                                                                                            Renew Contract No.
Site Contact Person                                                           Phone                                            Cancel Contract No.

CONTRACTOR:
Address
City/State/Zip                                                                                   TIN/SSN
Phone                                          Fax                                               Contact

        INCOME CONTRACT (Including Grants and Proposals)
SOURCE                                               BUDGET EXPENSE DETAIL                                 TOTAL
        Grant                                        1000:                                                 Total Object 1000-7000 $
        Specify                                      2000:                                                 Indirect Costs         $
        Participant                                  3000:                                                 Total Contract cost    $
        Contract Education                           4000:
        General Fund                                 5000:                                                 District Match                       $
        State Program                                6000:                                                 Notes:
        Other                                        7000:
                                                     Total:

        EXPENDITURE ONLY CONTRACT                                                                           IFAS ENCUMBRANCE No.                    .
        CHECK ALL BOXES THAT APPLY AND ATTACH REQUIRED DOCUMENTS
            Construction             Lease/Rental                     Maintenance                 Workshop/Seminar
            Fixed Form Master        License                          Professional Service        Other

CONTRACT INFORMATION
A.      Contract Period: From:                           to                       inclusive.
B.      Cost: $                          /     Day            Month        Year         Other
        Delivery: $                  Installation: $                                               Total Cost for Contract Period: $
C.      Invoiced:          Monthly     Quarterly              Yearly          Contract Period             Other (specify)
D.      Budget Detail: Account #                                                             Account #

SPECIFIC DESCRIPTION, PURPOSE, AND JUSTIFICATION/BACKGROUND                                                    (Describe each in full; use separate sheet if needed.)




APPROVALS                                                                                                   FOR DISTRICT OFFICE USE ONLY:
                                                                                                            Construction Projects
Initiator                                                                Date                               Facilities Review/Approval
Vice President/Executive Dean                                            Date                               Date
President/Vice Chancellor                                                Date                                Requires Certificate of Insurance
Business Office/Budget                                                   Date                                  Certificate Received
Vice Chancellor–Business Services                                        Date                                Approved  Ratified
CO01.F1 3/02                                                                                                   by Governing Board on:

								
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