index number: Section A: contract information contract type: new contract procurement type: product service type of product or service: service site (if applicable): site street address: city: state: zip code: start date: end date: / check (√) if contract covers contract period: / / / multiple years or contains multiple items, attach contract contract total: $ multi year/ multi site form, and indicate in the UOM cost as Unit of Measure $ “varies”. (UOM)cost: hours occurrences UOM & Number of Increments days months other: contractor contractor of address: record: contractor contractor phone: contact: ( ) - contractor fax: ( ) - ALL contractor NEW AND email: RENEWAL CONTRACTS Section ARE @ REQUIRED B: contractor TO PROVIDE information vendor A CERTIFICATE number: OF LIABILITY INSURANCE AND DESIGNATING THE STATE OF OHIO AS AN ADDITIONAL INSURED AS REFERENCED IN THE TERMS AND CONDITIONS SUPPLEMENTAL CONTRACT TERMS AND CONDITIONS S-13. Section C: government ordering office information agency, board or commission ohio department of transportation (odot) political Subdivision: UNIVERSITY: other: OF EDUCATION: ordering office: ordering office contact:
index number: Section A: contract information contract type: new contract procurement type: product service type of product or service: service site (if applicable): site street address: city: state: zip code: check (√) if contract covers multiple years or contains multiple items, attach contract multi year/ multi site form, and indicate in the UOM cost as “varies”. contract period: start date: / / end date: / / contract total: $ Unit of Measure (UOM)cost: $ UOM & Number of Increments hours occurrences days months other: Section B: contractor information contractor of record: contractor contact: contractor address: contractor phone: ( ) - contractor fax: ( ) - contractor email: @ vendor number: ALL NEW AND RENEWAL CONTRACTS ARE REQUIRED TO PROVIDE A CERTIFICATE OF LIABILITY INSURANCE AND DESIGNATING THE STATE OF OHIO AS AN ADDITIONAL INSURED AS REFERENCED IN THE TERMS AND CONDITIONS SUPPLEMENTAL CONTRACT TERMS AND CONDITIONS S-13. Section C: government ordering office information agency, board or commission ohio department of transportation (odot) political Subdivision: UNIVERSITY: OF EDUCATION: other: ordering office: ordering office contact:
CRP001%20CONTRACT%20APPROVAL%20FORM%20%20(REV%203.09.17).docx