Form No. VCB 1.20
(October 2003, Rev. 2015)
Clear Form
Special Project Number:
UNCW SPECIAL PROJECT REQUEST
(For Facility Modifications and Additions)
State CI Code Project:
Project Management #:
Yes
No
SECTION I – Project Description / Request for Estimate
Building / Facility:
Room:
Project Title: (Attach sketch or
layout and narrative description.)
Comments/Restrictions:
Reason for Required Completion Date:
Required Completion Date:
Requesting Department:
Ext.
Project Representative:
Approval:
Approval to Request Estimate:
______________________________________________________
_______________________________________________________________
Print Requesting Department Head
Print Requesting Dean or Assoc./Assist. Vice Chancellor
______________________________________________________
Date
Signature Requesting Department Head
_______________________________________________________________
Signature Requesting Dean or Assoc./Assist. V ice Chancellor
Date
Forward to Project Management for Processing, Attn: Justin Smith, Facilities Rm 173, Box 5910
SECTION II – Project Estimates
Project Management Recommendation:
Assigned Department:
Estimator:
Can Completion Date Be Met?
Yes
Process Via New Special Project Account
Process Via General Use Special Project Account
Date:
Estimated Number of Days to Complete Project After VCBA
Approval: (See accompanying letter.)
No
Estimate Effective Until:
Estimated Total Project Cost:
$
Forward to the Project Representative
SECTION III – Project Approval by Requesting Division
Are funds available to support this project?
Yes, Account #_________________________________ Funding Available: $_____________________
No
Comments: _______________________________________________________________________________________________________________________________
Departmental Review:
Authorization to Continue:
____________________________________________________
_________________________________________________________________
Requesting Dept. Head Signature
Requesting Vice Chancellor Signature
Date
Date
Forward to the Associate VCBA-Facilities, Attn: Janet Alexander, Facilities Rm 104, Box 5910
SECTION IV – Business Affairs
Project Assignment:
Comments (Completion date and other): __________________________________________
______________________________________________________________________________
Authorization:
Project Method:
ProjectManagement
Construction Method
Construction Svcs.
Procurement Method
Other______________________________________________
_____________________________________________________________
Associate VCBA-Facilities Signature
Date
Amount Funded: $________________________ Department: _______________________________________________ Account #: _______________________
Funding Approved: ______________________________________________________
Associate VCBA-Finance Signature
Forward to the Budget Office
Date
SECTION V – Budget Office
Charge project to this account number: ___________________________________
Copies to VCBA
Forward original to Project Management, Attn: Justin Smith, Facilities Rm 173, Box 5910
SECTION VI – Project Schedule / Completion
Start Date: ________________Completion Date: _______________
Final Total Project Cost: $__________________
________________________________________________
_________________________________
_________________________
Facilities Project Mgr. Signature
Dir. Facilities Admin. Signature
Director Signature
Date
Forward to the VCBA
Date
Date