CAMPUS NAME: CURRENT DATE: For use with Policy 804 Equipment and Personal Property Lease REQUEST FOR CHANCELLOR APPROVAL, from_____________________________________________ (institution name) 1. CLASSIFICATION: (circle one) (circle one) CAPITAL NEW LEASE or or 2. LEASE TERM: Beginning date (M/D/Y) ___________________ End date (M/D/Y) ____________________ OPERATING LEASE RENEWAL If renewal, what is existing lease term? Option to renew, if so, renewal terms 3. PAYMENTS: Rate of Interest: ____________________ Payment: fixed or variable Each Payment includes $_________ (principal) and $_________ (interest) for total payment of $____________ made every __________months/year Total number of Payments to be made during Lease Term: ________ Total sum to be paid during Lease Term: $_________________ Administrative or other costs of $________________________(describe) Source of Funds_______________________________________ 4. SUBJECT PROPERTY: 1. Vendor Name, Address and Contact Information: 2. Description of property (include model or serial number and manufacturer): 3. Location of Property: 4. Estimated Value of Property at start of Lease: 5. Intended use of property: 6. OTHER COSTS (estimated operating, utilities, maintenance, etc.) and SOURCES OF FUNDING: 7. Other project related debt, if any. 8. EXPLANATION OF NEED FOR LEASED EQUIPMENT OR PERSONAL PROPERTY, including discussion about consistency with Campus Strategic Plan and Budget 9. IF CAPITAL LEASE: 1. Description of property to be transferred to state or institution: 2. Date of transfer and projected future use: 3. If applicable, description of improvements to be paid for with public funds and explanation regarding necessity of improvements: 4. If applicable, estimated project timeline and completion date for capital lease improvements: Attach current list of institutional operating and capital lease debt Attach written analysis per 804, #6 (lease vs. buy), as appropriate 10. INSTITUTION CONTACT INFORMATION: contact name, phone number and email address: ________________________________________________________________________ ________________________________________________________________________