CAMPUS NAME: CURRENT DATE: (institution name)

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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:
________________________________________________________________________
________________________________________________________________________
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