FACILITIES
Request for Vice Chancellor Approval for
EMERGENCY AUTHORIZATION
The following is being provided in accordance Minnesota Statutes 136F.581,
Subd. 1; 16C.05, Subd. 2a; and 16C.10, Subd. 2.
1. CONTRACT ADMINISTRATOR/REQUESTOR:
Name: ____________________________
Institution: _________________________
Email: ____________________________
Phone: ____________________________
Project Title: ___________________________________________________________________
2. DATE OF REQUEST:____________________
3. EMERGENCY TYPE:
Check all that apply - at least one is required
□ Threat to public health
□ Threat to public welfare
□ Threat to public safety
□ Threatens the functioning of College or University
□ Threatens protection of College’s or University’s property
□ Threatens health or safety of people at College or University
4. DESCRIBE THE EMERGENCY, HOW IT MEETS THE ABOVE CRITERIA, AND THE
CIRCUMSTANCES LEADING TO THE EMERGENCY:
______________________________________________________________________________
5. DESCRIPTION OF REQUIRED EMERGENCY WORK:
______________________________________________________________________________
APPROVED: _____________
OR
DISAPPROVED: ____________
BY: __________________________________
Vice Chancellor - Chief Financial Officer
DATE:_________________________________
REASON FOR DISAPPROVAL:___________________________________________
______________________________________________________________________
Original form will be retained by the Finance Division and a copy returned to the requestor.
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FACILITIES
INSTRUCTIONS for
Request for Vice Chancellor Approval for
EMERGENCY AUTHORIZATION
The following is being provided in accordance Minnesota Statutes 136F.581,
Subd. 1; 16C.05, Subd. 2a; and 16C.10, Subd. 2.
1. CONTRACT ADMINISTRATOR/REQUESTOR:
 Please indicate the employee name requesting approval for the purchase or contract, Institution
name and location, employee’s email address and phone number. Provide a brief title for the
project. Note that requestor must have authority to sign contract or purchase order.
2. DATE OF REQUEST:
 List the date of the request.
3. EMERGENCY TYPE:
 Indicate type of emergency as defined by Minnesota Statute 16C.10.
4. DESCRIBE THE EMERGENCY, HOW IT MEETS THE ABOVE CRITERIA AND THE
CIRCUMSTANCES LEADING TO THE EMERGENCY:
 Describe the extent of the emergency
 Detail how it meets the criteria identified in item #3
 Describe the circumstances leading to the emergency
Attach additional sheet if needed.
5. DESCRIPTION OF EMERGENCY WORK:
 Describe work scope that is needed to address the emergency identified in item #4. Attach
additional sheet if needed.
6. PROCESSING THIS REQUEST FOR VICE CHANCELLOR-FINANCE APPROVAL:
 Please send this request form to OOC Program Manager to initiate the processing of the form.
Listing of Program Managers and assigned campuses is available at
http://www.finance.mnscu.edu/facilities/design-construction/responsibilities/index.html. If approved
by Vice Chancellor, a signed copy will be returned in an electronic format within 3 business days.
NOTE:
 If work begins prior to executing purchase order or contract, requestor is responsible to execute as
soon as possible.
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