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  • Capital Request and Justification Form

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    This document is a capital expenditure request and justification form. It requests information such as the department and division making the request, priority level, description and estimated costs of equipment or land/building purchases/improvements. It requires signatures of approval from the department head, director of procurement, and senior VP of institutional administration. Instructions are provided on how to complete the form and define terms such as equipment, estimated costs, existing equipment disposition, and land/building purchases.

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    This document is a capital expenditure request and justification form. It requests information such as the department and division making the request, priority level, description and estimated costs of equipment or land/building purchases/improvements. It requires signatures of approval from the department head, director of procurement, and senior VP of institutional administration. Instructions are provided on how to complete the form and define terms such as equipment, estimated costs, existing equipment disposition, and land/building purchases.

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    © All Rights Reserved
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    244 views2 pages

    Capital Request and Justification Form

    Uploaded by

    Kishan
    This document is a capital expenditure request and justification form. It requests information such as the department and division making the request, priority level, description and estimated costs of equipment or land/building purchases/improvements. It requires signatures of approval from the department head, director of procurement, and senior VP of institutional administration. Instructions are provided on how to complete the form and define terms such as equipment, estimated costs, existing equipment disposition, and land/building purchases.

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    © All Rights Reserved
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    Capital Request and Justification Form

    Department:
    Division: Priority: Upgrade

    Capital Expenditure Requested:


    (1) Equipment (Describe):

    A. Estimated Cost of Equipment


    B. Has the Vendor submitted an estimate of cost? No
    (If yes, attach a copy of estimate.)
    C. Does this Equipment replace any other Equipment? No
    D. If yes, what is the proposed disposition of the old Equipment? Surplus
    E. Age of old Equipment Years

    (2) Land Purchase, Building Addition, or Building Improvement (Describe):

    A. Estimated Cost of Land or Building


    B. Has the Vendor submitted an estimate of cost? No
    (If yes, attach a copy of estimate to Request form.)

    Justification for Above Request:

    Requested by: Date:


    (Name and Title)

    Approved by: Date:


    (Department Head or Dean Signature)

    Approved by: Date:


    (Director of Procurement)

    Approved by: Date:


    (Senior Vice President of Institutional Administration)

    For Internal Use Only: Date:


    Capital or Contingency?
    Project Number Assigned:

    Capital Account Number Assigned:

    Email Notification Sent To:


    Instructions: Capital Expenditure Request and
    Justification Form

    DEPARTMENT Name of the specific department making the request.

    DIVISION Name of department’s organizational location:


     Academic Administration
     Institutional Administration
     Institutional Relations

    IMPORTANT! Budget Managers are expected to anticipate needs for their departments prior to the
    annual budget approval process. Future capital needs should be planned for and
    incorporated during the annual budget request.

    PRIORITY 1: CRITICAL – Required to prevent a critical reduction in service, operating


    efficiency, economy, and/or safety; to protect valuable property; and/or comply with
    insurance or code requirements.

    PRIORITY 2: UPGRADE – Required for significant upgrade in service, operating efficiency,


    economy and/or safety of current operations.

    PRIORITY 3: DESIRABLE – Required to introduce desirable, but optional new service, program,
    faculty or staff, or to make small improvements in operating efficiency, economy
    and/or safety.

    “CAPITAL EXPENDITURE REQUESTED” EXPLANATION


    (1) How is equipment defined?
    Any item(s) not affixed to a building or land. Includes computer items, vehicles, furniture,
    etc.
    A. Estimated cost for project
    Total cost of acquiring and placing the equipment in service, including shipping,
    installation, consulting, training and other direct costs.
    B. Was an estimate of cost submitted by a vendor?
    Although helpful, quotes are not required as a part of the request for capital expenditure
    process. If the request is approved, the following schedule should be adhered to for
    securing quotes.
     $2,500 or above requires three (3) quotes
     $10,000+ requires the RFP process
    E. What is the proposed disposition of the old machine?
    If the old equipment is traded in to receive a lower price on the purchase of new
    equipment check "Trade" box. If not check "Surplus" box and contact Central Stores for
    removal.

    (2) Land Purchase, Building Addition, or Major Improvement


    Includes any new independent, habitable structures, additions or renovations of
    existing habitable structures, and furnishings and equipment which are permanently
    affixed to a habitable structure.
    A. Estimated cost for project
    Include shipping, installation, consulting and all other costs directly associated
    with acquiring the improvement and placing it in service.
    B. Was an estimate of cost submitted by a vendor?
    See explanation on (1) Equipment.

    Routing and approval process: Send request, signed by department budget manager, along with
    any explanatory attachments to: Office of Procurement
    Sampey Hall, Room 4103

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