Contract Routing Submission Form

The Contract Routing Submission Form is to be used for all Contracts/Agreements/Terms & Conditions/Memorandums of Understanding (MOU) and Licenses. All new contracts (monetary or not), renewals, and amendments, are to be submitted prior to the event or service to ensure all necessary approvals are captured. The Office of Legal Affairs reviews the agreement to ensure UWG is compliant with all state and federal statutes and regulations, and all USG policies. Contracts are to be submitted prior to the start of the payment and signature process.


Our Contract Management WorkWest site has information on the routing process, forms to use, the Delegation Authority Matrix, and more.


For the complete Policy and Procedure on Contract Management, see UWG PL 1007.



For any contract related inquiries, email contracts@westga.edu for assistance.

UWG Contact Information

(Include the contact information for the person submitting this form and the contract owner. The Office of Legal Affairs and/or any other approving departments will use this contact information if they have questions or need further information.)

(List the Company/Individual name and type of form used or services provided. i.e. Wolfie Express Pressuring Washing; Wolfie High School Prom FUA; Guest Speaker - Wolfie SEA; etc.)

(To list more than one, separate the names with a comma.)

(To list more than one, separate the email addresses with a comma.)

Contract Information

(Select what type of contract this is. This is a multi-selection question, select all that apply. If the type of contract you are submitting is not listed, select Other and describe the contract in the next field.)

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NOTE:

ITS will enter all Software, Software Maintenance, and Subscription orders in ePro. Once your contract has been approved, you will be notified to execute (sign) the contract. Once all signatures are on the contract and the contract has been emailed to contracts@westga.edu ITS will place the order for you.


PLEASE DO NOT ENTER ORDERS FOR SOFTWARE, SOFTWARE MAINTENANCE, OR SUBSCRIPTIONS UNLESS ITS HAS REQUESTED YOU TO DO SO.

If applicable, what was the cost of the software/subscription last year?

The date which the contract becomes effective

The date which the contract terminates

Number of users licensed for the software or subscription

(If the above list did not include the type of contract your are trying to submit, please list details here.)

ITS will process all orders for Software and Subscriptions. A chart string is required for the purchase.

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(Briefly describe the purpose/agreement details and/or services included in the contract.)

(Annual Contract, Month to Month, etc.)

If Renewal or Amendment is selected attach the original or most recent contract.

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Are Grant Funds involved?

(Example: Department Name, Project Name, Grant Name, Fund Source Name (E&G, Student Fees, Auxiliary, etc.))

(The total dollar value of the contract.)

Payment Type*
Will Services/Goods be Purchased?*

(If Yes, provide a brief description of the services or goods you are trying to purchase in the next field.)

(Brief description of the services or goods you are trying to purchase)

Company/Individual's Information

Contract Data Sharing Information

(Does the contract include any type of data sharing information related to Proprietary Information, Export-Controlled information, Payment Collection Information,etc.?)

Will you be disclosing and/or receiving Proprietary Information?*

(Proprietary Information means Confidential or knowledge or data concerning UWG’s/Company's businesses, including strategies, operations, financial affairs, organizational matters, personnel matters, budgets, business plans, marketing plans, studies, policies, procedures, products, ideas, processes, software systems, trade secrets, technical know-hows, etc. This includes information related to FERPA and HIPAA.)

(Provide a short description of the project leaving out any confidential or proprietary information.)

Are you going to disclose and/or receive Export-Controlled Information?

(Export-Controlled Information or material is any information or material that cannot be released to foreign nationals or representatives of a foreign entity, without first obtaining approval.)

Will any HIPAA information be shared as part of the contract?

(The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law that required the creation of national standards to protect sensitive patient health information from being disclosed without the patient's consent or knowledge.)

Will any FERPA information be shared as part of the contract?

(The Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. § 1232g; 34 CFR Part 99) is a Federal law that protects the privacy of student education records.)

Additional Considerations

Is this for an Event where an External 3rd Third Party will be providing Food on UWG Campus?

(Student Event, Camps/Conference, Food Truck Event, etc.)

Does the contract involve the use of UWG Logos or proprietary marks?*
Will this software/service be utilized to process Credit Card payments?*

(If Yes, you are indicating that the software/system will be used to accept payments for or on behalf of UWG. and may require additional review and documentation to be provided to the UWG PCI (Payment Card Industry) Department.)

Will any services be provided on the UWG Campus as part of this contract?*

(If Yes, a Services on Campus Addendum will need to be completed prior to services being performed.)

If Company is providing services on campus, have they provided a Certificate of Insurance?*

(If Yes, attach it with the Services on Campus Addendum and the contract.)

Will any services involve Student Interaction as part of this contract?*
Does the contract involve Study Abroad (International) or Study Away (Domestic)?
Will the Total Cost of the purchase (non-construction related) be more than $24,999.99?*
Has funding been encumbered on a Purchase Order?

(If this is a purchase of goods/services, a requisition will need to be entered in ePro.)

Will items be offered for resale as a result of this contract?
If Company is providing services of $2,500.00 or more have they provided an executed, notarized eVerify Affidavit?*

(If Yes, attach it, the COI, and the Services on Campus Addendum with your contract. If the Company is an iIndividual with no other employees, a copy of their Driver’s License can be accepted in lieu of a notarized affidavit.eVerify is a Federal Law and Mandated by the State of Georgia. eVerify is a web-based system that allows enrolled employers to confirm the eligibility of their employees to work in the United States. If you hold a public contract, which is a contract with a city, county, the state, a school board, etc. a notarized eVerify affidavit is required to be provided.)

Submitter Acknowledgement

I HAVE COMPLETED THIS FORM TO THE BEST OF MY KNOWLEDGE AND I WILL INDICATE TO THE OFFICE OF LEGAL AFFAIRS ANY OBJECTIONS I MAY HAVE TO THE PROVISIONS OF THE AGREEMENT.


YOU WILL AUTOMATICALLY RECEIVE AN EMAIL COPY OF YOUR SUBMISSION AFTER SUBMITTING THIS FORM.

Attach the contract along with any applicable supporting documentation including any terms & conditions, privacy policies, etc.


Incomplete submissions may result in processing delays.

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