Intake Form- Independent Contractor Agreements (ICA) & Vendor Agreements (For ASBs ONLY)

Intake Form- Independent Contractor Agreements (ICA) & Vendor Agreements (For ASBs ONLY)

This Agreement is to be utilized only by ASBs who are utilizing their own funding to pay for the services and it doesn't exceed $10,000.00 for the Fiscal Year.

Intake Form Deadlines 2024-2025

GSA / Vendor Agreement (ASB Funds Only)*

Have these services started?*

Select

Start Date of Services*

Agreement Term is the date the services shall commence.

End Date of Services*

Agreement Term is the date the services shall end on.

Requestor Name*

Point of Contact if there are questions related to this intake form. It is important this information is complete and accurate.

Requestor Title*

Requestor Email*

Work email address (sandi.net)

Requestor Phone*

Phone

Department ID*

Please use 4 digits.

School, Department, Location of Work*

This is the site on which the work will occur. If multiple locations, state "District-wide"

District Contract Representative (DCR) Name*

This is the District employee that will supervise the services being performed (Name, Title, Email and Phone).

DCR Title*

DCR Address*

Please include Address, City, State, and Zip.

CR Email*

CR Phone*

Phone

Agreement with (Company Name) Legal Name*

This is the legal name of the company or person performing services and matched the W9 form.

Company Point of Contact Name*

Person signing the contract

Company's Point of Contact Title*

Company Email*

Company Phone*

Phone

Company Address*

Please include Address, City, State, and Zip.

Total Compensation or NTE Amount*

This is the total cost of services. NTE (Not-to-Exceed)

Attach all completed forms from DocuSign.*

https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=be49bebb-8a30-4305-a8fe-fcbf0b890d0a&env=na3&acct=8b9bf4f5-3d6a-42eb-81e7-5d521cb9b195&v=2 1. DocuSign ICA Agreement 2. Proposal 3. W9

Drag and drop files here or

Important Notes to Contract Specialist:*

If there are contracts that need a District signature, state that here with the date signatures are needed.

Authorized Approver*

Choose your Area Superintendent, Director, or Chief.

Select

Authorized Approver's Title, Email, and Phone No.*

This information is needed for the Board Agenda.

Send me a copy of my responses

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