The Contract Coordinator shall complete the following information for each section
of the contract prior to forwarding to the Purchasing Department. Each instruction
hereafter contains an example for completing the service contract.

 

1. Insert the full name of the individual or business to be contracted with.

 

1. Contractor Name (Legal Name if Corporation):       ADDICTION PREVENTION MANAGERS, INC.

 

2. Insert the legal address (street / city / state / zip) of the contractor.

 

2. Contractor Address: 15246 Freedom Drive

Contractor City: State: Zip: Baton Rouge LA70801-0123

 

3. Insert the taxpayer identification number of the contractor (Employer Identification
Number or Social Security Number).

 

3. Contractor’s Fed ID or Social Security No.:

72-1234567

 

4.  Insert a complete description of the services to be performed and the objectives
to be met under the contract.

 

A.  When applicable, a description of the reports or other deliverables to be received. 

  

B.  When applicable, a schedule of dates when reports or other deliverables are to
be received.

 

4. Contractor hereby agrees to furnish the following services (if the scope of services is more lengthy than space permits here, it may be attached separately and referenced):   Contractor shall review and evaluate programs offered by the University to foster student and employee awareness on drug and alcohol abuse. Contractor shall submit written recommendations in report form no later then the termination date of the contract.

 

5.   Insert the maximum contract fee to be paid the contractor. If travel and other
reimbursable expenses are to be excluded from the maximum contract fee, then do not
include the estimated amount in the maximum contract fee. Refer to instruction 7 to establish the maximum amount contractor will be paid for travel and other reimbursable
expenses.

 

5. Maximum Contract Amount for Services Described in Item 4:

$2,400.00

Note: The above example reflects maximum contract fee is for services only, or that
travel, lodging, meals and other expenses are included in the maximum contract fee.

 

6.   Mark the appropriate line (one line only) concerning the schedule of payment
agreed upon for progress or completion of services. Complete the appropriate line
(one line only) reflecting the number of payments and the dollar amount per installment
or explain the method by which payment will be determined.

 

6. If progress and/or completion to the reasonable satisfaction of the State is obtained, payments are scheduled as follows (mark and complete one payable only): [ X ] Payable in (1) installment of $2,400.00 upon completion   [ X ] Payable in (10) monthly installments of $240.00 per month   [ X ] Payable in multiple installments of $1,200.00 / $600.00 / $600.00   [ X ] Payable as follows: Forty dollars ($40.00) per hour with a two (2) hour min. per visit not to exceed the maximum contract fee.

 

NOTE: All lines completed above are for example only.

 

7. Mark the appropriate block (one block only) concerning travel and other reimbursable
expenses that may or may not be part of the contract.

 

7. Travel and other reimbursable expenses (mark one block only): [ ] A. Not applicable to contract. Maximum contract amount is for services only.   [ ] B. The maximum contract amount includes travel, lodging, meals and other expenses.

 

NOTE: When travel and other reimbursable expenses are to be reimbursed from the maximum
contract fee, State Travel Regulations PPM 49 shall be followed to reimburse contractor.
See Attachment A – Travel, Lodging, Meals and Other Expenses.

 

8. Insert the name and title of the individual to monitor the contract and approve
all payments in connection with the contract

 

8. Payment will be made only on the approval of (name and title):   Dr. Lynn Evans, Director of Health & Welfare

 

9. Insert the commencement date and the termination date of the contract

 

9. Commencement Date: July 1, 2001

Termination Date: June 30, 2001

 

NOTE: Dates must be complete with a month, day and year.

 

10. Insert any additional conditions for cancellation of the contract prior to completion.

 

10. Other conditions for termination in addition to termination for cause and termination for convenience may be stated here, if any. The contract may be canceled at the convenience of the contractor upon ninety (90) days written notice.

11.  Reference end of contract CONTRACTOR SIGNATURE. The University person handling
the contract is responsible to have the Contractor Name typewritten or printed exactly
as it appears in Section 1 of the contract. The University person handling the contract
shall be responsible to secure the original signature and title of the contractor.
In addition the contractor shall be requested to insert the date the contractor accepts
and signs the contract. This date shall not reflect a date on or after the commencement
date stated in Section 9. Contractor Signature shown below is completed as an example
only:

 

THUS DONE AND SIGNED AT Hammond, Louisiana, on the day, month and year signed and
dated by the State.

 

CONTRACTOR SIGNATURE

Contractor Name   Addition Prevention Managers, Inc.

Signature Dale Adams

Title Vice President

Date 8/10/00

Telephone 504-836-1234

 

12. Scan any other requirements in the Financial System that may be required of the
Contractor (Board of Director’s resolution, Certificate of Authority, Disclosure of
Ownership affidavit, Affidavit for Architects & Engineers, professional liability
insurance, resume of consultant, etc.). See section On Other Requirements That May Be Required.

 

13. Scan the completed contract in the Financial System and forward at least one contract
with actual signature to thePurchasing Department. The Purchasing Department (not
the Contract Coordinator) will request the signature of the University President or
appropriate Vice President if the contract is in order. If the Contractor shall require
an original of the contract for the Contractor’s record, then a second signed contract
should be submitted with the other original contract.