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REQUEST FOR APPROVAL TO PROCEED OR ENCUMBER FUNDS
The Department of UNIVERSITY of CALIFORNIA-insert campus hereby requests
PWB / DOF action related to the following project:
1. Project ID: insert number Project Title: insert project title
2. Requested PWB/DOF Action Date: insert date Date of last approval:
insert date
3. Requested Action: (all reporting requirements related to this request
as defined in SAM, are attached)
____ Site Acquisition - Section 6848 (an agenda package has been submitted
to DGS)
____ Approve Preliminary Plans - Section 6851
____ Approve Working Drawings - Section 6852
____ Approve Proceed to Bid - Section 6852
____ Approve Construction Contract Award - Section 6853
____ Request for Augmentation Reversion - Section 6861, 6862
____ Approve Scope Change - Section 6863
____ Other, Specify:____________________________________________________________________
4. Project Completion Reporting: (reporting requirements as defined
in Section 6856 are attached)
____ Project Occupancy
____ Project Completion
____ Project Close-out
5. Project Certifications:
CEQA Compliance: (reporting requirements as defined in Section 6850 are
attached)
____ This project meets CEQA compliance requirements.
____ The action requested does not invalidate the CEQA compliance.
____ The action requested mandated a review of the CEQA compliance.
Scope Changes: (reporting requirements as defined in Section 6863 are
attached)
____ Project scope has not changed from that as defined in the previous
reporting.
____ A change in project scope is necessary in order to proceed with
the project.
Costs/Funding/Schedule Changes: (reporting requirements as defined in
Section 6861 are attached)
____ Costs, funding, and schedules have not changed from that as defined
in the previous reporting.
____ Changes in cost, funding and/or schedules are necessary in order
to proceed with the project.
(insert explanation as needed)
I hereby certify that the above is accurate and that the necessary reporting
requirements as defined in SAM are included with this request.
| _______________________________________ |
___________________________________ |
| Campus Approval |
Date:_________ |
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| _______________________________________ |
___________________________________ |
University Approval
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Date:_________
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 Request
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Request
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