Research Corporation of the University of Hawaiʻi

RCUH Form 154 Attachment 47 (03/2014)
Request for Advance Payment and/or Deposit to a Vendor or Contractor
To:
Name of Fiscal Administrator Name of Principal Investigator
Date:
From:
Contact Name: ______________________________________________________ Phone No.: _____________________
Advance Payment/Deposit is being requested for:
Vendor:
Total Amount of Contract or PO: Amount of Advance Payment/Deposit: Date Payment/Deposit Required: Project Account Number: Description of the goods/services to be purchased, including dates of services (if applicable).
Justification for the advance payment/deposit, including an explanation of whether attempts were made
to negotiate other arrangements (as applicable), and impact on the program/project if request is denied. In order to ensure receipt of goods/services, was consideration given to provider’s financial capability (such as review of audited financial statements, S&P/Moody’s rating), customer references, purchase of a performance bond, Hawaii Compliance Express, complaints filed with Hawaii Office of Consumer Protection and Better Business Bureau, etc.
Certification:
Approved By: _________________________________________ Date: _________________________
Signature of Principal Investigator
Reviewed By: _________________________________________ Date: _________________________ Signature of Fiscal Administrator
On behalf of my respective UH school or department, I hereby agree to reimburse the RCUH for all advance/deposit amounts:
Date: ______________________
Dean/Director/Chancellor/ Vice President or Other Authorized Official