Rev. Date: March 2020 PURPOSE STATEMENT: REVIEWERS DATE RECEIVED: DATE SIGNED: YES NO Undecided Review Only SIGNATURE: REVIEWER 1 NAME: RECOMMEND: COMMENTS: DATE RECEIVED: DATE SIGNED: YES NO Undecided Review Only SIGNATURE: REVIEWER 2 NAME: RECOMMEND: COMMENTS: REVIEWER 3 NAME: DATE RECEIVED: DATE SIGNED: RECOMMEND: YES NO Undecided Review Only SIGNATURE: COMMENTS: CFO OR CEO : DATE RECEIVED: DATE SIGNED: RECOMMEND: YES NO Undecided Review Only SIGNATURE: COMMENTS: SIGNATURE COORDINATION FORM INITIATION ORIGINATOR: RETURN TO: TRACKED BY (Choose One): Originator START DATE: MAIL* RETURN BY DATE: PROPOSED START DATE: REQUEST TYPE INTERNAL Department: Program: EXTERNAL W9 REQUIRED? Yes No INSURANCE CERTIFICATE REQUIRED? To Vendor From Vendor CONTRACT INFORMATION (If applicable) CRI CHI CRFI CRAI RYSI NAME OF CONTRACT: CONTRACT #: REVIEWER IDENTIFICATION - The action requested is for the following dollar amount: Between $0 – $500 Between $2,500 – $49,999 (Purchasing/ CFO review) Between $500 – $2,499 (Purchasing review) $50,000 and Above (Purchasing/ CFO/ CEO review) ACTION NEW MODIFICATION (extensions/renewals) RFP OTHER (INTERNAL): Executive Assistant