STATE OF MINNESOTA
STATE OF MINNESOTA
MINNESOTA STATE COLLEGES AND UNIVERSITIES
16A.15 Form
(Based on Minnesota Statute §16A.15)
College/University/Office of the Chancellor:_____________________________________________________________________
Division / Department:________________________________________________________________________________________
Vendor / Contractor Name:____________________________________________________________________________________
INSTRUCTIONS: Submit one original and two photocopies when processing the contract.
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|I. NO OBLIGATION INCURRED PRIOR TO ENCUMBRANCE OR CONTRACT EXECUTION |
|(Minnesota Statute §16A.15, subd. 3) |
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|I certify work has not started as of _______________ and will not begin until this contract is fully executed. |
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|Signature of Person Responsible:____________________________________________________Date:_________________________ |
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|II. OBLIGATION INCURRED PRIOR TO ENCUMBRANCE |
|(Minnesota Statute §16A.15, subd. 3) |
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|Total Contract Amount: $ Obligation Date: (when work started) |
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|Reason why obligation was incurred prior to funds being encumbered and contract being executed: |
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|What corrective action will be taken to prevent violation of M.S. §16A.15, subd. 3, from occurring in the future? |
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|Signature of Person Responsible:____________________________________________________Date:________________________ |
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|Signature of |
|Authorized Official*:_____________________________________________Date:________________________ |
|*as stated in Delegation of Authority Letter |
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