professional services agreement - gerald colbert

ROUTING FORM
Facilities PG&E Energy
Checkcontracttitle:0 Professional Services Contract D Amendment to PCS DWater Plan-Districtwide
This Form is NOT a Contract. Complete this form and a Contract. Forward these documents to the
Program Manager who will approve the IFAS Requisition. See Professional Services Contract Instruclion for
further information.
Contractor Information
Contractor
Contractor's
Name Gerald Colbert Contact Person Gerald Colbert
Street
Address 2232 Coolidge Avenue #4
Title
Project Manager
City Oakland Telephone 510-772·7801
State CA I Zip Code I 94601 Vendor #
Tax ID/Soc Sec # I
Has Contractor been an OUSD contractor? T
OUSD Project # NA
I Has Contractor worked as an OUSD employee? I
If yes to either, list the name(s) and tax ID/social security
number(s), if different.
I
Date Work Will End By
not more than 5 ears from start date June 30, 2009
Compensation
Total Contract Amount $ Total Contract Not To Exceed $96,600.00
Pay Rate Per Hour (If Hourly) $ If Amendment, Changed Amount $
Other Expenses Requisition Number
Budget Information
Funding Resources
211-12T2
1 1 I
9
Site
1 1
I
l!l
1
OrnKev#
Pro ram
9 T3 o 13
I I
F
8
Uni
0
ue
5 - 5T
1
Object
81 21
I 1
6
Amount
$96,600.00
$
Name of OUSD Contact,
Tele hone
Site/De t. Name
"'/~I
Approval and Routing
Princinal/Division Head
Prooram Manaqer
Contract Services
FCMAT Fiscal Advisors
State Administrator
-- ........, /'
VL,...
d Denied • / Date
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Additional aDDrova/s mav be needed if contract amount is areater than $59,600
Leoal
Leaal Review Needed:
I
Submittedto Leoalby: LeoalLao#: Returned to:
Contract Office Use Only
Dates of Clearance Submittedby: Email Address
TB Fingerprint YTD$ Full Funding in Req. Current Employee Unit Member Work Conflict
A999069.P001Rev,7/24/03 THIS FORM IS NOT A CONTRACT Prepared By: Susie Butler-Berkley