REQUEST FOR APPROVAL OF PERQUISITES
OR SALE OF GOODS AND SERVICES

AGENCY NAME:	UNIVERSITY OF SOUTH FLORIDA
			Purchasing Services – AOC 200
			Michael J. Abernethy, Director

REQUEST: (Check one)

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a. County Code        b. Facility & Initiator  

c.  Dept. Name, address & Mail Point:  

d. Authorized Departmental Approval:  	
	(Signature Required)                            Type or Print Name                   Phone Number (Ext.)

CLASSIFICATION INFORMATION

a. Pay Plan	b. Class Code	c. Class Title	d. FTE in class	

				

JUSTIFICATION:   

ITEM DESCRIPTION: Perquisite Category Code:   

Narrative Description:      	

PER UNIT COST INFORMATION:
a. Class Code	b. Annual Cost
to State	c. Annual Maint Allowance Cost	d. Annual Fair
Market Value	e. Annual Charge
to Employee	f. Monthly Cost
to State	

						

TOTAL ANNUAL COST FOR ALL POSITIONS:  $  

ACTION TAKEN:       	
Michael J. Abernethy, Director
Approving Authority	                         Signature	                                 Date