LONG-TERM VEHICLE ASSIGNMENT REQUEST
Systems and Procedures
A Division of The Corporate Controller's Office
IN

LONG-TERM VEHICLE ASSIGNMENT REQUEST

Form Instructions

  1. For Fleet Use
  2. Check one (1) of three (3) options and complete necessary information
    • New
    • Renewal
    • Modification
  3. If this request is for a renewal, enter the vehicle # to be renewed. If not a renewal, skip this field
  4. If this request is for a modification, select one (1) of three (3) types of modifications
  5. If this request is to modify the original Cost Object Type, select the Cost Object Type from the drop-down list as assigned on the original request and enter the Cost Object number to be assigned to this request. If not a Cost Object Type/Cost Object number modification, skip these fields
  6. If this request is modify prior request dates, enter the new date range
  7. If this request is for some other type of modification, provide an explanation
  8. Select the vehicle class and type from the drop-down list. Options include:
    • 311 - Mid-size Sedan (Ford Fusion, Chevy Malibu)
    • 350 - Mid-size Hybrid (Ford Fusion, Chevy Malibu)
    • 411 - Full-size Sedan (Chevy Impala)
    • 511 - Large passenger can (Chevy Maxi-Van)
    • 521 - Minivan (Dodge Caravan)
    • 720 - Mid-size 4WD (Jeep Patriot, Ford Escape)
    • 755 - Full-size 4WD (Ford Explorer)
    • 760 - Large 4WD (Ford Expedition, Chevy Suburban)
  9. Enter the assignment beginning date
  10. Enter the assignment ending date
  11. Check this box if requesting the zero deductible option (please be aware that there is additional fees per month for this option)
  12. Enter the estimated amount per fiscal year
  13. Enter the name of the person responsible for reporting monthly mileages
  14. Enter the office address of the person responsible for reporting monthly mileage
  15. Enter the phone number (including area code) for the individual responsible for reporting the monthly mileage
  16. Enter the email address of the individual responsible for reporting the monthly mileage
  17. Enter the name, phone number (including area code), and email address of an alternate contact person
  18. Select the Cost Object type from the drop-down list. If this request is for a modification, select the Cost Object that should be used
  19. Enter the appropriate Cost Object number to be charged
  20. Enter the general ledger account number to be charged
  21. Enter the name of the principal operator. If used by numerous persons, type "Pool"
  22. Enter the principal operator's address. If pool use, enter the office address
  23. Enter detail of vehicle needs for conducting official University business and reasons why these needs cannot be met by periodic use of "pool" vehicles
  24. Enter the precise University location where the vehicle will be parked in the evenings. See Policy BS20 University Vehicle Operations or Use, regarding parking University vehicles at employee's homes overnight
  25. Enter the name of the Budget Executive approving this request
  26. The Budget Executive must provide either their hand-written signature and date signed, or provide their digital ID
  27. Enter the name of the Financial Officer approving the financial transaction
  28. The Financial Officer must provide either their hand-written signature and date signed or provide their digital ID
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