Business ContractsOffice

Consultant Agreement (CA) Request Form

Please complete this form on the computer - boxes will expand to accommodate your text. Answer all questions in as much detail as possible.
This form must be signed by an individual with a Signature Authorization form on file for the selected chartstring.

REQUESTING DEPARTMENT
Clinic/Center/Department:
Contact Name: / Phone:
Fax: / Email: / Mail Code:
PROPOSED CONSULTANT
Please use the full legal name (no acronyms) and indicate if the party is a corporation, partnership, or individual (if uncertain, ask the outside party). If the contracting party is an unincorporated individual “doing business as” another name, use the individual’s name, then “dba,” then the other name (example: Mary Flynn dba Flynn Associates).
Full Legal Name:
Proposed Consultant(s):
Address:
Phone: / Fax: / Email:
BFS Vendor ID (if known): / BFS Requisition Number (if available):
SSN or Federal Employer Tax Identification Number:
PROJECT INFORMATION
Project Title(if any):
Period of Contract:
Due Date (include reason for expedited review, if appropriate):
Include a separate document (agreement’s Schedule A) that addresses these five topics and fully answers each of the questions:
1. Project Description/Need for Consultant:
a)Describe the overall purpose and objective of the project, including where the individual(s) will be located on campus, to whom he/she will report, and the length of the consulting assignment.
b)Describe the skills, experience and knowledge needed for this project.
c)Describe the process you followed to determine that these needed services are not available on campus.
d)Describe any concerns or risks to the University of which you are aware related to this proposed agreement.
2. Process/Discussions with Proposed Consultant:
a)Explain the process you followed in identifying the proposed consultant, including alternative sources you contacted and your justification for the selection of the proposed consultant.
b)How did you establish the fee rate with the proposed consultant? How did you determine that the fees were reasonable and competitive?
c)Have you and the proposed consultant reviewed the University’s model Consultant Agreement? Are there any points that need to be discussed, clarified or negotiated?
3. Funds and Fee Rates:
a)Describe the source of funds that will pay the consultant’s fees. Is there a sponsor and, if so, have you obtained the sponsor’s approval in writing to engage the consultant?
b)Have you obtained a Certificate of Insurance from the consultant? A copy of this certificate should be included when you submit this request form.
4. Statement of Work/Consultant’s Proposal/Deliverables:
a)Is payment to the consultant contingent on the written acceptance by Berkeley Law of deliverables?
b)Is there a schedule of deliverables? If so, please include a copy with this submission.
c)Describe the scope of authority of the Berkeley Law department project manager to make changes or modifications to the deliverables.
d)Are written status reports from the consultant required? Bi-weekly reports are recommended.
5. Campus Coordination - The Center for Organizational and Workforce Effectiveness (COrWE) may be consulted for services involving administration, management, and organization development projects.
a)Are there any other campus units/departments that might be impacted by the consultant’s work?
b)Are you or your consultant working with COrWE on this project?
Please note: Due to an existing contract with PriceWaterhouseCoopers, you are restricted from using their firm or employees of their companies to provide any type of consulting or professional services on the UC Berkeley campus.
Attachments to the CA Request Form:
  • Word version of a draft model Consultant Agreement prepared by the department using the Business Contracts Office template
  • Conflict of Interest Certification (if appropriate)
  • Certificate of Insurance provided by the consultant

DEPARTMENT APPROVAL
Signing this CA Request Form represents that you have complied with legislation wherein you will not be able to contract with the selected consultant in a subsequent agreement to work on any subsequent service, procurement, or other action that the consultant had required, suggested, or otherwise deemed appropriate in the initial contract.
Does your department have any prior agreements with this consultant?
Is the proposed consultant a present or former UC employee? If yes, attach a completed Conflict of Interest Certification.
Name of Approver (MSO level or higher):
Title: / Date:
Approver’s Signature:

Revised 9/30/09