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Meals with Meetings and/or Light Refreshments Authorization Form
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Educational Service District # 123
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NameTitleRequest Date
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Agenda AttachedNo Agenda Yet
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DepartmentCharge Code
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Workshop TitleWorkshop LocationWorkshop Date
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I. Authorized payment amount: (this section should be completed before the workshop)
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(A) Meals: (See 6213-P2 Meals with Meetings Light Refreshments)
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BreakfastLunchDinnerAnticipated # of ParticipantsTotal
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Estimated cost per person $ -
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Per diem authorized per person (to be completed by Fiscal) $ $ $ $
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(B) Refreshments: $3.00/person is the guideline for refreshments (See 6213-P2 Meals with Meetings Light Refreshments)
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CoffeeAnticipated # of Coffee PotsAmount per PotTotal
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Estimated cost $ 6.00 $ -
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Light Refreshments Anticipated # of ParticipantsAmount per personTotal
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Estimated cost $ 3.00 $ -
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Refreshment total less coffee $ -
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TOTAL includes tax & gratuity $ -
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attach original "sign-in sheet" with participant signatures & receipts
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*Coffee Service costs of $6.00 per pot (12 cups) includes: coffee, cups, creamers, sugar, etc. Outside coffee may not be used unless part of a catered meal.
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II. Actual payment amount: (to be completed by Fiscal)
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MealsLight Refreshments/Coffee
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(A) Actual Cost (see receipt)$(A) Actual Cost (see receipt)$
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(1) Actual # of Participants(1) Actual # of Participants
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(2) Total amount authorized x (2) Total amount authorized x $
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(B) Max. Payment ( (1) x (2) ) $ - (B) Max. Payment ( (1) x (2) ) $
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Total Payment Due ( lesser of (A) & (B) )$Total Payment Due ( lesser of (A) & (B) )
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RequestorAdministrator titleAsst. Supt., Finance & Operations
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