HOSPITALITYPAYMENT / REIMBURSEMENT REQUEST

Attach all support documentations, including itemized receipt(s) and proof of payment(s).

PAYEE (Make Check Payable To) Payee Name: SFSU ID / Supplier #:

Mailing Address:

City, State, Zip Code:

204 Form On File Submitted Prepared by: Ext:

HOSPITALITY EXPENSES * Official Host and Approver may not be the same person

Date of Event: PO #: Location:

Official Host Name* and Department: Number of Participant:

TYPE OF EVENT/ BUSINESS PURPOSE:

This type of event has occurred more than 12 times within the last 12 months? Yes No

PARTICIPANTS / GUEST(S) OR RECIPIENT(S) OF AWARD(S) Attach list of names, titles, and affiliation, if the group is 24 or fewer participants. List of attendees is not required if 25 or more participants, but a descriptive title of the participant groups is required.

NAME(S) - USE SEPARATE SHEET IF NEEDED TITLE(S) AFFILIATION / ORGANIZATION / SFSU DEPT

CERTIFICATION / AUTHORIZATION TO PAY I CERTIFY THAT THIS IS A TRUE STATEMENT OF EXPENSES INCURRED FOR OFFICIAL UNIVERSITY BUSINESS IN ACCORDANCE WITH THE UNIVERSITY POLICY ON HOSPITALITY, AND THAT THE ABOVE EXPENSES ARE APPROPRIATE AND ALLOWABLE CHARGES TO, AND AUTHORIZE PAYMENT FROM THE ABOVE ACCOUNT(S).

Payee Name: Department: Signature: Date:

Approver Name: Title: Signature: Date:

ORSP Approver: Title: Signature: Date:

DISBURSEMENT Mail Check Pick-Up Check Note, Employee only: If you have signed up for EFT, no action needed

Email: Extension:

AP USE ONLYInvoice #: Voucher #: Check #: Check Date:

FUND DEPT ID PROGRAM CLASS PROJECT AMOUNT

TOTAL $

CHARTFIELD STRINGSACCOUNT

EXCEPTION TO HOSPITALITY POLICY / PRACTICE DIRECTIVE If the request is submitted over 90 days of expenditure or hospitality expenses have exceeded the maximum rates, justify why the higher cost or other deviation from the policy /practice directive is necessary to achieve the University business purpose.

_________________________ _________________________________ ___________________

Vice President / Provost Signature Date

For detailed information on allowable hospitality expenses, please refer to the Hospitality Policy .

WHAT IS REQUIRED?

Invoice for catering or itemized receipts demonstrating payment has been made Proof of Payment – e.g. credit card receipt, bank statement, copy of the front and back of the cancelled check for payments made by

check Signature of the Payee (person seeking for reimbursement) Signature of department official(s) with delegation of authority (DoA)

o Approvers may not approve business related expenses of a person to whom they direct report. Event / Expense details (e.g. purpose, amount, date, participants, location)

Exception to Hospitality Practice Directive: If the request is submitted over 90 days of expenditure (or event) or hospitalityexpenses have exceeded the maximum rates, an exception to the practice directive must be approved by the appropriate Vice President orProvost.

Submit the approved Hospitality Payment/Reimbursement request to Accounts Payable, ADM 351

USEFUL INFORMATION:

Maximum Rates for Hospitality (inclusive of tax and services)

TYPE OF HOSPITALITY MAXIMUM RATES (PER PERSON)

Breakfast $20.00 Lunch $30.00 Dinner $50.00 Light Refreshment $15.00

Hospitality Program Codes:TYPE OF HOSPITALITY PROGRAM CODES

Food 2010

Entertainment 2020

Event Supplies 2030

Facility Rental 2040

Awards to Non-Employees 2050

Awards to Employees 2060

Awards to Students 2065