SLU Logo AUTHORIZATION TO RELEASE PAYMENT
FOR SERVICES COMPLETED OR RENDERED TO DATE

For Personal, Professional, Consulting or Social Service Contract

1.   Contractor Name (To be appear exactly as typed on service contract)


2.   Title Name Assigned to Contract or Brief Description of Service Contracted



3.   Services Rendered And Approved For Payment (Complete A or B / Not Both)

A.   The Contract Coordinator authorizes payment for completion of services rendered for the maximum fee of [___________].

B.   The Contract Coordinator authorizes payment for progress installment no. ____ for services rendered to date in the amount of [___________].

C.   Travel and other reimbursable expenses (mark one block only):

    [____] Travel, lodging, meals and other expenses are NOT applicable to this contract, or the maximum contract fee INCLUDED travel, lodging, meals and other expenses. Go to Step 4.

    [____] The maximum contract fee EXCLUDED travel, lodging, meals and other expenses. All reimbursable expenses shall be paid in accordance with State of Louisiana Travel Regulation (PPM 49).

      Excluded reimbursable expenses were not to exceed: [_________]

      * Total reimbursable expenses approved for payment: [_________] Go to Step 4.

    * Note:   The Contractor Coordinator shall require the Contractor to submit an itemized original invoice for reimbursable expenses and any required receipts in accordance with State Travel Regulations.
4.   The Contract Coordinator affirms the contract services rendered to have been performed satisfactorily and authorizes payment as outlined.
Contract Coordinator ______________________________________________________
 Legible SignatureDate (Mo/Day/Yr)
A Performance Evaluation should be completed by the Contract Coordinator upon final payment of services rendered or within (30) days of termination date.