Request for Budget Increase

REQUEST FOR BUDGET INCREASE

Requesting Department:     Approving Authority:

Project Name:     Date of Request:

WHEREAS

WHEREAS, the Requesting Department requires additional funds to complete the scope of work described herein for the project identified as ; and

WHEREAS, the Approving Authority has the statutory and/or delegated budgetary authority to approve adjustments to the project budget in accordance with applicable policies and internal controls; and

WHEREAS, the Requesting Department has submitted a detailed justification and cost breakdown that demonstrates the need for a budget increase as set forth below;

NOW, THEREFORE, the Requesting Department formally requests an increase to the budget under the terms and conditions set forth in this Request for Budget Increase (the "Request").

REQUESTED BUDGET ADJUSTMENT

SCOPE OF WORK

PAYMENT TERMS

Payment Amount to be Allocated:

Late Payment Fee or Interest:

TERM AND TERMINATION

Requested Effective Start Date:

Requested Effective End Date:

Termination for Convenience or Material Breach: Either party may terminate this Request or any associated disbursement schedule upon written notice in accordance with the notice period above. Termination shall not relieve either party of obligations accrued prior to the termination date, including payment for work completed and documented costs incurred.

CONFIDENTIALITY

All non-public information exchanged in connection with this Request, including cost breakdowns, projections, and proprietary methodologies, shall be treated as confidential by the receiving party and shall not be disclosed except as required by law or with prior written consent of the disclosing party. The receiving party shall use at least the same degree of care it uses to protect its own confidential information, but in no event less than a reasonable standard of care.

Acknowledgement of Confidentiality: I acknowledge the confidentiality obligations described above.

GOVERNING LAW

This Request shall be governed by and construed in accordance with the laws of: , without regard to conflict of law principles.

ENTIRE AGREEMENT

This Request, together with any attachments, itemized cost breakdown, and any subsequent written approvals, constitutes the entire agreement between the Requesting Department and Approving Authority with respect to the subject matter hereof and supersedes all prior oral or written communications and understandings. Any modification to this Request must be made in writing and signed by authorized representatives of both parties.

ADDITIONAL TERMS

AUTHORIZATIONS

Requestor Name:

Requestor Title:

Approver Name:

Approver Title / Office:

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