Service Agreement Request Form

Use this form to request payment for any Equipment Maintenance, Service & Support Agreements.

Please provide at least 30 days notice to process this request.

To be used when requesting the purchase of equipment maintenance, service and support agreements with a cost of $5,000.00 or greater.

Please direct all individual maintenance requests (not associated with a larger agreement) to the upcipurchasingagents@upmc.edu inbox, along with a completed Standard Order Form, for processing. Not for use when requesting agreements to be placed on the Short Form Services Agreements or Contract Payment specialty forms in PantherExpress.

Instructions for Completing and Submitting Form

1. Please obtain the following attachments (as applicable) and adhere to the documentation requirements:
   • Quote
     • Required for all Service Agreement requests.
     • The quotation must be valid, current, in USD, and from a university-wide contracted supplier.
     • This quote must also have an expiration date that is no less than 30 days (45 days preferred) from date submitted.
   • Certificate of Insurance with required minimums
     • Required for all installation, training, maintenance, or other services performed on university property.
     • The University of Pittsburgh must be named as an “Additional Insured” and as the certificate holder.
     • Adhere to the Minimum Insurance Requirements for Contracts.
   • Competitive Bidding / Directed or Sole Source Justification
     • Required for all purchases that are $10k+ and not with a university-wide contracted supplier.
     • Evidence of Competitive Bidding must include at least 3 quotes from 3 different suppliers for the same equipment/service, to verify that the lowest bid was selected for purchase.
     • Competitive Bidding is the preferred method and negates the need for a Directed or Sole Source Justification Form.
     • DSSJ forms must be completed using DocuSign to obtain a signature of approval from the HCC Director.
   • EH&S approval
     • Required for all purchases involving any of the following:
       • lasers or laser-related equipment,
       • chemical fume hoods,
       • gas cabinets, and
       • biological safety cabinets.
     • You must acquire approval from EH&S prior to submitting your request, you will be asked to attach a pdf copy of the EH&S approval email while completing the form.
2. Please complete and submit the following form:  Service Agreement Request Form via DocuSign