Complete the following and forward to Purchasing (zot #4530) with your UCI Purchase Requisition. This questionnaire is available as a Word document.

Household and Library/Laboratory Moves

 
Department Name:

Department Contact:                                                  

Phone: 

Client name:                                                                    Title:

Appointment:   Academic _____                    Staff: _____                            Other: _____

Client Phone: Work:                                    Home:  

Move Date: 

Move Household From: (complete address)

Move Household - Destination:

Please select one or both:     Library move:                     Laboratory move:     

Move Library/Laboratory - Origin:

 

Move Library/Laboratory - Destination:

 

Carrier's Insurance Protection Plan includes a minimum of $50,000.  Will additional insurance be required?        Yes:                   No:


Will storage be required:  

Estimated time:    Weeks:                Months:

Please list unusual or heavy items (major appliances/piano):

 

Special instructions or remarks:

 

 

Please review UC Business & Finance Bulletin -- G-13 and the Campus procedures (715-16) covering moving and relocation.  Buyer contact: Diane Silver, (949) 824-7018. Fax (949) 824-4115. E-mail: dhsilver@uci.edu.