ࡱ> uxt Jbjbj[[ 4v99'"zz8 \|/f6"8L t/v/v/v/v/v/v/$[1 4^/XXX/H/XFt/Xt/CñTF`//0/k4$k4k4XXXXXXXX//XXX/XXXXk4XXXXXXXXXz : MAPP 05.01.01 - ADDENDUM A UNIVERSITY OF HOUSTON Departmental Petty Cash, Change Funds Request for Establishment or Modification Acknowledgement of Receipt of Funds and/or Cash Policies and Procedures Certification NOTE: College/Division/Departmental Cash Handling Policy and Procedures must be submitted to and approved by General Accounting prior to completion of Addendum A for newly established change funds or petty cash funds or prior to naming new cash handlers. SECTION I (Complete for Petty Cash/Change Funds/All requests for Treasury) ACTION REQUESTED FOR FY  FORMTEXT YEAR FOR  FORMTEXT DEPARTMENT NAME  FORMCHECKBOX  Establish New Fund  FORMCHECKBOX  Close Existing Fund  FORMCHECKBOX  Annual Reauthorization of Existing Fund/On-Line Certification  FORMCHECKBOX  Modify Existing Fund  FORMCHECKBOX  Increase Amount  FORMCHECKBOX  Decrease Amount From $ FORMTEXT Amount To $ FORMTEXT Amount TYPE OF CASH RESPONSIBILITY  FORMCHECKBOX  Petty Cash  FORMCHECKBOX  Change Fund  FORMCHECKBOX  Operational Cash Advance $ FORMTEXT AMOUNT PHYSICAL LOCATION OF FUND  FORMTEXT ENTER ADDRESS OF WHERE FUND IS LOCATED. SPECIFY IF FUND IS STORED IN A SAFE, LOCKED DRAWER, ETC. COST CENTER  FORMTEXT ENTER COST CENTER FOR FUND SECTION II Fund Custodian Certification and Approval I hereby certify that I am an employee that has been authorized to handle cash or serve as custodian of a Departmental Cash Fund and acknowledge receipt of the fund. I have completed on line cash handling certification training prescribing the management of cash, and agree to accept responsibility for the accounting and control of the cash in accordance with policies and procedures. These policies and procedures include MAPP 05.01.01 Cash Handling; ɫ System Administrative Memorandum 03.F.01 Gift Acceptance Policies; ɫ System Administrative Memorandum 01.C.04 Reporting /Investigating Fraudulent Acts; and the College/Division/Department Cash Handling Policy and Procedures.  Custodian Name, Please Print Custodian Signature & Date SECTION III Cash Handler(s) Certification and Approval I hereby certify that I am an employee that has been authorized to handle cash or serve as custodian of a Departmental Cash Fund and acknowledge receipt of the fund. I have completed online cash handling certification training prescribing the management of cash, and agree to accept responsibility for the accounting and control of the cash in accordance with policies and procedures. These policies and procedures include MAPP 05.01.01 Cash Handling; ɫ System Administrative Memorandum 03.F.01 Gift Acceptance Policies; ɫ System Administrative Memorandum 01.C.04 Reporting /Investigating Fraudulent Acts; and the College/Division/Department Cash Handling Policy and Procedures. Employee Name, Please Print Employee Signature & Date Employee Name, Please Print Employee Signature & Date Employee Name, Please Print Employee Signature & Date Employee Name, Please Print Employee Signature & Date Employee Name, Please Print Employee Signature & Date Employee Name, Please Print Employee Signature & Date Employee Name, Please Print Employee Signature & Date Employee Name, Please Print Employee Signature & Date Employee Name, Please Print Employee Signature & Date SECTION IV Certification and Approval 1.Custodian Name, Please PrintCustodian Signature & DateCustodian PhoneCustodian Mail Code2.College/Division Business Administrator Name, Please PrintC/D BA Signature & DateC/D BA PhoneC/D BA Mail Code3.Department Head Name, Please PrintDepartment Head Signature & DateDepartment Head PhoneDepartment Head Mail Code Complete the following, if requesting cash advance for operational purpose, establishing a new change fund or petty cash fund or for new cash handlers for your College/Division. College/Division/Departmental Cash Handling Policy and Procedures submitted to and approved by General Accounting on  FORMTEXT DATE. 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