Hospitality Payment Request - Single Event, Single Supplier

LBCMP LBFDN LB49R

Employee, Campus CSULB Student Other
Employee, Foundation Non-CSULB Student Other State Employee

Vendor 204 Form

Attached On-file N/A

Supplier ID

Employee/Stu ID

Payee Name

Payee Phone

Payee Name 2 (DBA)

Payee Email

Mailing Address

City, State and Zip

Event Name

Official Host

Event Date

Event Time

Location

Num of Participants

Food Service Provided

Breakfast $30 Lunch $40 Dinner $75 Light Refreshments $20 Hors d'oeuvres $30

Calculated cost per person for this event

Does cost exceed policy amount?

No Yes

Business Unit	Amount	Account	Fund	Dept ID	Program	Class	Project

Total Amount

Statement of payee/requester responsibilities (if requesting employee or student reimbursement, signature is required)

I certify that this expenditure is reasonable and necessary for the department's operations and the University's mission.

Statement of Appropriate Administrator/Approver Responsibilities

I certify that the funds are available for this expenditure and that this expenditure is reasonable and necessary for the dept.'s operations and the University's mission.

Special Handling, Enclosures Pick-up

Reimburse at Cashiers BH148

Sign and Date

Attach all receipts, invoices and supporting documentation to this Hospitality Payment Request form and submit to Accounts Payable: LBCMP/LBFDN/LB49R - University Controller's Office Accounts Payable,
Foundation Building Suite 280, 6300 State University Drive, Long Beach CA 90815 Phone: (562)985-2512. Form Rev. Date: 2018-12

California State University Long Beach

Hospitality Payment Request - Single Event, Single Supplier