ࡱ> {z g2ɀ\p Joseph King Ba== ?F#8X@"10Arial10Arial10Arial10Arial10Arial10Arial1 0Arial1$0Arial1h0Arial1@0Arial1@0Arial10Arial10Arial10Arial10Arial10Arial10Arial10Arial10Arial10Arial10Arial10Arial10Arial1zCalibri1 zCalibri1zCalibri14zCalibri1 zCalibri1zCalibri1zCalibri1,8zCalibri18zCalibri18zCalibri1>141<zCalibri1?zCalibri1h8zCambria1zCalibri1 zCalibri"$"#,##0_);\("$"#,##0\)!"$"#,##0_);[Red]\("$"#,##0\)""$"#,##0.00_);\("$"#,##0.00\)'""$"#,##0.00_);[Red]\("$"#,##0.00\)7*2_("$"* #,##0_);_("$"* \(#,##0\);_("$"* "-"_);_(@_).))_(* #,##0_);_(* \(#,##0\);_(* "-"_);_(@_)?,:_("$"* #,##0.00_);_("$"* \(#,##0.00\);_("$"* "-"??_);_(@_)6+1_(* #,##0.00_);_(* \(#,##0.00\);_(* "-"??_);_(@_)"Yes";"Yes";"No""True";"True";"False""On";"On";"Off"],[$ -2]\ #,##0.00_);[Red]\([$ -2]\ #,##0.00\)$[$-409]dddd\,\ mmmm\ dd\,\ yyyy mm/dd/yy;@#,##0.0_);\(#,##0.0\) 0.0%00\-0000\-0000                                                                      ff + ) , *      P  P !  !  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Currency [0]/Explanatory TextG5Explanatory Text %0 : Followed Hyperlink 1Good;Good  a%2 Heading 1G Heading 1 I}%O3 Heading 2G Heading 2 I}%?4 Heading 3G Heading 3 I}%235 Heading 49 Heading 4 I}%6( Hyperlink 7InputuInput ̙ ??v% 8 Linked CellK Linked Cell }% 9NeutralANeutral  e%"Normal :Noteb Note   ;OutputwOutput  ???%????????? ???<$Percent =Title1Title I}% >TotalMTotal %OO? Warning Text? Warning Text %XTableStyleMedium2PivotStyleLight16`f Data Sheet  ;  ;8fNf8@ b:]6߮IqD}nu:]6߮IqDPNG  IHDRk46`PLTE333vvvJJJxxxfffZZZ;;;,,,RRR} cmPPJCmp0712HstRNS.bKGDHgIFg>UfIDATXGWۖ ă. @{(/Hd&(3>a7ϪۨXG%ڇ(13uڱᔏ콸հ7)ٚıSwܣ9C¹a\bٍ.b X-+F"7&UXKBM0%щjnIl|)< ,Fwapԉ.zBc$ΪNu;f(vw; .e*CѻCOY_lt9F{$DrH!4,8{sYWj((Q^=U+]P\@'/.{IENDB`3 A@@   I.General InformationII.2User Information, Monitoring, and Rate Development projected costs,&actual costs of the billing period, orFinancial Support/Assistance Annual AmountIV. ID NumberItem DescriptionTotalV. Equipment DescriptionPO # Date Acquired1.2.3.4.5.6.7.4Are other activities taking place in the same space?YesNo8.~If yes, indicate which services and which user groups receive free service or discounted rate(s). State the reasons for such Billing rates are based on:!(c.) External to the University:e(Note: External users should be charged internal user rate plus applicable indirect cost assessment.)If yes, explain.Other (specify)$Manufacture warranty expiration dateAnnual Maintenance Fee Dept. No.3Indicate below the reason for completing this form:8(b.) Percentage use of the space for other activities: FAre any users provided services at discounted rates or free of charge? treatment.Date Subsidy Endsprior year costs,.combination of prior year and projected costs, Maintenance or Service Contracts7Do billing rates include any indirect cost assessments?FIf Subsidized, Describe (source of subsidy, how it will be used, etc.)qEquipment location, if different from the information provided in I.6. above (include building and room number). TOTAL(d.) Square footage of[What unit of measure is used as a billing base (hour, day, procedure, test, mileage, etc.)?|(a.) Are any costs for equipment with an original cost of $5,000 or more, scholarships or fellowships, tuition expenses, or)Percentage use of equip./item for service&center billing rates?DeptCollegeDirector/ManagerDeanVice PresidentnHow will the center cover the financial assistance portion after the funding source(s) expires or terminates? I100% of operating cost will be recovered from the service center revenue.VI. Comments:e(Capital equipment has a purchase price greater than or equal to $5,000 per item and is administered ( via the UTSA Capital Assets Management)1If yes, what percentage is used by this activity?}(c.) If no, what financial controls does the center have in place to ensure these unallowable costs are not included in the   7(b.) If yes, specify each item. See NOTE in 5b above."  III. H(Add additional lines as necessary to report on each piece of equipment)$Mtnc/service contract begins (MM/YY) Annual Mtnc.Name: Title:BContact information of responsible administrator (for operations):Phone:Email: Reports To:(a.) Building name(b.) Building number(c.) Room number(s) specific activity room:Do competitors for this service center exist outside UTSA?Total (must equal 100%)&Please complete all gray fields below.Other (specify): Other: (Check all that apply):Service Center Name:oStart-up (seed) money: usually one-time receipt subsidy that pays for the costs associated with initial set-up.n Subsidy: use of funds from another source that is an integral part of the center s annual operating budget. mq(a.) Are any unallowable costs (e.g., bad debts, entertainment, alcoholic beverages, fines and penalties, and/or2 interest payments) included in the billing rate?{(b.) If yes, specify each cost item. NOTE: A-21 unallowable costs are ineligible as rate components and must be excluded.'Ofc Loc:|It is the responsibility of department management to periodically review balances and adjust rates as appropriate to ensure compliance under federal regulations. Any surplus or deficit at fiscal year-end must be a component of the subsequent year's rate.~List or attach a description of the services to be provided, including a statement of purpose consistent with UTSA's mission: wIf yes, fill out the information below for each item. If no, go to Section V. Equipment. Absent a maintenance/serviceBcontract, annual maintenance costs are reported in Part V.2 below.00/00UTSA Tag Number PgmProvide information on the funding sources currently assisting the operating costs of the center as indicated above. Insert additional rows as required.Total Acquisition CostAnnual Depreciationa)b)c)d)e) Signatures: Datem None (If  None, skip the remainder of this section and go to Section IV, Maintenance or Service Contracts) w(c.) If no, what financial controls does the center have in place to ensure that these excluded costs are not charged *or included in the center's billing rates?vIs any equipment listed in V.2. above used by or for activities other than the specific activity in the service centerlIf equipment depreciation expense has not been included in previous recharge rates, explain how the service Service Center Information SheetUService Centers are defined as units or departments that provide goods and/or services to users, primarily within the University. Service Centers may charge, directly or indirectly, federal grants and contracts and as a result, the University must comply with cost principles and accounting standards promulgated by the United States' Office of Management and Budget Circular A-21. Rates must be calculated based on actual costs and/or known or anticipated changes and only include allowable costs as defined in Circular A-21. External users may be charged a higher rate than internal users. Higher rates cannot be charged for one product or service to offset or subsidize losses on another. Internal users cannot be charged different rates for the same product or service; rates must be applied consistently internally with no price discrimination.&To establish a new service center rateFTo add additional activities or services to an existing service center.To review or update an existing service center1(a.) Name of current or proposed service center:2(b.) Service center rate (if currently charged): 4Department Name to which the service center reports: Service center room information:  (a.) If yes, provide a brief description of the other activities such as (1) the funding source of the other activities (research, instruction, other institutional or departmental activities, or other), and (2) the relationship between the service center and other activities, if any. FIf yes, describe how the service center rates compare to market rates.Rinternal space rental costs included in the proposed service center billing rates?_If the proposed service center receives financial assistance, indicate the types of assistance.(Equipment: defined as tangible, nonexpendable personal property with a purchase price greater than or equal to $5,000 per item, provided by a sponsored project, the university or a university department. That is, not the property of the service center and/or not purchased by the service center. }Provide a brief description/explanation of the relationship between the service center and the financial assistance source(s) identified above.dDoes this service center subsidize or provide any type of financial assistance to other activities? PDoes the service center intend to recover maintenance or service contract costs?^Does the service center use any capital equipment in the production of its goods or services? List all capital equipment that is used in the specific service center activities in the schedule provided below. No depreciation can be included for fully depreciated assets. (Insert additional rows as required.)Bcenter will fund or has funded future equipment replacement costs.Last updated 8/2014[(a.) Internal to the University - non-sponsored: (funds other than 51XX, 52XX, 53XX, 54XX)9 CZ(b.) 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