Instructions For Completion of Request for Approval of
Perquisites or Sale of Goods and Services Form

PERQUISITES

1. GENERAL INFORMATION
   1. The University may furnish perquisites to certain employees who are required to use special equipment or wear certain clothing, such as safety shoes, uniforms and the like for purposes of safety or identification.
   2. Departments requiring employees to use such will pay for the perquisites and the maintenance of such perquisites from departmental funds.
   3. After obtaining approval to provide a perquisite, departments will requisition all uniforms, equipment, and assorted items through the Purchasing Department.
   4. Approval of perquisite is secured through the University Personnel Services Department and the appropriate division vice president.
   5. Safety items provided to all employees that are not personalized in any way such as aprons, smocks, safety glasses (non-prescription) or head/shoe coverings are not considered perquisites and may be purchased at the discretion of the Department or division head.
2. PROCEDURES
   1. Requests for approval of perquisites or the sale of goods and services shall be submitted at least thirty (30) days prior to the desired effective date. Retroactive approvals will not normally be granted.
   2. All original requests to provide perquisites are to be made by the completion of the FAU Request for Approval of Perquisites or Sales of Goods and Services form.
   3. The completed request is to be submitted to the University Personnel Services Department for review and recommendation to the appropriate division vice president for final action.
   4. The Vice President’s Office returns the “Request for Approval of Perquisites or Sale of Goods and Services” to Personnel Services.
   5. Personnel Services will return the original with appropriate signature to the requesting department for action.
   6. The requesting Department will contact the University Purchasing Department to coordinate the requisitioning and maintenance of perquisites through a contracting organization.
   7. Departments terminating the provision of perquisites and/or perquisite items for an employee or a group of employees must submit a completed Request for Approval of Perquisites or Sale of Goods and Services for to University Personnel Services. The type of request should be indicated as a “Request to Delete.”
   8. Perquisites are valid for one fiscal year but may be renewed annually.
3. FORM INSTRUCTIONS

   ITEM 1  -  UNIVERSITY CODE
   Type the appropriate university code from the following list:

   CODE - UNIVERSITY
   FAU     -  Florida Atlantic University

   ITEM 2  -  REASONS FOR SUBMISSION OF FORM
   Check only one box.

   1. New request for approval – Check this box if this is a new request. The Office of Personnel Services will assign a Request Number.
   2. Request to revise existing approval-Request # - Check this box to revise an existing approval and enter the Request Number previously assigned by the Office of Human Resources.
   3. Request to delete existing approval-Request # - To discontinue the provision of such prior approval, check this box and enter the Request Number.

   ITEM 3  -  LOCATION

   1. County Code – Type the two-digit county code below that reflects where the perquisite or sale of goods and services is to be provided.

      CODE	NAME
      06	BROWARD
      31	INDIAN RIVER
      43	MARTIN
      50	PALM BEACH
      56	ST. JOHN
      98	OUT-OF-STATE
      99	OUT-OF-COUNTRY

      
      
   2. Facility – Enter as applicable the name of the college/school, department, division, center or hospital where the perquisite or sale of goods and services is to be provided.
   3. Address – If the perquisite is housing of any type, i.e., room, apartment, trailer, house, or a trailer space, provide a street address, room number, or trailer space number as appropriate.

   ITEM 4  -  CLASSIFICATION INFORMATION
   For each class to receive the perquisite or sale of goods and services, Sections 4a. through 4d. must be completed.

   1. Pay Plan – Enter the appropriate pay plan code from the following list for each class:

      CODE	PAY PLAN
      21	Administrative Managerial Professional
      22	Faculty
      23	Support Personnel
      24	Executive Service (a subset of the AMP pay plan)
      99	Temporary

      
      
   2. Class Code – Enter four-digit Class Code, do not omit leading zero.
   3. F.T.E. in Class – Enter the Full Time Equivalence (F.T.E.) of the positions in each class which will receive the perquisite or be sold goods and services.
   4. Class Title – Enter the official Class Title. Do not use a working title. Abbreviate only if there is insufficient space to enter the full Class Title.

   ITEM 5  -  JUSTIFICATION / REMARKS

   1. Required – Indicate by “Y” (yes) or “N” (no) whether the perquisite or sale of goods and services is a condition of employment for the employee(s).
   2. Justification Code – Enter the code from the following list which represents the primary benefit or purpose for provision of the perquisite or sale of goods and services:

      CODE	PRIMARY JUSTIFICATION
      ACC	Access
      COD	Continuous On-Duty
      CON	Convenience
      ER	Emergency Response
      H&S	Health & Safety
      ID	Identification
      MON	Monitoring
      OTH	Other
      PRO	Protection
      PR	Public Relations
      SAN	Sanitation
      SEC	Security

   3. Justification Narrative – Enter narrative justification as required in the procedures section of the Rules governing the approval of perquisites or the sale of goods and services. The narrative justification must relate to the Justification Code used in ITEM 5b. and should also include justification (if any) beyond the primary justification.

   ITEM 6  -  ITEM DESCRIPTION

   1. Goods or Services Code / Narrative Description – Enter the code from the following list which describes the perquisite/goods or services to be provided. Enter the Narrative Description which matches the Goods and Services Code. Additional narrative should be included if necessary to adequately describe the perquisite/goods or services to be provided.

      Note: Do not enter more than one Goods or Services Code. A different Goods or Services Code requires completion of a separate Perquisite Form. Further, a separate Perquisite Form must be submitted for each apartment, duplex, house, trailer, or trailer space.

      CODE	NARRATIVE DESCRIPTION
      A105	Appliances
      B110	Barber or Beautician Services
      C115	Cash Allowance, Equipment replacement
      C120	Cash Allowance, Laundry (personal clothes only)
      C125	Cash Allowance, Law Enforcement deck shoes
      C130	Cash Allowance, Meals
      C135	Cash Allowance, Others
      C140	Cash Allowance, Shoes (not part of uniform)
      C145	Cash Allowance, Sworn Law Enforcement Plain Clothes allowance and shoe allowance
      C150	Cash Allowance, Personal property replacement
      C155	Cash Allowance, Tools
      D159	Clothing, Airplane Uniform with shoes, with no uniform maintenance or shoe allowance
      D160	Clothing, Athletic Uniform with shoes, with uniform maintenance and shoe allowance
      D165	Clothing, Athletic Uniform with shoes, with uniform maintenance allowance only
      D170	Clothing, Athletic Uniform with shoes, with shoe allowance only
      D175	Clothing, Athletic Uniform with shoes, with agency provided laundry
      D180	Clothing, Athletic Uniform with shoes, with no allowance or laundry
      D225	Clothing, Medical Uniform, agency laundry service
      D226	Clothing, Medical Uniform with Shoes, no allowance or laundry service
      D227	Clothing, Medical Uniform without shoes, no allowance or laundry service
      D270	Clothing, Other Uniform with shoes, with uniform and shoe allowance
      D271	Clothing, Other Uniform without shoes, no allowance or laundry service
      D275	Clothing, Other Uniform with shoes, with uniform allowance only
      D280	Clothing, Other Uniform with shoes, with shoe allowance only
      D285	Clothing, Other Uniform with shoes, with agency laundry service
      D290	Clothing, Other Uniform with shoes, rental
      D295	Clothing, Other Uniform with shoes, no allowance or laundry service
      D296	Clothing, Lifeguard Uniform without shoes, no allowance or laundry service
      D300	Clothing, Personal Clothing with shoes, with clothing and shoe allowance
      D305	Clothing, Personal Clothing with shoes, with laundry service
      D310	Clothing, Personal Clothing with shoes, with no allowance or laundry
      D315	Clothing, Personal Clothing with shoes, rental
      D320	Clothing, Personal Clothing without shoes, with clothing allowance
      D325	Clothing, Personal Clothing without shoes, with laundry service
      D330	Clothing, Personal Clothing without shoes, no allowance or laundry service
      D335	Clothing, Personal Clothing without shoes rental
      D337	Clothing, Formal wear, rental
      D340	Clothing, Protective Outer, Lab
      D345	Clothing, Protective Outer, Lab, agency laundry
      D350	Clothing, Protective Outer, Lab, rental
      D355	Clothing, Protective Outer, Medical
      D360	Clothing, Protective, Outer, Medical, agency laundry
      D365	Clothing, Protective Outer, Medical, rental
      D370	Clothing, Protective Outer, Service
      D375	Clothing, Protective Outer, Service, agency laundry
      D380	Clothing, Protective Outer, Service, rental
      D385	Clothing, Protective Outer, Food Service
      D390	Clothing, Protective Outer, Food Service, agency laundry
      D395	Clothing, Protective Outer, Food Service, rental
      D400	Clothing, Protective Outer, Diving
      D405	Clothing, Protective Outer, Rain
      D410	Clothing, Security Uniform with shoes, with uniform maintenance and shoe allowance
      D415	Clothing, Security Uniform with shoes, with uniform maintenance allowance only
      D420	Clothing, Security Uniform with shoes, with shoe allowance only
      D425	Clothing, Security Uniform with shoes, with agency laundry service only
      D430	Clothing, Security Uniform with shoes, with no maintenance allowance
      D435	Clothing, Security Uniform without shoes, with uniform maintenance allowance
      D436	Clothing, Security Uniform without shoes, with uniform maintenance and shoe allowance
      D440	Clothing, Security Uniform without shoes, with agency laundry service
      D445	Clothing, Security uniform without shoes, with no allowance
      D450	Clothing, Service Uniform with shoes, with uniform maintenance and shoe allowance
      D455	Clothing, Service Uniform, with shoes, with uniform allowance only
      D460	Clothing, Service Uniform with shoes, with shoe allowance only
      D465	Clothing, Service Uniform with shoes, with agency laundry service
      D470	Clothing, Service Uniform with shoes, rental
      D475	Clothing, Service Uniform with shoes, with no allowance or laundry service
      D480	Clothing, Service Uniform without shoes, with uniform allowance
      D485	Clothing, Service Uniform without shoes, with agency laundry service
      D490	Clothing, Service Uniform without shoe, rental
      D493	Clothing, Service Uniform without shoes, with shoe allowance only
      D495	Clothing, Service Uniform without shoes, with uniform maintenance and shoe allowance
      D500	Clothing, Service Uniform without shoes, no allowance or laundry service
      D505	Clothing, Specialty, Cap
      D507	Clothing, Specialty, Promotional Straw Hat
      D510	Clothing, Specialty, Vest
      D511	Clothing, Flight Suit with shoes, with maintenance allowance
      D512	Clothing, Flight Suit only, without maintenance allowance
      D513	Clothing, Sworn Law Enforcement identification shirt
      D514	Clothing, Sworn Law Enforcement identification jacket
      D515	Clothing, Sworn Law Enforcement Uniform with shoes, with uniform allowance and shoe allowance
      D520	Clothing, Sworn Law Enforcement Uniform with shoes, with uniform maintenance allowance only
      D525	Clothing, Sworn Law Enforcement Raid Uniform without shoes, no allowance
      D527	Clothing, Sworn Law Enforcement Training Uniform without shoes, no allowance
      D530	Clothing, Sworn Law Enforcement Uniform without shoes, with uniform maintenance allowance
      D531	Clothing, Sworn Law Enforcement Uniform without shoes, no allowance
      D532	Clothing, Sworn Law Enforcement Uniform without shoes, with uniform maintenance and shoe allowance
      D533	Clothing, Band Uniform, no allowance
      D534	Clothing, Usher/Ticket Collection Shirt
      D535	Clothing, Not elsewhere classifiable
      D541	Clothing, Fatigue Uniform with boots
      E540	Equipment, prescription safety lenses
      E545	Equipment, rubber boots
      E550	Equipment, safety boots
      E555	Equipment, safety equipment
      E560	Equipment, safety shoes
      E565	Equipment, snake boots
      E567	Equipment, operating room shoes
      E568	Equipment, tennis shoes
      F570	Food Products (Not including meals)
      G780	Telephone Service, answering service
      G785	Telephone Service, calls only
      G790	Telephone Service, extension phone with SUNCOM
      G800	Telephone Service, listing service
      G805	Telephone Service, mobile phone with SUNCOM
      G810	Telephone Service, mobile without SUNCOM
      H575	Housing, Apartment, with all utilities provided
      H580	Housing, Apartment, with water, sewer provided
      H585	Housing, Apartment, with water provided
      H590	Housing, Apartment, employee paid utilities
      H620	Housing, 1 Bedroom House, with all utilities provided
      H625	Housing, 1 Bedroom House, with water, sewer provided
      H630	Housing, 1 Bedroom House, with water provided
      H635	Housing, 1 Bedroom House, employee paid utilities
      H640	Housing, 2 Bedroom House, with all utilities provided
      H645	Housing, 2 Bedroom House, with water, sewer provided
      H650	Housing, 2 Bedroom House, with water provided
      H655	Housing, 2 Bedroom House, employee paid utilities
      H660	Housing, 3 or More Bedroom House, with all utilities provided
      H665	Housing, 3 or More Bedroom House, with water, sewer provided
      H670	Housing, 3 or More Bedroom House, with water provided
      H675	Housing, 3 or More Bedroom House, employee paid utilities
      H595	Housing, Duplex, with all utilities provided
      H600	Housing, Duplex, with water, sewer provided
      H605	Housing, Duplex, with water provided
      H615	Housing, Duplex, employee paid utilities
      H680	Housing, State Trailer, with all utilities provided
      H685	Housing, State Trailer, with water, sewer provided
      H690	Housing, State Trailer, with water provided
      H695	Housing, State Trailer, employee paid utilities
      H700	Housing, Trailer Space, with all utilities provided
      H705	Housing, Trailer Space, with water, sewer provided
      H710	Housing, Trailer Space, with water provided
      H715	Housing, Trailer Space, employee paid utilities
      J740	Medical Service, Annual Physical provided by State personnel
      J745	Medical Service, Annual Physical provided by private personnel
      J750	Medical Service, Periodic Check-up provided by State personnel
      J755	Medical Service, Periodic Check-up provided by private personnel
      J760	Medical Service, Pre-employment Physical provided by State personnel
      J765	Medical Service, Pre-employment Physical provided by private personnel
      J770	Medical Service, Inoculations provided by State personnel
      J775	Medical Service, Inoculations provided by private personnel
      K820	Transportation, bus
      K825	Transportation, taxi
      K830	Transportation, other
      K835	Transportation, vehicle, personal use of State-owned
      K840	Transportation, vehicle, personal use of leased
      L845	Personal Service, janitorial
      M720	Meals, all
      M725	Meals, breakfast
      M730	Meals, dinner
      M735	Meals, lunch
      N815	Tickets
      T100	Off-Duty Use – Law Enforcement vehicle, equipment, uniform
      T200	Office Enhancements
      T400	USAID – Employee/Dependent immunizations and medications
      T401	USAID – Employee/Dependent passport and related fees
      T402	USAID – Employee/Dependent pre-departure subsistence
      T403	USAID – Employee/Dependent temporary lodging allowance
      T404	USAID – Dependent educations allowance
      T405	USAID – Dependent per diem and air fare
      T406	USAID – Employee/Dependent physical examinations
      T500	Legal Services
      T550	Relocation Expenses
      TTTT	Other

   2. University Item I.D. – For use by Personnel Services only.

   ITEM 7  -  PER UNIT COST INFORMATION

   1. Class Code – Enter the Class Code of recipient. The Class Code(s) entered must match those entered in ITEM 4.b. of the perquisite form.
   2. Annual Cost to the University – Show the annual cost to the University for one F.T.E. If there is an identifiable direct cash payment to the employee, such as shoe allowance, cleaning allowance for clothing, etc., do not include that cost here. It should be reported under ITEM 7C.
   3. Annual Maintenance Allowance Cost – Enter the annual maintenance allowance cost for one unit. This is a direct cash allowance payment to the employee only; do not enter, for example, the cost to maintain housing.
   4. Annual Fair Market Value – Housing only, all other categories leave blank. Enter the annual fair market rental valued for each housing unit.
   5. Annual Charge to Employee – Enter the annual charge to the employee, if any, for each unit.
   6. Monthly Cost to the University – Enter the total monthly cost to the University per unit.

   ITEM 8  -  TOTAL ANNUAL COST FOR ALL POSITIONS
   Enter the grand total cost of all units for all positions in all classes covered by the request.

   ITEM 9  -  BEGINNING DATE AND ENDING DATE
   Enter the proposed effective beginning and ending date of the perquisite. Do not cross over fiscal years.

   ITEM 10  -  BASIS FOR COST DETERMINATION
   Enter the basis for determining the cost and/or fair market value as reported in ITEM 7, Per Unit Cost Information.

   ITEM 11  -  REQUESTING DEPARTMENT SIGNATURE
   Dean/Director or higher level Authority signature required.

   ITEM 12  -  DATE
   Enter the date the above authority signed the perquisite form.

   ITEM 13  -  PERSONNEL SERVICES
   A personnel representative will sign indicating documentation has been submitted properly.

   ITEM 14  -  DATE
   Enter the date the above authority signed the perquisite form.

   ITEM 15  -  ACTION TAKEN
   For use by Chief Financial Officer for approval

   If “Approved”, the request shall remain in effect for the remainder of the fiscal year unless otherwise notified by the Office of Personnel Services and provided no changes occur to any reported information. If changes occur, the requesting department shall submit a new “Request for Approval of Perquisite”, in a timely manner.

Microsoft Word Form or PDF Format (print only)

Please direct questions to Natasha Terry, 561/297-3026, Taina Teran, 561/297-1389, or Debra W. Brooks, 561/297-2401.