Property Loan Form - California State University, Dominguez Hills

Property Loan Form
Property Tag Number:
Model Number:
Serial Number:
I agree to assume responsibility for the above California State University Dominguez
Hills equipment during the period of:
(not to exceed 30 days)
The Director of Procurement and Contracts may approve extension of this date.
I understand that I may be held financially responsible for loss, theft, or damage due to
negligence on my part. Should the University determine my negligence resulted in loss
of, or damage to the property, I will reimburse the University in a manner prescribed by
the University.
When circumstances require that the University Property is to be taken off campus, the
Dean or Unit Head must authorize the loan and record that transaction on this form. Off
campus use must be related to University business and should not exceed 30 days unless
approved by the Director of Procurement and Contracts prior to the item being taken off
University Property.
I further understand that I am not relieved of responsibility for the above item (s) until the
appropriate signature is obtained below.
Please print the name of faculty/staff member: ____________________________ _____
Signature of faculty/staff member: ___________________________________________
Approval Signature:_________________________ Please Print: ___________________
(Dean or Administrative Department Head)
CC: Director of Procurement and Contracts
Completed upon return of property.
I acknowledge return of the following item (s)__________________________________
Signature: _______________________________
(Dean or Administrative Dept. Head)
or Procurement & Contracts
Date: _________________________