Consulting Contract Return on Investment Justification Form Requester InformationName of Requester * Required First Last Requester Phone NumberRequester Email * Required DepartmentDepartment Buyer Name * Required First Last Consultant InformationIndividual Consultant or Consultant Group Name * RequiredMain Contact Phone * RequiredMain Contact Email * Required Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Service to be Provided * RequiredThe service that is being provided by the Consultant.Term of Service * RequiredHow long the Consultant will be providing the services? Format: MM/DD/YYYY – MM/DD/YYYYNot To Exceed (NTE) Fee Amount * RequiredFormat $1,234.56Does Consultant/Contractor Accept Credit Card Payment? * Required Yes No Consulting Return on Investment JustificationThe Commonwealth of Virginia laws mandate Higher Education to maximize competition in the procurement process. Exemptions from competition must be fully justified, documented and pre-approved. Consulting services valued up to $100,000 are exempt from competition, however, all Consulting services valued above $10,000 require a completed return on investment justification prior to procuring. The following is a list of questions which will substantiate a Consulting procurement and ensure a Return on Investment for the University. Please attach to this form and any additional documents as necessary to fully answer all questions. DISCLAIMER: Before procuring the services of the above reference Consultant, a Consulting Contract must be created and executed by Procurement Services.Briefly, provide an explanation for the need for consulting services. * RequiredBriefly, provide a background on the expertise of the chosen consultant. * RequiredWhy was this specific Consultant selected? What other Consultants were considered? What attributes of this Consultant prevailed above and beyond those of other similar Consultants? * RequiredHow was the fee for the consultant determined? What effort was made by the University to negotiate this fee? Please explain why the fee is considered fair and reasonable for the University. * RequiredWhat is the expected return on investment or value add for the University? What should the University expect to gain from this relationship relative to the expense? * RequiredAttachments: (W9, contract, scope of work, quote, etc.) * RequiredMax. file size: 6 MB. Please provide any attachment files necessary for evaluation of this request. Δ See Accounts Payable for their Independent Contractor Questionnaire and Guide.