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Docusign Envelope ID: B94A7A7D-AOC2-4E5C-867B-62FAAB4A6E80 EXHIBIT 4 <br /> City of San Marcos On-Call Agreement <br /> Fund Allocation Request Form <br /> 'Fund Allocation Number: <br /> Instructions for Use: This Form will be used to"assign"or allocate services for project scopes to approved firms <br /> through the related Master On-Call Agreement.Assigned services may NOT begin until this form is completed <br /> (front and back)with all signatures and a Purchase Order is issued by COSM. <br /> Company Name: _ Project Name: <br /> Company PM: On-Call Agreement Name: <br /> On-Call Agreement#: <br /> This Fund Allocation Form authorizes the Consultant(Firm)to provide the services described below in accordance with <br /> the Master On-Call Professional Services Agreement between the Consultant(Firm)and the City of San Marcos. <br /> PROJECT DESCRIPTION: <br /> SCOPE OF BASIC SERVICES: <br /> This information must be completed prior to making the assignment/Fund Allocation: <br /> *Fill out page 2 first for calculations. <br /> Original On-Call Agreement Amount: $ <br /> Change In Service(change order/amendments to Date: $ <br /> Revised Agreement Amount: $ 0.00 <br /> Previous Fund Allocations Amount: $ 0.00 <br /> Released Purchase Order Funds: $ 0.00 <br /> Amount of this Request:1 $ <br /> Funds Remaining on On-Call Agreement:Agreement:1 $ 0.00 <br /> Requested By Date <br /> Reviewed and Approved by: <br /> City Project Manager Date <br /> Director Date <br /> Authorization to Proceed: Following receipt of COSM Purchase Order,the Consultant(Firm)is authorized to proceed with the Services <br /> described above. <br /> **For Internal Use Only.To be filled out by PM** <br /> Project Fund Phase Amount <br /> GL Account rev 2/6/2020 <br /> Submit invoices via email to the City PM and copy kfoxworth@sanmarcostx.gov <br />