Ex6C: Personal Property Loan Agreement

This agreement is used when property is loaned to OSU.  The completed agreement and signed exclusions page should be forwarded to Property Management.  If the property will be in OSU’s custody for more than 90 days and is to be insured by OSU, a completed Fixed Asset Data Entry (FADE) form should be attached as well.

Page 1

• Lender: Enter full name of individual or organization loaning the property to OSU.

Personal Property Loan Agreement with sample data (page 1)

Page 2

To Be Completed By Lender:

• Name: Enter full name of individual or organization loaning the property to OSU.
• Address: Enter mailing address of lender.
• Telephone: Enter phone number of lender.
• Date Object(s) Will Arrive: Enter month, day and year the property will arrive at OSU for loan.
• Date Object(s) Will Be Removed: Enter month, day and year the loan will terminate, not to exceed two years from the day the property arrives.
• Title of Exhibit (if any): Enter title, if loaned item is displayed.
• Name & Telephone of LENDER’s Insurance Co.: Enter name and phone number of the insurance company that insures the lender’s other personal property (either corporate or homeowner’s insurance).
• Will LENDER’s Insurance Company Cover Object(s)?: Check “Yes” if the lender’s insurance will insure the property while it is loaned to OSU; check “No” if the lender’s insurance will not insure the property while it is loaned to OSU.

To Be Completed By OSU:

• Department: Enter OSU department borrowing the equipment.
• Address: Enter address of the OSU department borrowing the equipment.
• Telephone: Enter departmental phone number of the department borrowing the equipment.
• Contact Person: Enter name of person coordinating the agreement for the OSU department borrowing the equipment.
• Is Insurance To Be Provided By OSU?: Check “Yes” if OSU is expected to insure the property, and “No” if OSU is not expected to insure the property.
• If yes, explain. . .: Follow instructions on the form.

Listing of Object(s) on Loan:

• Description: Enter complete description of property on loan (i.e., common or generic noun, manufacturer, model number, etc.).
• Serial number or ID No.: Enter manufacturer’s serial number or lender’s identifying number, if marked.
• Estimated value: Enter replacement value supplied by lender.
• Identification Numbers: Enter manufacturer serial number or other identifying number.
• Condition on Arrival at OSU: Enter lender’s and borrower’s estimate of condition.
• Examined By: Enter name of OSU employee who examined equipment and verified condition, identification numbers, etc.
• Title: Enter position title of OSU employee who examined equipment.
• Date: Enter date equipment was examined.
• LENDER: Legal signature of lender, and date of signature.
• Property Management: Signature of Property Management staff approving the loan.

Personal Property Loan Agreement with sample data (page 2)

TO BE COMPLETED BY LENDER: Name:____ELLEN HELMRICK__________________ Address:1450 NW Grant Ave.,Corvallis, OR 97330 Telephone:      (541) 752-7722                       Date Object(s) will arrive at OSU:    01/05/02     Date Object(s) will be removed:     05/31/02       Title of Exhibit (if any):__________________________________ Name & Telephone number of LENDER’S Insurance Co.   State Farm Insurance Co., (541) 758-6767   Will LENDER’S Insurance Company cover object(s)? Yes:___________ No:             X              .

TO BE COMPLETED BY OSU: Department:          FORESTRY                          Address  104 Peavy Hall                                Telephone:        (541) 737-4047                         Contact Person:       Eileen Gibby                      Is insurance to be provided to OSU?  Yes X No __ If yes, explain what direct or material benefit will accrue to OSU by the loan of this object(s). If personal property is being loaned to OSU for on-the-job use by LENDER, explain why OSU does not provide the equipment.   Equipment is not available within the department   and is only needed for a short term project.

LISTING OF OBJECT(S) ON LOAN:                 Description / Manufacturer / Model         Serial or ID No.      Value         Condition on Arrival at OSU   Cassette Recorder, Mitsubishi HS-U54, s/n U54009188M____$499.00___________Good_________ _Camera, Olympus 35mm SLR, s/n N/A___________________$250.00___________Good_________ ____________________________________________________________________________________ ____________________________________________________________________________________ Examined by:___Eileen Gibby_____________       Title:_Office Specialist II               Date:__01/03/02____ LENDER has read the Department of General Services, Policy Manual, “Exclusions” to insurance provided by OSU and understands what is not covered.  The parties have caused this Agreement to be executed as of the date of the last signature. ____Ellen Helmrick____________01/03/02      _______________________________________ LENDER                                   Date                 PROPERTY MANAGEMENT             Date NOTE: If OSU agrees to provide insurance, agreement must be signed by OSU Property Management.  Send to Property, Contract & Risk Management, 644 SW 13th Street, Corvallis, OR 97333-4238). Direct questions to Property Management at 737-7350.

 

Page 3

Personal Property Loan Agreement with sample data (page 3)

Page 4

• Signature: Legal signature of lender, and date of signature.
• Typed or Printed Name: Enter full name of lender, typed or printed.
• Telephone Number: Enter telephone number of lender.

Personal Property Loan Agreement with sample data (page 4)