SOM New Design Project Authorization Form

Have a new furniture project? Please complete the form below. Requests South of Highway 55 are handled by Marie Shaw. If you are North of Highway 55, email it to AmyV@interphaseinc.com. A designer will be in contact with you to kick off the design process! This form may be used for State Leased Spaces only. If you are in a State-owned facility, you will need to go through the Work Order process to begin a new project.

Design Authorization
Are you located North of Highway M55?*
If yes, your request will be forwarded to Amy VanderMeer.
- Yes
- No
Date*
MM slash DD slash YYYY
Agency Name*
Project Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Floor/Pillar #
Agency Contact*
First Last
Email
On-Site Contact
If different than Agency Contact
First Last
On-Site Contact Phone*
Project Scope*
Describe the project you are looking to have completed by DBI
Anticipated Project Completion Date*
MM slash DD slash YYYY
Consent*
Please be advised that, per the contract - Section 1.3.B Programming and Design Services- you will be responsible for any design fees associated with this project even in the event that the project is canceled, put on hold or any other event that prevents the completion of the project.
I agree to the policy.
Authorized By*
First Last
Title*
Date
MM slash DD slash YYYY

SOM New Design Project Authorization Form

Design Authorization