Please read the following information before you go to the next page of the ASSA On-Line Form.

A. When you open the on-line ASSA Form a number will automatically be assigned on the top of the form.  This number cannot be changed.  If you are completing an amendment to a previous ASSA request, after you print the form, you must cross out the assigned number by hand and write in the number of the ASSA you are amending.

B. Complete all fields on the form as indicated by tabbing to each field.

C. Once entries are completed, you cannot save the form to your computer.

D.  PRINT BOTH SIDES of the form.  If you print the Terms & Conditions on a separate page, the contractor MUST initial and date the second page OR the ASSA will be returned.  We will not accept any requests without the Terms and  Conditions page.

E.  Four (4) copies of the ASSA are required:
  • The Original and one (1) copy should be sent to Pre-Audit
  • One (1) copy should be given to the Contractor
  • One (1) copy should be retained by the department
  • All four copies must have Signatures.

F.  Any questions please call pre-audit at Extension #6656

NOTE:  We WILL NOT accept the old version of the ASSA Form after March 1, 2013

Please click here to download the form