Download New Charitable Contribution / Sponsorship Form

Charitable Contributions and
Charitable Event Sponsorships
Approval Request Form
This form must be completed if:
a) The contribution / sponsorship amount is greater than $2,500, or
b) The contribution / sponsorship (in any amount) has been requested by a Government Customer OR the Beneficiary is
affiliated or associated with a Government Customer (see Definition 1, below).
NOTE: This Form and the related approval paths do NOT apply to NON-Charitable (Trade/Marketing) Events and
Sponsorships (see Definition 2, below).
The completed form must include or be accompanied by:
 All appropriate pre-approvals as outlined in the appropriate Approval Matrix
 Supporting documentation with information about the charity/event (e.g. brochure, flyer, or website)
 A justification for the donation (e.g. relationship-building, networking, community support) including the nature and
purpose of the contribution / sponsorship
 A completed Global Payment Request form (GPR) unless the donation is in-kind (e.g. products or services).
NOTE: Other methods of payment, including corporate credit card, are prohibited.
Legal Compliance Approval is to be obtained by submitting the completed form with all prior approvals to:
www.JCIComplianceForms.com
1.
What is the total value of the contribution / sponsorship in U.S. Dollars?
2.
Who is the Beneficiary (recipient of the donation or
proceeds from the event)?
3.
Is the Beneficiary a Charitable Organization (see Definition 3, below)?
4.
Is this an event sponsorship? (a specific occasion of limited duration)
$
Y/N
Y/N
If yes, date of event:
Y/N
If yes, is Johnson Controls the only Sponsor of the event?
If yes, who will attend the event on behalf of or as a
guest of Johnson Controls (see Definition 4, below)?
5.
Is the contribution / sponsorship in-kind (e.g. products or services)?
Y/N
6.
Was this contribution / sponsorship requested by a Johnson Controls customer or prospective
customer or someone who has decision-making authority with respect to awarding Johnson
Controls business?
If yes, is the customer a Government Employee
(see Definition 5, below)?
Y/N
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Y/N
Effective Date 05/01/2017
This document contains trade secrets and proprietary information of Johnson Controls, Inc. Disclosure of this publication is absolutely prohibited
without the express written permission of Johnson Controls, Inc. © 2017 Johnson Controls, Inc. All rights reserved.
Charitable Contributions and
Charitable Event Sponsorships
Approval Request Form
Y/N
If yes, will the contribution / sponsorship directly
benefit the Government Employee?
7.
Is the Beneficiary connected to or affiliated with a Johnson Controls customer or prospective
customer?
Y/N
8.
9.
Are there any pending business negotiations between Johnson Controls and the Beneficiary?
Are there any pending business negotiations between Johnson Controls and the person who
suggested this contribution / sponsorship or his or her employer?
Has Johnson Controls made contributions to or sponsored events for the Beneficiary in the
past?
If yes, please provide the amount of the most
recent prior contribution / sponsorship.
Y/N
Y/N
10.
Y/N
$
If you need more room for any of your answers or you answered “YES” to any part of questions 5, 6, 7, 8, or 9, provide a
written description of the specific circumstances below or in a separate, attached, document.
Requester: I have personally verified the accuracy of the information provided above and, based on that information, I
believe that the proposed Charitable Contribution / Event Sponsorship will not violate any policy of the recipient
organization.
Requester Printed Name
Requester Signature
GLOBAL ID
Date
Refer to the appropriate Approval Matrix and obtain the required approvals. Not all of the approvals listed below
are necessary for every transaction.
Approvals
Printed Name
Signature
(or attach email
approval)
GLOBALID
Date
Supervisor
Operations / Business
Function (Indicate
Approval Level)
Finance
(Indicate Approval
Level)
Page 2 of 3
Effective Date 05/01/2017
This document contains trade secrets and proprietary information of Johnson Controls, Inc. Disclosure of this publication is absolutely prohibited
without the express written permission of Johnson Controls, Inc. © 2017 Johnson Controls, Inc. All rights reserved.
Charitable Contributions and
Charitable Event Sponsorships
Approval Request Form
Finance - Second
Approver, if required
(Indicate Approval
Level)
Legal Compliance
(Approval Level 30)
Legal Compliance
(Approval Level 40)
Business Unit HQ
Executives (Approval
Level 60)
Definitions:
1) Government Customer - Any customer which is: (i) a body or branch of national, regional, provincial, state, municipal or local
government, whether legislative, executive, or judicial, or any person acting in an official capacity on behalf of a government entity; (ii) a
public international organization or political party; (iii) Government Controlled Businesses.
2) NON-Charitable (Trade/Marketing) Events and Sponsorships – Payments for event attendance and/or sponsorship, or
contributions/donations to non-charitable organizations or trade-related associations. Such non-charitable events may include a
contractor's association dinner, trade conference, energy forum, golf outing, tickets to a sporting event, concerts or other events where
the primary purpose of the payment of money is to develop business relationships and promote Johnson Controls products and
services.
3) Charitable Organization - A non-profit organization that provides aid or assistance to others or that has a philanthropic, public
service mission. While Charitable Organizations are not the same thing as tax-exempt organizations such as schools, hospitals,
municipalities, governmental or government-controlled entities or agencies, they can include separately organized and governed
charitable affiliates of such tax exempt organizations. Charitable Organizations do not include for-profit business organizations.
4) All invitees to the event MUST be in compliance with Johnson Controls’ Policy on ‘Third Party Travel, Gifts and Entertainment (1025),’ more specifically, the section on Guidelines for Providing Entertainment (section E). Special care should also be taken if
customers are government officials and/or there is business pending with them.
5) Government Employee - Any individual who is: (i) an employee, representative, officer, director, agent, consultant or board
member of any body or branch of national, foreign, regional, provincial, state, municipal or local government, whether legislative,
executive, or judicial, or any person acting in an official capacity on behalf of a government entity; (ii) an officer, representative director,
employee, agent, consultant, or official of a public international organization, officials of political parties, candidates for political office,
political parties; (iii) officers, representative directors, employees, agents, consultants, or officials of Government Controlled
Businesses.
For further information, reference:
Charitable Contribution and Charitable Event Sponsorship Policy (140-70)
Or contact [email protected]
Page 3 of 3
Effective Date 05/01/2017
This document contains trade secrets and proprietary information of Johnson Controls, Inc. Disclosure of this publication is absolutely prohibited
without the express written permission of Johnson Controls, Inc. © 2017 Johnson Controls, Inc. All rights reserved.