DJJ Form A "Cardholder Agreement - State of Florida Purchasing Card Program" - Florida

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State of Florida Purchasing Card Program
Cardholder Agreement
I AGREE TO THE FOLLOWING REGARDING THE USE OF THE FLORIDA PURCHASING CARD ASSIGNED
TO ME FOR OFFICIAL STATE BUSINESS ONLY.
I understand that I am being entrusted with a powerful and valuable tool and will be making financial
1)
commitments on behalf of the State of Florida and will strive to obtain the best value for the State.
I understand that under no circumstances will I use the Purchasing Card to make personal purchases,
2)
either for myself or others. Using the Purchasing Card for personal gain or unauthorized use may result
in disciplinary actions up to and including termination of employment and prosecution to the extent
permitted by law.
I will follow Florida Law, purchasing policies of my employing agency, and the established guidelines
3)
for using the Purchasing Card. Failure to do so may result in either revocation of my card privileges or
other disciplinary action.
I have been provided a copy of the Purchasing Card Guidelines and attended training on
4)
________________ and understand the Purchasing Card Program. I have been given an opportunity to
ask any questions to clarify my understanding of the Purchasing Card Program.
I agree to review and reconcile transactions timely, and will maintain all applicable information and
5)
receipts.
I agree that, should I violate the terms of my Agreement, I will reimburse the State of Florida for all
6)
incurred charges and any costs related to the collection of such charges. Additionally, any such
charges that I owe the State may be deducted from any money which would otherwise be due and
owing me, including salary or wages, in accordance with Rule 3A-21.004, F.A.C.
I agree to immediately surrender the Purchasing Card issued to me upon termination of employment
7)
with the Department of Juvenile Justice.
_______________________________________
________________________________________
Cardholder Name (Print)
Supervisor Name (Print)
________________________________________
________________________________________
Cardholder Signature
Supervisor Signature
________________________________________
________________________________________
Date
Date
Form A
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State of Florida Purchasing Card Program
Cardholder Agreement
I AGREE TO THE FOLLOWING REGARDING THE USE OF THE FLORIDA PURCHASING CARD ASSIGNED
TO ME FOR OFFICIAL STATE BUSINESS ONLY.
I understand that I am being entrusted with a powerful and valuable tool and will be making financial
1)
commitments on behalf of the State of Florida and will strive to obtain the best value for the State.
I understand that under no circumstances will I use the Purchasing Card to make personal purchases,
2)
either for myself or others. Using the Purchasing Card for personal gain or unauthorized use may result
in disciplinary actions up to and including termination of employment and prosecution to the extent
permitted by law.
I will follow Florida Law, purchasing policies of my employing agency, and the established guidelines
3)
for using the Purchasing Card. Failure to do so may result in either revocation of my card privileges or
other disciplinary action.
I have been provided a copy of the Purchasing Card Guidelines and attended training on
4)
________________ and understand the Purchasing Card Program. I have been given an opportunity to
ask any questions to clarify my understanding of the Purchasing Card Program.
I agree to review and reconcile transactions timely, and will maintain all applicable information and
5)
receipts.
I agree that, should I violate the terms of my Agreement, I will reimburse the State of Florida for all
6)
incurred charges and any costs related to the collection of such charges. Additionally, any such
charges that I owe the State may be deducted from any money which would otherwise be due and
owing me, including salary or wages, in accordance with Rule 3A-21.004, F.A.C.
I agree to immediately surrender the Purchasing Card issued to me upon termination of employment
7)
with the Department of Juvenile Justice.
_______________________________________
________________________________________
Cardholder Name (Print)
Supervisor Name (Print)
________________________________________
________________________________________
Cardholder Signature
Supervisor Signature
________________________________________
________________________________________
Date
Date
Form A
Reset/Clear Form
Save As
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