Purchase of Goods/Services Requisition Form - Colorado

This "Purchase of Goods/Services Requisition Form" is a part of the paperwork released by the Colorado Department of Military and Veterans Affairs specifically for Colorado residents.

The latest fillable version of the document was released on September 25, 2015 and can be downloaded through the link below or found through the department's forms library.

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COLORADO DEPARTMENT OF MILITARY AND VETERANS AFFAIRS
PURCHASE OF GOODS/SERVICES REQUISITION FORM
Form is not complete unless accurate, all signatures obtained, and required documentation attached.
Requested by:
Work Unit:
Phone:
Dated Requested:
Date Needed:
Fax Number:
Requested Vendor:
Vendor FEIN:
Vendor Phone:
Vendor Address:
Item(s) or Service Requested (Please be specific):
Qty
Unit
Complete Description
Item #
Unit Price
Total
$
TOTAL:
$
Approvals:
Authorized Signature:
Date:
Authorized Signature:
Date:
OSA Delegate (if required):
Date:
Shipping Information:
Facility:
Address:
Bldg No.:
City, State, ZIP:
SHIP CODE:
Requestor Checklist (Form will not be accepted by Accounting/Purchasing and Contracts without being completed, all
signatures obtained, and required documentation attached.) PLEASE CHECK ALL THAT APPLIES:
Goods $10k - $150k:
_____
Services <$25k:
_____
Services >$25k <$150k:
_____
Vendor Quote w/in 30 days: ____
Scope of Work Attached: _____
Product Picture attached: ____
Sole Source: ____
Sole Source Justification: ____
Personal Services Cert: ____
Business Case: _____
Personal Services Waiver: _____
Cost Analysis: ____
Insurance Certificate: _____
Documented Quote Required: ___
>$150k RFP/IFB/AFB required: __
PLEASE NOTE PROCESSING TIMES AND PLAN ACCORDINGLY, allow additional time for procurements requiring BIDS:
Accounting: 5 BUSINESS days from receipt; Purchasing and Contracts: 5-7 BUSINESS days from receipt.
CORE Funding Codes:
LINE
FUND
DEPT
UNIT
APR UNIT
OBJT
ACT
LOC
PROG
AMOUNT
% STATE/
CODE
CODE
FED
________________________________
DMVA Accounting Approval
Date
PAC Revised: 09/25/2015
COLORADO DEPARTMENT OF MILITARY AND VETERANS AFFAIRS
PURCHASE OF GOODS/SERVICES REQUISITION FORM
Form is not complete unless accurate, all signatures obtained, and required documentation attached.
Requested by:
Work Unit:
Phone:
Dated Requested:
Date Needed:
Fax Number:
Requested Vendor:
Vendor FEIN:
Vendor Phone:
Vendor Address:
Item(s) or Service Requested (Please be specific):
Qty
Unit
Complete Description
Item #
Unit Price
Total
$
TOTAL:
$
Approvals:
Authorized Signature:
Date:
Authorized Signature:
Date:
OSA Delegate (if required):
Date:
Shipping Information:
Facility:
Address:
Bldg No.:
City, State, ZIP:
SHIP CODE:
Requestor Checklist (Form will not be accepted by Accounting/Purchasing and Contracts without being completed, all
signatures obtained, and required documentation attached.) PLEASE CHECK ALL THAT APPLIES:
Goods $10k - $150k:
_____
Services <$25k:
_____
Services >$25k <$150k:
_____
Vendor Quote w/in 30 days: ____
Scope of Work Attached: _____
Product Picture attached: ____
Sole Source: ____
Sole Source Justification: ____
Personal Services Cert: ____
Business Case: _____
Personal Services Waiver: _____
Cost Analysis: ____
Insurance Certificate: _____
Documented Quote Required: ___
>$150k RFP/IFB/AFB required: __
PLEASE NOTE PROCESSING TIMES AND PLAN ACCORDINGLY, allow additional time for procurements requiring BIDS:
Accounting: 5 BUSINESS days from receipt; Purchasing and Contracts: 5-7 BUSINESS days from receipt.
CORE Funding Codes:
LINE
FUND
DEPT
UNIT
APR UNIT
OBJT
ACT
LOC
PROG
AMOUNT
% STATE/
CODE
CODE
FED
________________________________
DMVA Accounting Approval
Date
PAC Revised: 09/25/2015
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