"Procurement Card Violation Warning Form" - Colorado

Procurement Card Violation Warning Form is a legal document that was released by the Colorado Department of Military and Veterans Affairs - a government authority operating within Colorado.

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Download "Procurement Card Violation Warning Form" - Colorado

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Procurement Card Violation Warning Form
This form is required for any transaction where a violation has occurred.
Note: Violations could result in revocation of the procurement card.
Information
Cardholder:
Department:
Approving Official:
Today's Date:
Transaction Reference #:
Transaction Date:
Merchant Name:
Amount:
Type of Violation
The following violation has been found in reference to the above transaction.
Approving Official Instructions – Obtain information from the Cardholder as to why the purchase was
made on the procurement card. Mark the appropriate category below. See Approving Official or
Cardholder Handbook for details on recognizing a violation.
________
Personal purchase
________
Cash transaction
________
Transaction over $5000
________
Split Purchase
Inappropriate purchase:
________
Restaurant meals (Unless Cardholder has been granted an exception for official
functions)
________
Travel & travel related expenses
________
Motor vehicle expenses unless authorized by the Program Administrator
________
1099 Re-occurring reportable services
________
Other (describe): _____________________________________________
________
Lack of Documentation - The Documentation of Lost or Unavailable Transaction
Information form must be completed and attached.
________
Unallowable purchase under the terms of a grant or similar project
Cardholder Explanation – Explain why the purchase was made on an agency credit card and provide
detailed information on what has been done to correct the situation. Attach additional sheet if necessary.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Cardholder Certification - I hereby acknowledge that the above transaction is in violation of the
procurement card policies and that repeated violations could result in revocation of my procurement card.
I further acknowledge that I have been warned through the use of this form. I understand that I am
permitted to make purchases that are in compliance with procurement card policies and agree to refer to
my User Handbook or contact my department Liaison or Program Administrator if I am unsure about the
procurement card policies or instructions.
___________________ ______________________________
_________________
Date
Cardholder Signature
Printed Name
Approving Official Determination and Certification
Procurement Card Violation Warning Form
This form is required for any transaction where a violation has occurred.
Note: Violations could result in revocation of the procurement card.
Information
Cardholder:
Department:
Approving Official:
Today's Date:
Transaction Reference #:
Transaction Date:
Merchant Name:
Amount:
Type of Violation
The following violation has been found in reference to the above transaction.
Approving Official Instructions – Obtain information from the Cardholder as to why the purchase was
made on the procurement card. Mark the appropriate category below. See Approving Official or
Cardholder Handbook for details on recognizing a violation.
________
Personal purchase
________
Cash transaction
________
Transaction over $5000
________
Split Purchase
Inappropriate purchase:
________
Restaurant meals (Unless Cardholder has been granted an exception for official
functions)
________
Travel & travel related expenses
________
Motor vehicle expenses unless authorized by the Program Administrator
________
1099 Re-occurring reportable services
________
Other (describe): _____________________________________________
________
Lack of Documentation - The Documentation of Lost or Unavailable Transaction
Information form must be completed and attached.
________
Unallowable purchase under the terms of a grant or similar project
Cardholder Explanation – Explain why the purchase was made on an agency credit card and provide
detailed information on what has been done to correct the situation. Attach additional sheet if necessary.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Cardholder Certification - I hereby acknowledge that the above transaction is in violation of the
procurement card policies and that repeated violations could result in revocation of my procurement card.
I further acknowledge that I have been warned through the use of this form. I understand that I am
permitted to make purchases that are in compliance with procurement card policies and agree to refer to
my User Handbook or contact my department Liaison or Program Administrator if I am unsure about the
procurement card policies or instructions.
___________________ ______________________________
_________________
Date
Cardholder Signature
Printed Name
Approving Official Determination and Certification
Mark appropriate category and take the actions listed.
____ The above transaction is a violation of the procurement card policies. The Cardholder
has been warned through the use of this form. The card will not be revoked at this time.
Actions – 1) Obtain the Cardholder’s signature on this form. 2) Send the original of this
completed form to the agency's Program Administrator along with the documentation for
the above transaction. 3) Keep a copy of this form with the Cardholder’s statement and/or
in a separate “violations file” in the department.
4) Provide a copy of this form to the Cardholder. 5) Request that the Program
Administrator send a copy of this form to the State Controller’s Office.
____ The above transaction is in violation of procurement card policies and the credit card is
being revoked.
Actions – 1) Notify the Cardholder in writing that their card is being revoked.
2) Retrieve the card, destroy it, and request immediate cancellation of the card.
3) Notify the Program Administrator that the card has been revoked. 4) Contact the
Liaison or Program Administrator to determine if there are additional reporting
requirements to maintain coverage under the Master Coverage Liability Protection
Program 5) Request that the Program Administrator provide written notification to the
State Controller’s Office of this incident.
___________________ ______________________________ ___________________
Date
Approving Official Signature
Printed Name
Instructions: Procurement Card Violation Warning Form
This form is required for any procurement card transaction where a violation has occurred.
Repeated violations could result in revocation of the card.
The Approving Official should follow the instructions below after a determination has been
made that a transaction is a procurement card violation.
Approving Official Instructions:
1. Obtain an explanation from the Cardholder as to why this purchase was made on the
credit card and what action has been taken to correct the situation.
2. Review the Cardholder’s violation history to determine if the Cardholder has repeatedly
had procurement card violations. This history will be a factor in the decision to warn the
Cardholder or to revoke the credit card.
3. Evaluate previous card violations for:
Split purchases.
Inappropriate purchases.
Lack of documentation that was determined to be a card violation.
Personal purchase that was immediately reported and reimbursed or credited by
the merchant.
The Approving Official will investigate the number and nature of the Cardholder’s
violations and their impact on the agency. The determination needs to be made in
consultation with the Liaison and/or Program Administrator and the Cardholder's
supervisor.
No revocation of the procurement card will occur at this time. If the Cardholder
history indicates that the Cardholder does not routinely have violations of any
type, the Approving Official may determine that the card will not be revoked at
this time
Revocation of the procurement card. If the Cardholder's history indicates that the
Cardholder has a history of violations of any type, the Approving Official may
determine that the card should be revoked.
If the violation involves any of the following, the Approving Official should review
guidelines established for various program violations, if applicable.
Personal purchase that was not immediately reported and corrected
Cash or cash type transaction
Lack of documentation that was determined to be a card violation and may involve fiscal
misconduct
4. Obtain the Cardholder signature in the Cardholder Certification signature section.
5. Notify the Cardholder's supervisor of the decision to revoke the card.
6. Indicate the appropriate determination in the APPROVING OFFICIAL
DETERMINATION and CERTIFICATION section on the front of this form.
7. The Approving Official needs to document the specific reasons for revoking card
privileges.
8. Notify the Program Administrator.
9. Request that the Program Administrator provide written notification to the State
Controller’s Office of these circumstances and action(s) taken.
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