"Planned Purchase Request Form" - Mississippi

Planned Purchase Request Form is a legal document that was released by the Mississippi Department of Information Technology Services - a government authority operating within Mississippi.

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Download "Planned Purchase Request Form" - Mississippi

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3771 Eastwood Drive
Jackson, Mississippi 39211
Phone 601-432-8000 Fax 601-713-6380
Planned Purchase Request
Project Title: Planned Purchases for FY20___
ITS Project # (IT Plan):
Stimulus (ARRA) Funds? Yes__ No __
Customer Contact Information
Agency/Institution:
Contact Person:
Address:
Phone:
Fax:
Email Address:
MAGIC Customer Number (only required from state agencies)
Division/Dept:
Handmail:
Yes
No
Project Summary
Narrative Description of Project
Cost Estimates
Fiscal Year
Initial Costs
Ongoing Costs
Total
Discuss Funding (e.g. how much of needed funding is definite; total project budget; any matching or other non state funds; fund number)
Anticipated Lifecycle of Products/System (i.e. estimate years effective use)
Acquisition Details
Items Requested:
Name
Quantity
Description
EPL Name and Number
Building Location(s)
Describe any project utilization or connectivity to the State’s infrastructure (voice/data/video networks; State Data Center; eGovernment portal,
payment engine, hosting, co-location; security; VPN, firewalls):
Progress to Date: What has been done related to this project and utilization?
Vendors Contacted:
For a Planned Procurement, you must attach the written quotes received from EPL vendors, accompanied by any substitutions letter(s) if applicable. Also
attach a printout of the EPL page(s) containing the product(s) to be acquired and verify that vendor pricing is the same or less than EPL pricing.
For acquisitions up to $1,000,000.00, attach a minimum of two vendor quotes. Above $1,000,000.00, attach a minimum of three vendor quotes.
Selection and Justification: Indicate the selected vendor(s) from the quotation received.
(1) If the quotes requested were brand-specific, please include documentation on how the manufacturer standard was established. See ITS
Procurement Handbook, 0190-030 Setting a Manufacturer Standard for requirements.
(2) If quote chosen was not the low cost, provide substantial justification for the selection.
There is a charge for ITS procurement services associated with this request which will be billed to the requestor by ITS. By my signature I acknowledge
that my agency/public university is responsible for these charges/costs.
_______________________________________
___________________________________
Name (Agency Head or Public University CIO)/Title
Signature
Date
3771 Eastwood Drive
Jackson, Mississippi 39211
Phone 601-432-8000 Fax 601-713-6380
Planned Purchase Request
Project Title: Planned Purchases for FY20___
ITS Project # (IT Plan):
Stimulus (ARRA) Funds? Yes__ No __
Customer Contact Information
Agency/Institution:
Contact Person:
Address:
Phone:
Fax:
Email Address:
MAGIC Customer Number (only required from state agencies)
Division/Dept:
Handmail:
Yes
No
Project Summary
Narrative Description of Project
Cost Estimates
Fiscal Year
Initial Costs
Ongoing Costs
Total
Discuss Funding (e.g. how much of needed funding is definite; total project budget; any matching or other non state funds; fund number)
Anticipated Lifecycle of Products/System (i.e. estimate years effective use)
Acquisition Details
Items Requested:
Name
Quantity
Description
EPL Name and Number
Building Location(s)
Describe any project utilization or connectivity to the State’s infrastructure (voice/data/video networks; State Data Center; eGovernment portal,
payment engine, hosting, co-location; security; VPN, firewalls):
Progress to Date: What has been done related to this project and utilization?
Vendors Contacted:
For a Planned Procurement, you must attach the written quotes received from EPL vendors, accompanied by any substitutions letter(s) if applicable. Also
attach a printout of the EPL page(s) containing the product(s) to be acquired and verify that vendor pricing is the same or less than EPL pricing.
For acquisitions up to $1,000,000.00, attach a minimum of two vendor quotes. Above $1,000,000.00, attach a minimum of three vendor quotes.
Selection and Justification: Indicate the selected vendor(s) from the quotation received.
(1) If the quotes requested were brand-specific, please include documentation on how the manufacturer standard was established. See ITS
Procurement Handbook, 0190-030 Setting a Manufacturer Standard for requirements.
(2) If quote chosen was not the low cost, provide substantial justification for the selection.
There is a charge for ITS procurement services associated with this request which will be billed to the requestor by ITS. By my signature I acknowledge
that my agency/public university is responsible for these charges/costs.
_______________________________________
___________________________________
Name (Agency Head or Public University CIO)/Title
Signature
Date