Form STD.96 "Purchase Order/Estimate Change Request" - California

What Is Form STD.96?

This is a legal form that was released by the California Department of General Services - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on October 1, 2019;
  • The latest edition provided by the California Department of General Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form STD.96 by clicking the link below or browse more documents and templates provided by the California Department of General Services.

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Download Form STD.96 "Purchase Order/Estimate Change Request" - California

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STATE OF CALIFORNIA
SEND TO:
DEPARTMENT OF GENERAL SERVICES
PROCUREMENT DIVISION
PURCHASE ORDER/ESTIMATE
CHANGE REQUEST
AGENCY
AGENCY CONTACT PERSON
STD. 96 (REV. 10/2019)
Purchase Order Change (S.A.M. Section 3566)
PROCUREMENT DIVISION BUYER
CONTACT PHONE NUMBER
CALNET NUMBER
AGENCY TO COMPLETE
CHANGE TO
(C
)
HECK ONE AND ATTACH COPY OF DOCUMENT BEING CHANGED
PURCHASE ORDER NUMBER
AGENCY BILL CODE
PURCHASE ESTIMATE NUMBER
PURCHASE
ESTIMATE
ORDER
A
CONFIRMING 96 FOR ADDITIONAL FUNDS REQUESTED BY O/P
G
CHANGE IN VENDOR'S NAME
B
CHANGE IN QUANTITY
H
MATHMATICAL ERROR OVER $10.00
C
CANCELLATION OF ITEM
I
CHANGE IN ESTIMATE NUMBER
D
CHANGE IN DESCRIPTION, SPEC'S., OR SUBSTITUTION OF MATERIAL
J
INVOICE TERM DISCOUNT IS LESS THAN P.O.
E
ADDITION OF ITEM
K
CHANGE IN F.O.B. POINT
F
CHANGE IN UNIT PRICE
L
OTHER
DESCRIPTION OF PURCHASE ORDER OR ESTIMATE CHANGE
.
.
P
E
LINE
QUANTITY
UNIT
STOCK ITEM NUMBER
DESCRIPTION
UNIT PRICE
EXTENSION
.
.
.
PG
NO
NO
REASON FOR CHANGE (S
S.A.M. S
3559)
EE
ECTION
BUDGET ALLOTMENT TO BE CHARGED - TO BE COMPLETED FOR INCREASE OR DECREASE
PAYABLE FROM FUND
PROGRAM/CATAGORY (C
T
)
FUND TITLE
ODE AND
ITLE
OPTIONAL USE
APPROPRIATION
ITEM
CHAPTER
STATUTE
FISCAL YR.
OBJECT OF EXPENDITURE (C
T
)
ODE AND
ITLE
I HEREBY CERTIFY
UPON MY OWN PERSONAL KNOWLEDGE THAT THE UNENCUMBERED
1.
PREVIOUS TOTAL
,
BALANCE OF THE DEPARTMENTAL BUDGET PROVISION FOR THE PERIOD
FUNCTION AND
.
OBJECT STATED ABOVE IS CORRECT
AMOUNT OF THIS ESTIMATE
2.
INCREASE OR DECREASE
(A
T.B.A.
) (A
B.A.
)
FTER
FTER
ACCOUNTING OFFICER'S SIGNATURE
3.
TOTAL OF REVISED ESTIMATE
I HEREBY CERTIFY
;
UPON MY OWN PERSONAL KNOWLEDGE THAT THE SERVICE SPECIFIED HEREON IS NECESSARY TO PERFORM THE FUNCTION INDICATED
,
,
;
THAT THE COST OF EACH ITEM HAS BEEN CAREFULLY ESTIMATED AND IS
TO THE BEST OF MY KNOWLEDGE AND BELIEF
ADEQUATE TO COVER THE ACTUAL COST
.
AND THAT THE ITEMS SET FORTH ARE IN ACCORDANCE WITH THE CURRENT BUDGET PROVISIONS
SIGNATURE
PHONE NUMBER
TITLE
DATE
Print
Clear
STATE OF CALIFORNIA
SEND TO:
DEPARTMENT OF GENERAL SERVICES
PROCUREMENT DIVISION
PURCHASE ORDER/ESTIMATE
CHANGE REQUEST
AGENCY
AGENCY CONTACT PERSON
STD. 96 (REV. 10/2019)
Purchase Order Change (S.A.M. Section 3566)
PROCUREMENT DIVISION BUYER
CONTACT PHONE NUMBER
CALNET NUMBER
AGENCY TO COMPLETE
CHANGE TO
(C
)
HECK ONE AND ATTACH COPY OF DOCUMENT BEING CHANGED
PURCHASE ORDER NUMBER
AGENCY BILL CODE
PURCHASE ESTIMATE NUMBER
PURCHASE
ESTIMATE
ORDER
A
CONFIRMING 96 FOR ADDITIONAL FUNDS REQUESTED BY O/P
G
CHANGE IN VENDOR'S NAME
B
CHANGE IN QUANTITY
H
MATHMATICAL ERROR OVER $10.00
C
CANCELLATION OF ITEM
I
CHANGE IN ESTIMATE NUMBER
D
CHANGE IN DESCRIPTION, SPEC'S., OR SUBSTITUTION OF MATERIAL
J
INVOICE TERM DISCOUNT IS LESS THAN P.O.
E
ADDITION OF ITEM
K
CHANGE IN F.O.B. POINT
F
CHANGE IN UNIT PRICE
L
OTHER
DESCRIPTION OF PURCHASE ORDER OR ESTIMATE CHANGE
.
.
P
E
LINE
QUANTITY
UNIT
STOCK ITEM NUMBER
DESCRIPTION
UNIT PRICE
EXTENSION
.
.
.
PG
NO
NO
REASON FOR CHANGE (S
S.A.M. S
3559)
EE
ECTION
BUDGET ALLOTMENT TO BE CHARGED - TO BE COMPLETED FOR INCREASE OR DECREASE
PAYABLE FROM FUND
PROGRAM/CATAGORY (C
T
)
FUND TITLE
ODE AND
ITLE
OPTIONAL USE
APPROPRIATION
ITEM
CHAPTER
STATUTE
FISCAL YR.
OBJECT OF EXPENDITURE (C
T
)
ODE AND
ITLE
I HEREBY CERTIFY
UPON MY OWN PERSONAL KNOWLEDGE THAT THE UNENCUMBERED
1.
PREVIOUS TOTAL
,
BALANCE OF THE DEPARTMENTAL BUDGET PROVISION FOR THE PERIOD
FUNCTION AND
.
OBJECT STATED ABOVE IS CORRECT
AMOUNT OF THIS ESTIMATE
2.
INCREASE OR DECREASE
(A
T.B.A.
) (A
B.A.
)
FTER
FTER
ACCOUNTING OFFICER'S SIGNATURE
3.
TOTAL OF REVISED ESTIMATE
I HEREBY CERTIFY
;
UPON MY OWN PERSONAL KNOWLEDGE THAT THE SERVICE SPECIFIED HEREON IS NECESSARY TO PERFORM THE FUNCTION INDICATED
,
,
;
THAT THE COST OF EACH ITEM HAS BEEN CAREFULLY ESTIMATED AND IS
TO THE BEST OF MY KNOWLEDGE AND BELIEF
ADEQUATE TO COVER THE ACTUAL COST
.
AND THAT THE ITEMS SET FORTH ARE IN ACCORDANCE WITH THE CURRENT BUDGET PROVISIONS
SIGNATURE
PHONE NUMBER
TITLE
DATE