PURCHASE REQUISITION PR LOG NO _ PD-1 Rev 100411 Paper Document: Send one signed original or PDF and email all specifications to purchase@montana.edu – Requestor should keep a copy Electronic Document: Email Requisition, Supporting Documentation and Approvals to purchase@montana.edu MONTANA STATE UNIVERSITY BILL TO: Division for Student Success SUB 174 P.O Box 174220 Bozeman, MT 59717 ATTN: Jen Joyce TEL.#: 406-994-2828 X New Purchase of Goods or Services Please choose one (1) of the following options: NOTE: THIS IS NOT AN ORDER SHIP TO: Division for Student Success SUB 174 P.O Box 174220 Bozeman, MT 59717 ATTN: Jen Joyce Renewal of Purchase Order (PO) or Contract PO or Contract Number: TEL.#: 406-994-2828 Extension of Purchase Order (PO) or Contract PO or Contract Number: GOODS/SERVICES BEING REQUESTED: CAPITAL ITEM Yes/ No NO No DESCRIPTION, SIZE AND FULL DETAIL (Attach additional pages as needed for requirements) MFG & CAT NO QTY MSU Alert Text Message Service as Software PD-14 Brand and Sole Source Justification If you have specified a BRAND NAME, complete Questions 1-3 on PD-14 If there is only ONE SUPPLIER for the product or service, complete the entire PD-14 form UNIT OF MEASURE Requisition Date: 9/1/2012 Required Delivery Date: 9/15/2012 UNIT COST 9450 TOTAL 9450 Estimated initial purchase price 9450 Estimated Total Contract Value (for potential entire term) 9450 SUPPORTING DOCUMENTATION: Check all that apply Please send an electronic version of paperwork to purchase@montana.edu PD-14 Brand Justification PD-14 Sole Source Justification DPES- Computer Equip BOR- Approval ($>50,000) PARR – Trade-In FUNDING SOURCE: (this information will be used to encumber funds to be used for payment of the Purchase Order or Contract) Index Number 4s1141 Index Number Org Number 441141 Org Number Acct Code 62802 Acct Code Split % or $ 9450 Split % or $ SUGGESTED SUPPLIER(S): (List three if possible Fiscal Year 2013 Fiscal Year If Sole Source and PD-14 has been completed list the sole source supplier) NAME: Inspironlogistics ATTN: Dana Fleck ADDRESS: South Main Street CITY: Akron TELEPHONE #: 866-998-9367 STATE: OH ZIP CODE: 44308 FAX #: 330-922-4750 EMAIL: dfleck@inspironlogistics.com NAME: ATTN: ADDRESS: CITY: TELEPHONE #: NAME: ADDRESS: CITY: TELEPHONE #: Federal Funds Yes No X Federal Funds Yes No STATE ZIP CODE: FAX #: EMAIL: ATTN: STATE: ZIP CODE: FAX #: EMAIL: FUNDING APPROVAL: I hereby certify that the items specified on this Requisition were absolutely necessary; that there is proper authority of law and sufficient balance in the index indicated above for this purchase; and this purchase will not result in any request for additional funds Required Signatures: Printed Name: Signature: Date: Requestor/PI Erika M Swanson Department Head College Dean/Director OSP Administration (OSP Funded Only) Vice President Dr James Rimpau (All Fund Types Except OSP) These instructions are provided for assistance only and should not be submitted with purchase requisition PURCHASE REQUISITION INSTRUCTIONS Bill To: Provide complete information, including name and phone number of contact person Ship To: Provide complete physical address and any special instructions, name and phone number of contact person Type of Requisition: Check the appropriate box to indicate the reason for this requisition • If you are adding money or extending a Contract please provide a revised statement of work justifying the cost increase or the extension GOODS/SERVICES BEING REQUESTED: Capital Item: An item that costs $5,000 or more and has a life expectancy of greater than year Item #: Provide a line number for each item being purchased; if an item consists of a group or package of items, this • • • • • • • • • would be a single item number Description: The name of the commodity and specification details can be provided in the space available on the Requisition form or attached in a Word document Include name, size (dimensions); color; physical requirements, as well as any other specifications required for a vendor to provide a complete quote If the requisition is being submitted for a renewal or extension of a Purchase Order or Contract, provide the time period, description of services to be provided Mfg & Catalog Number; Quantity; Unit of Measure; Unit Cost; Unit Total: For each item specify this information Unit of Measure, for example, may be “year”, “month”, “lot”, “system”, “each”, etc Estimated Total: The estimated total is the total for this purchase request Total Contract Value: Is the Total Contract Value (TCV) for all Purchase Orders or the Contract for this product or service For example if it is a multiple year contract, the TCV would be a sum of all the Purchase Orders Requisition Date: Show date Requisition was submitted for approval signatures Date Required: Provide a reasonable date you would like the item to be delivered For services, use the date you would like service to begin Please note that purchases are governed by the State Procurement Bureau and proper purchasing procedures must be followed The time required for your requisition to be processed will vary You should plan according Additional Requirements: Consider any additional requirements to support a successful selection of the responsible, responsive, lowest bidder Things to consider include Warranties, Installation, Training, Maintenance and Support, Special Delivery Instructions, Documentation (Owner/Operator Manuals), References, Demonstrations, Samples, Parts, etc SUPPORTING DOCUMENTATION: If any of the following apply, the completed signed forms must accompany the Requisition when submitted, check the appropriate boxes for all that are included: • Brand and Sole Source Justification (PD-14): Only one brand meets the requirement however this brand may be • • • • available from more than one supplier http://www2.montana.edu/policy/purchasing/1800/PD-14.doc Sole Source Justification (PD-14): Only one supplier is available to provide the supply or service The goods cannot be obtained through an alternative source http://www2.montana.edu/policy/purchasing/1800/PD-14.doc Property Asset Removal Request (PARR): Required for Trade-In of MSU Property http://www.montana.edu/wwwbu/prop_forms.html Justification to Acquire Data Processing Equipment and Software (DPES): Required for the purchase of computer equipment or software totaling $500 or more http://www2.montana.edu/policy/purchasing/Attachments/AppendixC.pdf Board of Regents Approval as required for IT purchased exceeding $50,000 per http://mus.edu/borpol/bor900/9201.htm FUNDING SOURCE: • Index #(s); Org #; Acct Code(s); Split: Specify this information identifying any funding allocations between accounts If • • additional splits are required attach details on an attachment to the Purchase Requisition Federal Funds: Are federal funds used to pay for this purchase? Fiscal Year Allocation: Specify from which fiscal year the funds will be used to pay for this purchase SUGGESTED SUPPLIER(S): Provide complete contact information for at least three vendors or preferred suppliers, if available If it is a sole source purchase and you have completed a PD-14 provide the vendor information for the sole source vendor FUNDING APPROVAL: Route for required approval signatures according to schedule in Appendix E of the Purchasing Procedures Manual Submission Instructions: The Requisition form must be completely filled in, including complete description and specifications If additional space is needed for the Specifications, please attach a second page Requisitions may not be used for commodities or services that have already been received Call the Purchasing Department to discuss at x3211 Electronic Submittal: a Type the names of the individuals who are required to approve the requisition in the printed name box of the funding approval section b Email all the requisition (PDF with signatures) and all supporting documentation to purchase@montana.edu Paper Submittal a Submit signed original Requisition to the Purchasing Department b Attach original versions of completed and signed Supporting Forms to the Requisition c Email required specifications to the Purchasing Department at purchase@montana.edu as a Word attachment d Attach signed original copies of all written quotations, if available Quotations should only be obtained if it is a sole source purchase