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Payments to Vendors by United States Attorneys' Offices

Report No. 04-07
December 2003
Office of the Inspector General

Appendix II
Southern District of Florida's
Procurement Form

U.S. ATTORNEY'S OFFICE
Southern District of Florida

LITIGATION and/or PROCUREMENT REQUEST
Vendor Name:   Auth No:  
Vendor Address:   Tax ID #   Auth Date:  
City/State:   Zip:   SOC:  
Vendor Phone:   Fax No:   Initial:  
For Purchase orders(any request over $2,500): Check for business classification Delivery Date:
___ Small         ___ Other than Small         ___ Disadvantaged         ___ Woman-Owned
Case Name:   Program Code   Date
Case No:   Project Code  
Case Type: (X one) ___ Direct  ___ OCDETF  ___ Asset Forf.  ___ HIDTA  ___ HCF  ___ Daily  ___ HCF Project Other:
Transcripts ___ DEPO    ___ Grand Jury    ___ Trial    ___ Regular    ___ Expedited    ___ Daily    ___ Hourly
Description of Service Est. Qty. Cost Per (Unit) Amount
         
         
         
         
      Total  
JUSTIFICATION (required): Funds are / are not available     Budget Officer__________________________
 
REQUESTOR
AUSA Signature:
AUSA: Ph#
Delivery Address:
Secretary: Ph#
AUTHORIZATION
Section &
Section
Chief		   Date
 
Division
Chief		   Date
 
INSTRUCTIONS FOR REQUESTOR:
After receiving written authorization number from Fiscal, this form must be FAXED TO VENDOR. Keep This signed copy for your records to avoid any discrepancies in services requested. Make sure to give the vendor a contact phone number.
INSTRUCTIONS FOR VENDOR:
Understand that the service and amount hereby stated on this litigation request form is final. Any product or services delivered above this amount will not be accepted for payment. If any portion of this order is incorrect and/or canceled, you must notify the requestor at the US Attorney's Office for proper amendment.

Vendors must submit an itemized original, invoices with complete name, mailing address, phone & fax number, Federal Tax ID#/SSN and authorization number to constitute a proper invoice upon completion of service/goods.
Billing Address: U.S. Attorneys Office, SDFL, Attn. Administrative Division, Suite 200, 99 NE 4th Sbeet, Miami, FL 33132.
Receipt of Goods/Services By:                                                                              Date:

Credit Card Purchase Request
REQUESTOR
NAME:__________________________		 DATE
PREPARED:____/____/_____		 CONTRACTING
OFFICER: ______________________
VENDOR NAME: ______________________________________________________TAX ID #___________________
ADDRESS: _______________________________________________________________________________________
CITY/STATE/ZIP: __________________________________________________________________________________
CONTACT/PHONE/FAX NO: ________________________________________________________________________
DELIVERY ADDRESS: ______________________________________________________________________________
Mandatory Sources:
____AGENCY INVENTORY & EXCESS PROPERTY ____UNICOR ____FEDSTRIP/CSC ____NIB/NISH
____GSA ADVANTAGE http://www.fss.gsa.gov/cgi-bin/advwel ____GSA CONTRACT #_____________
____OPEN MARKET ____COMPETITION REQUIRED( page 4) WAIVER(S) REQUIRED?_____(Attach)
PRE-APPROVAL REQUIRED?__________________ NAME/DATE________________________
____SMALL BUSINESS: ____DISADVANTAGED ____OTHER THAN SMALL ____WOMEN OWNED

STOCK # ITEM DESCRIPTION QTY UNIT $ TOTAL $
         
         
         
         
         
         
    GRAND TOTAL $

JUSTIFICATION FOR REQUEST:____________________________________________________________________

________________________________________________________________________________________________

CONTRACTING OFFICER SIGNATURE:___________________________________________Date:_______________

APPROVING OFFICIAL SIGNATURE:_____________________________________________Date:_______________

RECEIPT OF GOODS - SIGNATURE ______________________________________________Date:_______________

COST CENTER: ______________________DCN: __________________ OBJ.CLASS:__________________________
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Southern District of Florida Procurement Checklist
 
_____ Each proposed contractor must be checked against the "List of Parties Excluded from Federal Precurenrent and Non-Procurement Programs. This can be checked in the publication received in Miami or by web site at http://epls.arnet.gov.
 
  This contractor is not excluded per publication dated _______________, or Internet site check on____________
 
_____ Ensure that the Service Contract Act (FAR 22.10) is followed for service that involves the use of 5 or more individuals to perform the required service (movers). Include DOL wage determinations.
 
_____ Open Market Over $10,000.00 - Requirement must be posted in a public place within contracting office (attach copy).
 
 
_____ Open market purchases over $2,500.00 must be given to small businesses unless the contracting officer certifies that it is unlikely that 2 or more small business concerns can provide the goods/services at a reasonable price.
 
Justification For Not Using a Small Business:________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________
 
On this _____day of_____,2003 I, ___________________, as Contracting Officer certify that it is unlikely that 2 or more small business concerns can provide the goods/services required at a reasonable price.

SECTION 508 ACCESSIBILITY STANDARDS (Contracting Officer to check all that are applicable)

[ ] 1194.21 Software Applications and Operating Systems
[ ] 1194.22 Web-based Intranet and Internet Information and Applications
[ ] 1194.23 Telecommunications Products
[ ] 1194.24 Video or Multimedia Products
[ ] 1194.25 Self Contained, Closed Products
[ ] 1194.26 Desktop and Portable Computers
[ ] 1194.31 Functional Performance Criteria
[ ] 1194.41 Information, Documentation, and Support

Justification for Non-Compliance of Section 508

It has been determined that the requirement of Section 508 cannot be made for the following reason:

[ ] National Security System
[ ] EIT incidental to the order. The primary purpose of this order is to ___________________________________
[ ] EIT located in spaced frequented only by service personnel for maintenance, repair or occasional monitoring of equipment.
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Southern District of Florida
Procurement Checklist

(continued)
 
[ ] Would impose an undue burden on the agency. This undue burden is:
  [ ] Significant expense and funds are not available.
[ ] Signiflcant difficulty of compliance.
 
Explain: ____________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________
 
If an undue burden is other than an increased cost that can be funded, state the alternative means of access that will be provided that will allow the individuals with disabilities to use the information, data or equipment.
 
Energy Efficient Standby Power Devices
_____ Is product commercially available, off-the-shelf that uses extenial standby power devices, or that contains an internal standby power function.
  _____
_____		 Does product use no more than one watt in its standby power consuming mode?
Is this the product with the lowest standby power wattage? If no, provide justification in file why product that meets energy efficient standby requirement is not being acquired.
 
Greening the Government (FAR 23.404)
_____
_____		 Is product identified on EPA's list of designated products (http://www.epa.gov/cpg)?
Is the aggregate amount paid for product, or for functionally equivalent products, in the preceding fiscal year $10,000 or more?
_____ The Contracting Officer must determine that the price is fair and reasonable.
 
I ____________________________, as Contracting Officer have determined that the price for the goods and/or services being requested is fair and reasonable based on the following:
 
  _____
_____
_____
_____
_____		 Market Research and Quotations (see attached).
Comparison of the proposed price with prices found reasonable on other purchases (list them).
Comparison with similar items in a related industry(attach).
Current price lists, catalogs or advertisements.
My personal knowledge and experience of the item being purchased. Explain:______________________________
 
____________________________________________________________________________________________________
 
_____ Any other reasonable basis. Explain:__________________________________________________________________
Page 3

Southern District of Florida
Competition/Sole Source Worksheet

PRICE QUOTES
 
  Vendor 1 Vendor 2 Vendor 3  
 
Name of Vendor _________ _________ _________  
 
Vendor Spokesperson _________ _________ _________  
 
Date Contacted _________ _________ _________  
 
Telephone Number _________ _________ _________  
 
Unit Price _________ _________ _________  
 
Total Amount Quoted _________ _________ _________  
 
Discount Terms _________ _________ _________  
 
Business Designation _________ _________ _________  
 
Delivery Time Promised _________ _________ _________  
 
Delivery/Freight Charges _________ _________ _________  
 
Vendor selected:_____________________________________________________________________________________
 
Justification:________________________________________________________________________________________
 
SOLE SOURCE JUSTIFICATION
 
 
 
_____________________________________
Contracting Officer Signature		 ______________
Date		  
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