ABCDEFGHIJKLMNOPQRSTUVWXY
1
2
3
Model Procurement: Check one that supports this expenditure
4
School:Intergovernmental
5
Name of Vendor:
Bid List Proposal No.
6
Address:
Non-Competitive D&F Attached
7
Small Purchase D&F Attached
8
9
10
DateQuantityItem or Service DescriptionUnit CostTotal Cost
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
TOTAL $ -
27
28
Vendor Certification
29
I hereby certify that the above is a correct statement of the amount due from the above-named school for articles furnished or for services rendered as itemized.
30
Vendor Signature:______________________________________________
31
32
33
Approval for Payment
34
35
Activity Account:
36
Person Receiving Item
37
Check Number:
38
39
Faculty Sponsor
Amount Paid:
40
41
Date Paid:
42
Principal
43
44
Updated August 2019
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100