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Model Procurement: Check one that supports this expenditure
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School:Purchase under $5,000
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Name of Vendor:
Intergovernmental
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Address:Bid List Proposal No.
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Non-Competitive D&F Attached
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Small Purchase D&F Attached
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DateQuantityItem or Service DescriptionUnit CostTotal Cost
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TOTAL $ -
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Vendor Certification
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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.
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Vendor Signature:______________________________________________
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Approval for Payment
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Activity Account:
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Person Receiving Item
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Check Number:
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Faculty Sponsor
Amount Paid:
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Date Paid:
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Principal
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Updated August 2019
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