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BUSINESS SERVtCES - REQUEST FOR PURCHASE ORDER <br />.~-- <br />Division: ~Cl~ L 1 I~ (rwt~- Date: S <br />Purchase Order Type: ~ ~~~ ~$~~ <br />~o~ ~t~ <br />~ Standard PO {1 time goods/materials purchase or contracfua! service) <br />Amount based goods PO (open PO, maximum $5,000 for various purchases} <br />B[anket PO (open PO for specifred fotal, no encumb~ance unti! rnvoice released) <br />Amend PO # <br />.~Sf~ f~C.. <br />Vendor: ~`. ~ZST Vendor Tax lD: <br />Address: 73~ S• ~ J1(!~~ , Tax Status: o Corporatian ^ Sole Proprietor <br />Description <br />Amount: S 7~,5 O Cost Center/Account: ~~~~/0~ I <br />~ l`l l ~ i~~t ~ 5t~ <br />** A purchase order Js requrred prior to any commi! <br />Purchasing Guidelines: <br />$ 0 - 2,500 <br />2,500 - 5,000 <br />s,oao - so,ooo <br />50,000 + <br />Attachments: <br />~ Quotes (or RFP/Bid) <br />O County Administratar review form <br />^ Contract <br />ment of county funds `~ ~~~~~ _ dvlai i1`~vt~tC~, <br />C.OS~ C~en~ ~' <br />No quotes required <br />Three (3) verbal quotes required <br />Three (3) written quotes required <br />Formal competitive process (RFP(bid) <br />Note: Any commifinenf over $10,000 requrres pre-approva! by County Administrafor before purchase can be <br />made or service can begin. A completed review form shoufd be sent to Adminrstration who wrll to coo~dinate <br />securing approval. Upon receipt, the ~eview form wiI! be returned fo the divisron for completion of purchase <br />order request form and quotes and/or confract as applicable. (~ ~~~ Q~~ D <br />3 ~~~~~ ~'~u <br />Requesting Employee: 1.~ JUL 2 6 2 0 ~ ~ <br />Division Manager Approval: <br />MARION COUNTY SUPPORT <br />SERVICES DEPARTMENT <br />on use only: <br />Reviewed by: <br />Requisition created by: <br />Date: <br />PO #: <br />Request retumed;to ~division ~fo~ further.action: <br />PO printed o <br />Copy of-PO'to Division ^ <br />Copy of~PQ #o Finance o <br />,, <br />.r; <br />}7~~' Lp,~~ ~ g~~~ ~. Other: ~ t AT'~ C~~uT/~d-c 0- <br />