3524R13 - OS-501 Confirmation of Service.pdf

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Bridge Engineering Software Services
Solicitation number
3524R13
Issued by
Pennsylvania

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This is a Confirmation of Service form (OS-501) used by the Pennsylvania Department of Transportation (PennDOT) to document and authorize payment for services rendered by vendors under purchase orders. The form serves as the official record that a vendor has completed work or delivered goods as specified in a purchase order, and it initiates the payment approval process through PennDOT's financial systems. Vendors complete the form by entering service dates, their company information, the ten-digit purchase order number, SAP vendor number, and a detailed breakdown of line items including descriptions, quantities, units of measure, unit prices, and item totals. The form accommodates multiple line items across two pages to account for complex purchase orders with numerous deliverables. The document must reference the exact descriptions and line items from the fully executed purchase order to ensure accuracy and prevent payment discrepancies.

The completion and approval process involves three key stakeholders within PennDOT: the vendor initially submits the signed and dated form to the appropriate PennDOT project manager, who verifies that services were received satisfactorily and approves payment authorization. The project manager then forwards the form to the Goods Receiver, who certifies that a Goods Receipt entry has been made in SAP within 48 hours of receipt, in compliance with Management Directive 310.31, and provides the SRM Confirmation Number or R3 Material Document Number. The completed and fully executed form is then filed in the procurement file for record-keeping purposes. Users must save the form locally rather than working with it in-browser to ensure proper calculation rounding to the nearest cent, and the form is available on the PennDOT website for download and use.

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OS-501 (5-26)

CONFIRMATION OF SERVICE

www.pa.gov/penndot

Date(s) Service Rendered:________________ - _______________ Vendor Name: __________________________________________ Phone: ________________________________________________

PURCHASE ORDER #:___________________________________

SAP Vendor Number: ____________________________________ Address (1): ____________________________________________ Address (2): ____________________________________________ City: ____________________ State: _______ Zip Code: ________

(Reference line items on purchase order that match the services that were performed.)

PO Line # Description / Product ID Quantity U.O.M. Unit Price Item Total

PENNDOT USE ONLY

I certify the services represented by the confirmation of service form above were received satisfactorily. Therefore, I approve payment be made.

Project Manager Signature Date (mm/dd/yyyy)

I certify that I have entered a Goods Receipt in SAP for this service. This should occur within 48 hours of receipt (per Management Directive 310.31).

SRM/R3 Receiver Signature Date (mm/dd/yyyy) SRM Confirmation # / R3 Material Document #

Vendor Signature:_______________________________________________________________ Date:__________________________

Total of Page 1

Total of Page 2

Grand Total

Continued on page 2

PO Line # Description / Product ID Quantity U.O.M. Unit Price Item Total

Total of Page 1

Total of Page 2

Grand Total

Instructions:

Complete the OS-501 form in accordance with the instructions below.

1. The Vendor completes the OS-501 form, then forwards the signed/dated form to the appropriate PennDOT representative for approval (may be done electronically via email). Explanations for fields on the form are listed below.

Date Service Rendered: Provide the date of service (i.e., Date or date range).

Vendor Name*: Enter name.

Phone*: Area code and phone number.

PURCHASE ORDER #*: The ten digit number in the upper right corner.

SAP Vendor Number*: This is the vendor’s six digit vendor number (e.g. 412345).

Address (1)*: Vendor's street address.

Address (2)*: Enter the Floor, Suite, etc. of the vendors address, if applicable.

City*: Vendor's City.

State*: Vendor's State.

Zip Code*: Vendor's Zip Code.

PO Line #: Enter the PO line item number(s) in this column. Many PO’s contain numerous line items.

Use separate lines to account for each item that was delivered.

Description/Product ID*: Enter the exact description from the PO line item Description/Product ID column. Quantity:

Enter the quantity delivered for the time period.

U.O.M.*: This is the unit of measure for the service/material rendered (e.g. hours, days, number, etc).

Unit Price*: Cost per individual unit of measure.

Total: Calculated Amount of the Quantity x Unit Price.

*Enter information exactly as it appears on the fully executed Purchase Order.

2. The PennDOT Representative confirms services were received satisfactorily and approves payment to be made by signing and dating on the “Project Manager Signature” line. The PennDOT Representative forwards the signed/dated form to their Goods Receiver.

3. The Goods Receiver certifies that a Goods Receipt has been entered in SAP for the by signing, dating, and providing the SRM Confirmation Number/R3 Material Document Number.

4. The Goods Receiver provides a copy of the completed and signed/dated form to the PennDOT Representative for placement in the Procurement file.

5. Users need to save the form to their local drive in order for the calculations to round up numbers correctly.

When the PDF is opened from the website, it will show in-browser, which does not have the functionality to round up numbers to the next cent correctly.

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PURCHASE ORDER:
Contractor Name:
Phone:
SAP Vendor Number:
Check Box3: Off
Date:
Date mmddyyyy:
Confirmation Number:
Date mmddyyyy_2:
Total Page 1: 0
Total Page 2: 0
Grand Total: 0
Date Service Rendered:
Date Service Rendered2:
Address 1:
Address 2:
City:
State:
Zip Code:

File details come from the government source that posted it. Updated .