Attachment 16-FTC-ADM-1A PR.pdf

FLETC TC CONTROL NO.

PURCHASE REQUISITION DATE:

(Materials, Supplies, Equipment, & Services)

(3) DATE:

(4) TELEPHONE NO.

(5) BUILDING NO.

(6) ROOM NO.

(9)(a) VENDOR: (10)(a) CONTRACT NO:

(b) TERMS:

(c) DELIVERY TIME:

(d) FOB POINT:

ARTICLE NO.

UNIT OF

ISSUE UNIT PRICE TOTAL

(11) (14) (15) (16)

PROCUREMENT

(21)(a) AUTHORIZED BY:

(b) DATE: (c) TITLE: (b) DATE: (c) TITLE:

(22)(a) RECEIVED BY: (b) DATE:

DESCRIPTION

(12)

(b) DATE ITEMS NEEDED:

(17) PURPOSE AND JUSTIFICATION:

MONTHS NEEDS(19) SUPPLIES: ORDER PROVIDES

(20)(a) APPROVED BY:

IMPREST FUND AND STOCKROOM ACTIVITY

(c) GRAND TOTAL

(b) POSTAGE/TRANSPORTATION COST (EST)

(18)(a) TOTAL FROM CONTINUATION PAGE

QUANTITY

(13)

(d) CONTACT PERSON (if known):

(c) TELEPHONE NO. (if available):

(b) ADDRESS (if available):

(8) ACTIVITY CODE:(7) FUNDS TO BE CHARGED TO:

(1) REQUESTING OFFICE: (2) (a) REQUESTED BY:

FTC-ADM-1A(Rev. 7-87)

PROCUREMENT DIVISION USE ONLY

INSTRUCTIONS ON THE REVERSE

DETAILED FORM COMPLETION

PURCHASE REQUISITION

(Materials, Supplies, Equipment, & Services)

CONTINUATION

ARTICLE NO. DESCRIPTION QUANTITY

UNIT OF

ISSUE UNIT PRICE TOTAL

TOTAL CARRIED FORWARD TO FIRST PAGE:

SPECIFIC FORM COMPLETION INSTRUCTIONS

(See FLETC Directive No. 70-06, Part IV)

ITEM 1 Self-explanatory. ITEM 13 Total number of a particular line item.

ITEM 2 Self-explanatory. ITEM 14 Appropriate unit of issue as purchased i.e., each, box, pair, carton, etc.

ITEM 3 Self-explanatory. ITEM 15 The unit of issue price.

ITEM 4 Self-explanatory. ITEM 16 Multiply the values in item 13 and item 15 and enter it in item 16 for ITEM 5 Self-explanatory. each line item.

ITEM 6 Self-explanatory. ITEM 17 The purpose and justification for the requested purchase.

ITEM 7 The specific fund to which the purchase is to charged, i.e. ITEM 18 (a) The total from all the continuation pages.

S&E, OJJDP, INFO-ADP, ATF, U.S. Customs, etc. (b) The estimated (generally 15%) or actual freight charge for the ITEM 8 Fill in the most finite level, i.e. FLETC division, branch, purchase.

section, etc. activity code pertaining to the requestor's organizational (c) The sum of item 18a and b.

location. Example: Equipment and Materials Branch 34 ITEM 19 Self-explanatory.

(your 2 digit numeric code). ITEM 20 (a) Signature of the Assistant Director or Division Chief who approves

ITEM 9 (a) Self-explanatory. the items on this requisition as legitimate and needed for Center

(b) Self-explanatory. training or operations.

(c) Self-explanatory. (b) The date approving officila signs the requisition.

(d) Self-explanatory. (c) The title of the approving official.

ITEM 10 (a) Appropriate government contract number if available i.e. ITEM 21 (a) Signature of a Center official empowered to authorize the V797P-5650; GS-00F-85307. procurement action (Director, Deputy Director, Procurement

(b) The terms of the contract, i.e. NET 30 days. Officier, Assistant Director (ADM) and Deputy Assistant

(c) The delivery time offered by the vendor or contract, i.e. 90 Director (ADM)).

days ARO (After Receipt of Order). (b) The date authorizing official signs the requisition.

(d) Fill in with FOB Destination (Freight already figured in), or (c) The title of the authorizing official.

FOB Shipping Point (Freight to be figured in. See item 18b.). ITEM 22 (a) Signature of the party who receives monies from the imprest

ITEM 11 Fill in with a sequential number using one number per line, fund or supplies from the office supply stockroom.

i.e., 1, 2, 3, 4, etc. (b) The date party in 22(a) above receives imprest monies or

ITEM 12 Self-explanatory stockroom supplies.