726DVR7525 Appendix IV Monthly Acctg Form.xlsx

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Attached to
Informal Request for Proposal # 726DVR7525 - Vending Machine Services, Juneau Area
Solicitation number
IRFP 726DVR7525
Issued by
Anchorage Municipality, Alaska

About this file

This is a Monthly Accounting Report form for the Alaska Department of Labor and Workforce Development, Division of Vocational Rehabilitation, Business Enterprise Program (BEP), used to report vending machine commission payments. The form serves as the reporting mechanism for vendors providing vending machine services in state and federal buildings throughout the Juneau area. Vendors must submit monthly reports detailing gross sales, commission percentages, and commission amounts due for each vending machine by location type (federal or non-federal) and product category (snack, cold food, soft drink, juice, coffee, and similar items). The report requires vendor certification under penalty of perjury that all commission calculations are accurate and comply with the vending services agreement terms and conditions. Payment must be received by the 15th day of the month following the reporting period, submitted by mail to the BEP office in Juneau with either a check or money order.

The form may be submitted in computerized format with prior BEP approval, allowing vendors flexibility in reporting methods while maintaining standardized data collection. The monthly accounting structure ensures regular commission remittance to support the state's vending machine program, which provides business opportunities typically operated by individuals with disabilities as part of the vocational rehabilitation initiative. Vendors are responsible for accurate meter readings, sales documentation, and timely payment submission, with the BEP serving as the centralized collection point for all commissions generated through vending operations across designated state and federal facilities in the Juneau area.

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Sheet1

APPENDIX IV

MONTHLY ACCOUNTING REPORT FOR SUBMITTING
VENDING MACHINE COMMISSIONS
Vendor Name:_____________________________ City:_______________________
Contract #: _____________________ Reporting Period:______Month:______Year_____
Each Vending MachineMeter ReadingMachineProductGross SalesCommComm.
LocationBegEndTypeType%Due
Total Commissions Submitted
*Indicate the location as federal (F) or non-federal (N)
**Snack, Cold Food, Soft Drink, Juice, Coffee, etc.
UNDER PENALTY OF PERJURY, I DECLARE I HAVE EXAMINED THIS REPORT AND CERTIFY THAT
THE COMMISSIONS SHOWN HEREON ARE CORRECT TO APPLICABLE TERMS AND CONDITIONS
OF THE VENDING SERVICES AGREEMENT.
Signature: ______________________________Date: __________________________
Title: ___________________________________
Payment in full must be postmarked by the 15th day of the month following the end of the month of
reporting period. Please mail this report with your check or money order to:
Department of Labor & Workforce Development
Division of Vocational Rehabilitation
Business Enterprise Program
Attn: Ellen Doig
PO Box 115516
Juneau, AK 99801-5516
A computerized form may be used with BEP approval.

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