Attachment 4 Missouri Statewide Quarterly Admin Fee Report and Instructions.pdf
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- Solicitation number
- 300000295666351
- Issued by
- Missouri
About this file
This document is the Missouri Statewide Quarterly Administrative Fee Report and Instructions, issued by the Division of Purchasing for contractors participating in statewide contracts with the State of Missouri. The report applies to all purchases made under statewide contracts for which payment has been received by contractors during a specified reporting quarter. Contractors must submit the completed report to the Division of Purchasing no later than the 15th calendar day of the month following the applicable reporting quarter. The quarters are defined as Q1 (January 1 – March 31), Q2 (April 1 – June 30), Q3 (July 1 – September 30), and Q4 (October 1 – December 31).
The administrative fee is calculated as one percent of the overall total payments received during the reporting quarter, with payments tracked separately from Missouri state agencies, Missouri political subdivisions (cities and counties), Missouri universities, and governmental entities in other states, minus any returns and credits. Contractors must report their total payments received from each category and submit the calculated one percent administrative fee payment using one of four methods: personal check, money order, company check, or ACH electronic payment. The report should be submitted to the Division of Purchasing by mail to P.O. Box 809, Jefferson City, MO 65102-0809, by fax to (573) 526-9815, or by email to ereports@oa.mo.gov. If no payments were received during a reporting quarter, contractors may check the applicable box and submit the report without payment. Questions regarding contract areas or report submission should be directed to Purchasing at (573) 751-2387.
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Text version
Contractor Name Contractor name as it appears on the contract.
Statewide Contract Number
Date Report Submitted
Report Contact Name Contact Phone Number Phone number for person completing the report.
Contact Email Address Email address for the person completing the report.
Reporting Quarter
Signature of Reponsible Party for Report Content: The signature and title of the person completing the report on behalf of the contractor and the date the report was completed.
Date Administrative Fee Report is submitted.
Administrative Fee Payment Calculation - The total amount in payments received (minus returns & credits) from state agency(ies), political subdivision(s), universities, and governmental entities in other states, the Overall Total Payments Received, and the Total Administrative Fee Payment (calculated as 1% of the Overall Total Payments Received) for the Reporting Quarter.
Q1: January 1 - March 31 Q3: July 1 - September 30 Q2: April 1 - June 30 Q4: October 1 - December 31
If no payments were received during the Reporting Quarter, check the box below: Complete section if applicable.
Attachment 4
Quarterly Administrative Fee Report
Quarter for which the contractor is reporting purchases for which payment has been received. This must be in format QX, where X is the Quarter number as follows:
Header Definitions.
The contractor shall submit a "Quarterly Administrative Fee Report" to the Division of Purchasing (Purchasing) for all purchases made under the contract for which payment has been received by the contractor during the reporting quarter. The contractor must submit the "Quarterly Administrative Fee Report" to Purchasing no later than the 15th calendar day of the month following the "Reporting Quarter". The contractor shall complete the "Quarterly Administrative Fee Report" in accordance with the definitions and requirements stated below.
Completed electronic forms will feed into a central database for aggregate usage. Please contact Purchasing
(573) 751-2387 if you have specific questions about your contract area, the submission of this report, or payment of the administrative fee.
Name of the person completing the report on behalf of the contractor.
Statewide contract number as listed on the first page of your contract with the State of Missouri.
STATE 0000000240SL
Attachment 4 - Missouri Statewide Contract Quarterly Administrative Fee Report
Contractor Name: Report Contact Name:
Statewide Contract Number: Contact Phone Number:
Date Report Submitted: Contact Email Address:
Total Payments Received (minus returns & credits) from Missouri State Agencies during the Reporting Quarter :
[ ] July 1 - September 30 Quarter 1
[ ] October 1 - December 31 Quarter 2
Total Payments Received (minus returns & credits) from Missouri Political Subdivisions (cities, counties, etc.)
during the Reporting Quarter:
[ ] January 1 - March 31 Quarter 3
[ ] April 1 - June 30 Quarter 4
Total Payments Received (minus returns & credits) from Missouri Universities during the Reporting Quarter:
Total Payments Received (minus returns & credits) from Governmental Entities in Other States during the Reporting Quarter:
Overall Total Payments Received (minus returns & credits) during the Reporting Quarter : $0.00
1% Administrative Fee (Multiply Overall Total Payments by 1% to determine Total Administrative Fee Payment)
1.00%
Total Administrative Fee Payment for the Reporting Quarter:
$0.00
If no payments were received during the Reporting Quarter, check the box below: Signature of Responsible Party for Report Content:
[ ] No payments were received this calendar quarter for any purchases on the contract identified above.
Submit this report to the Division of Purchasing (Purchasing) using one of the methods below:
Indicate below the method of payment used for submitting the Total Administrative Fee Payment for the Reporting Quarter and date of payment submission:
Reporting FY Quarter (check one):Administrative Fee Payment Calculation:
(If no payments received during Reporting Quarter, skip to next section)
Signature: _______________________________________________ Title: _______________________________ Date: ______________
Method of Payment Used:
[ ] Personal check [ ] Money Order [ ] Company check [ ] ACH (Electronic Payment) [ ] Cashier's check
Date of Payment Submission: __/__/20__ (mm/dd/yyyy)
1) Mail: Division of Purchasing, P.O. Box 809, Jefferson City MO 65102 - 0809 OR 301 West High Street, Room 630, Jefferson City MO 65101 - 1517
2) Fax: (573) 526-9815
3) Email: ereports@oa.mo.gov
| Instructions |
| Admin Fee Report |
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