Attachment 4 - Missouri Statewide Quarterly Admin Fee Report and Instructions.xlsx

XLSX spreadsheet 18 KB Posted

Attached to
Statewide Concrete Qualified Vendors List (QVL) (For Additional Vendors)
Solicitation number
300000270305366
Issued by
Missouri

About this file

This document is a Quarterly Administrative Fee Report form and instructions issued by the Missouri Division of Purchasing for contractors operating under statewide contracts with the State of Missouri, including those on the Statewide Concrete Qualified Vendors List. The report requires contractors to submit quarterly documentation detailing all purchases made under their contracts for which payment was received during the reporting quarter. Submissions must be made no later than the 15th calendar day of the month following each reporting quarter (Q1: January-March, Q2: April-June, Q3: July-September, Q4: October-December). The form requires contractor identification information, reporting contact details, and certification by a responsible party with appropriate signature and title.

The administrative fee is calculated at 1% of the overall total payments received from Missouri state agencies, political subdivisions, universities, and governmental entities in other states during the reporting quarter. Contractors must report total payments received minus returns and credits for each category separately before calculating the total administrative fee payment. Payment of the calculated fee must be submitted using one of four methods: personal check, money order, company check, or ACH electronic payment. Completed reports should be submitted to the Division of Purchasing by mail to P.O. Box 809, Jefferson City, MO 65102-0809 or 301 West High Street, Room 630, Jefferson City, MO 65101-1517; by fax to (573) 526-9815; or by email to ereports@oa.mo.gov. Contractors receiving no payments during a reporting quarter must indicate this status on the form and are excused from fee payment for that period.

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Instructions

Quarterly Administrative Fee Report
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.
Header Definitions.
Contractor NameContractor name as it appears on the contract.
Statewide Contract NumberStatewide contract number as listed on the first page of your contract with the State of Missouri.
Date Report SubmittedDate Administrative Fee Report is submitted.
Report Contact NameName of the person completing the report on behalf of the contractor.
Contact Phone NumberPhone number for person completing the report.
Contact Email AddressEmail address for the person completing the report.
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.
If no payments were received during the Reporting Quarter, check the box below: Complete section if applicable.
Reporting QuarterQuarter 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:
Q1: January 1 - March 31 Q3: July 1 - September 30
Q2: April 1 - June 30 Q4: October 1 - December 31
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.

Attachment

Admin Fee Report

Contractor Name:Report Contact Name:
Statewide Contract Number:Contact Phone Number:
Date Report Submitted:Contact Email Address:
Administrative Fee Payment Calculation:
(If no payments received during Reporting Quarter, skip to next section)Reporting FY Quarter (check one):
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:Submit this report to the Division of Purchasing (Purchasing) using one of the methods below:
Total Payments Received (minus returns & credits) from Governmental Entities in Other States during the Reporting Quarter: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

Overall Total Payments Received (minus returns & credits) during the Reporting Quarter :$0.00Indicate below the method of payment used for submitting the Total Administrative Fee Payment for the Reporting Quarter and date of payment submission:
1% Administrative Fee (Multiply Overall Total Payments by 1% to determine Total Administrative Fee Payment)1.00%

Method of Payment Used:

[ ] Personal check [ ] Money Order [ ] Company check [ ] ACH (Electronic Payment) [ ] Cashier's check

Date of Payment Submission: __/__/20__ (mm/dd/yyyy) 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.Signature: _______________________________________________

Title: _______________________________ Date: ______________

&"Arial,Bold"&12 Attachment - Missouri Statewide Contract Quarterly Administrative Fee Report

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