Attachment%20J%20P2Inter-AgencyVoucherReq.pdf

PDF 138 KB Posted

Attached to
Facility Protection Services - UPDATED State and local contract opportunity
Solicitation number
RFP 32110-22726
Issued by
Davidson County, Tennessee

About this file

This is an Inter-Agency Journal Voucher Request form from the Tennessee Department of General Services (DGS) Facilities Management division used to process internal facility service requests between state agencies. The form facilitates cost allocation and authorization for facility-related projects by capturing project scope of work, building locations, and cost center information. Tenants submit the form with a detailed description of the work needed, and DGS provides cost estimates for labor and materials. Project authorization and commencement are contingent upon the tenant's authorized fiscal representative signing and approving the estimated project cost.

The form includes standard fields for building addresses, organization and speed chart identifiers, cost center information, and signature blocks for both the tenant and DGS Facility Administration leadership. The STREAM Director of Facility Administration must countersign the voucher request once the tenant authorizes the estimated charges. This appears to be a standard internal administrative form (revised February 2017, Form RDA SW-25 GS-1128) designed to ensure proper cost allocation and authorization tracking within Tennessee's state facility management system, with no specific pricing terms, set-asides, or external funding sources indicated on the document itself.

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Text version

Date:

Tennessee Department of General Services Facilities Management Inter-Agency Journal Voucher Request

To (DGS Coordinator):

From (Agency):

Complex:

Organization #:

Speed Chart #:

Location Chartfield #:

Building, Address

Example: 3210101000

Example: GS00000062

AKA Cost Center, Legacy #

Scope of Work:

Signature: Tenant Date

Above signature authorizes tenant to be charged with all costs associated with estimating this request.

For Tenant Requests Projects: This form will be returned to the tenant for signature after estimated project costs have been determined.

Estimated cost for Labor and Material to complete the above described scope of work: $

If this cost meets with your approval, please digitally sign and return as soon as possible. Project will proceed upon receipt of authorized signature.

Tenant’s Authorized Fiscal Rep Signature

STREAM Director of Facility Admin. Signature Date

DGS Internal Agency Journal Voucher Request Form (02-2017)

RDA SW-25

GS-1128

undefined:
To DGS Coordinator 1:
To DGS Coordinator 2:
Building Address:
Example 3210101000:
Example GS00000062:
AKA Cost Center Legacy:
Date:
Date_2:
Text12:
Text14:

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