.11 Confirmation of Service Form (OS-501) SAMPLE.pdf

This is a Confirmation of Service Form (OS-501) used by the Pennsylvania Department of Transportation (PennDOT) to document and authorize payment for tree trimming and stump removal services rendered within Washington County. The form serves as the official record that services matching the referenced purchase order line items have been satisfactorily completed and received. Vendors must complete the form by documenting the date(s) services were rendered, their company information, the applicable purchase order number, SAP vendor number, and a detailed breakdown of line items performed including quantity, unit of measure, unit price, and item totals. The form requires certification and signature approval from both the PennDOT Project Manager and the SRM/R3 Receiver within 48 hours of receipt, in accordance with Management Directive 310.31, along with vendor signature and date confirmation.

The form functions as the critical payment authorization document within PennDOT's procurement and accounting system, requiring Project Manager verification that services were received satisfactorily before payment approval and SRM/R3 Receiver confirmation that a Goods Receipt entry has been made in the SAP system. The contract opportunity itself is restricted to DGS-certified small businesses only, as designated under the Small Business Procurement Initiative (SBPI) established by Executive Order 2011-09. All bids must be submitted electronically through the PA Supplier Portal at www.pasupplierportal.state.pa.us, with technical support available through the Supplier Service Center at (877) 435-7363. The work scope encompasses tree trimming and stump removal services across all State Routes, PennDOT facilities, and other areas where the department has responsibility, with waste disposition including chips, mulch, leaves, and branches to be hauled away unless specific "fly chipping" instructions are provided for individual projects.