EVT0010924_-_Complaint-to-Vendor.pdf
PDF 84 KB Posted
- Attached to
- Janitorial Services - Manhattan DLEX
- Solicitation number
- EVT0010924
- Issued by
- Rooks County, Kansas
About this file
This document is a Complaint to Vendor form (DA-112) issued by the Kansas Department of Administration, Division of Purchases, located at 900 SW Jackson, Room 102 N, Topeka, Kansas 66612-1286. The form is designed for state agencies to formally document vendor performance issues related to purchase orders or contracts. The form enables agencies to report specific complaint categories, including late delivery, refusal to deliver, after-hours delivery, shipment discrepancies (undershipment or overshipment), inadequate service, unauthorized substitution, inferior or shoddy merchandise, improper labeling, and damaged shipments. Additionally, agencies may note whether the carrier has been notified and may describe other complaint types as needed.
The form requires completion in triplicate, with the original and one copy sent to the Division of Purchases and one copy retained by the initiating agency. Critically, the form explicitly states that it should not be sent directly to the vendor by the agency. The document includes fields for the vendor information, agency information, purchase order or contract number, purchase requisition number, group number, date of the purchase order, complaint date, remarks section for detailed explanation of the complaint, and authorization signature from the person initiating the complaint. This form serves as an official mechanism for documenting vendor performance deficiencies within the Kansas state procurement system.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
NOTICE OF
Department of Administration Division of Purchases DA-112 (Rev. 1/94)
COMPLAINT TO VENDOR
DATE: _______________ P.O./CONTRACT NO. ___________________
DATE OF P.O. ___________________
PURCHASE REQUISITION NO. ___________________
GROUP NO. ___________________
DIVISION OF PURCHASES
900 SW JACKSON, ROOM 102 N
TOPEKA, KANSAS 66612-1286
VENDOR INFORMATION AGENCY INFORMATION
NAME:
ADDRESS:
NAME:
ADDRESS:
Late Delivery Refusal of Vendor to Deliver Delivery Made After Hours Undershipment Overshipment Inadequate Service
Substitution by Vendor Inferior or Shoddy Merchandise Merchandise Not Properly Labeled Damaged Shipment Carrier Notified Other – Explain Below in Space Provided for “Remarks”
REMARKS: This space is to be used to: (1) Elaborate on items checked above or (2) Describe additional complaints. Be accurate, specific, complete, and factual.
NAME AND TITLE OF PERSON INITIATING COMPLAINT
AUTHORIZED SIGNATURE
This form should be filled out in triplicate. The original and one copy should be sent to the Division of Purchases, 900 SW Jackson, Room 102 N, Topeka, Kansas 66612- 1286. The Agency will retain one copy. This form should not be sent to the vendor by the agency.
File details come from the government source that posted it. Updated .