EVT0010927_-_Complaint-to-vendor.pdf
PDF 84 KB Posted
- Attached to
- Janitorial Services - Wichita Area
- Solicitation number
- EVT0010927
- Issued by
- Sedgwick County, Kansas
About this file
This is a Complaint to Vendor form (DA-112) issued by the Kansas Department of Administration Division of Purchases, designed for state agencies to formally document vendor performance issues related to state and local contract opportunities, specifically in this instance involving Janitorial Services for the Wichita Area managed by the Kansas Department of Revenue. The form serves as an official mechanism for agencies to record complaints against vendors and is submitted to the Division of Purchases located at 900 SW Jackson, Room 102 N, Topeka, Kansas 66612-1286.
The form provides a standardized complaint documentation process with checkboxes for common vendor issues including late delivery, refusal to deliver, delivery made after hours, undershipment, overshipment, inadequate service, substitution by vendor, inferior or shoddy merchandise, merchandise not properly labeled, damaged shipments, and other complaints. Required information includes the P.O./contract number, purchase requisition number, vendor information, agency information, date of complaint, and space for detailed remarks explaining the nature of the complaint. The form must be completed in triplicate, with the original and one copy sent to the Division of Purchases and one copy retained by the initiating agency, and explicitly should not be forwarded to the vendor by the agency.
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 .