Exhibit B Contractor's Equipment List.pdf
PDF 249 KB Posted
- Attached to
- Master Agreement AZ|CTR078753
- Contract number
- CTR078753
- Issued by
- Arizona
About this file
FES-1000AFORFF Contractor's Equipment List Summary
The FES-1000AFORFF is an equipment inventory control form issued by the Arizona Department of Economic Security (DES). This form is used to track capital and stewardship equipment items purchased with Department contract funds by contractors. The document serves as a standardized reporting mechanism for contractors engaged in DES contract agreements to maintain accurate records of equipment acquisitions and their associated costs throughout the contract period.
Contractors are required to complete and submit the equipment list within 30 days of acquiring any equipment purchased with contract funds, with annual submissions thereafter until contract termination, and a final end-of-contract inventory upon conclusion. The form requires detailed information for each equipment item, including item description and model number, manufacturer identification, serial number, acquisition date, physical location address (excluding P.O. Box designations), total item cost, and the amount of DES contract funds used to acquire the item. Contractors must submit completed forms to the DES Program Division/Administration Contract Unit, and all information must be typed. The form designates specific fields for contractor signature and DES staff completion, with documentation requirements applying equally to contract inception, annual inventory periods, and end-of-contract inventories.
View the file
Other files
Show all 15
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
FES-1000AFORFF (1-16) ARIZONA DEPARTMENT OF ECONOMIC SECURITY
☐ Contract Inception
☐ Annual Inventory
☐ End-of-Contract Inventory
CONTRACTOR’S EQUIPMENT LIST
(Capital and Stewardship Equipment Items) Page ______ of ______
CONTRACTOR’S NAME(Legal name and DBA “doing businessas” name) FEI/SSN MAILING ADDRESS(P.O. Box or No., Street, City, State,ZIP)
PHONE NO. DES CONTRACT NO. CONTRACT BEGIN DATE CONTRACT END DATE INVENTORY DATE
Item Description Manufacturer Serial No.
Acqu.
Date Physical Location
Total Item Cost
DES
Contract
Cost
EXHIBIT B
CONTRACTOR’S NAME(Printed) TITLE
CONTRACTOR’S SIGNATURE DATE SIGNED
DES CONTRACT NOTICES PERSON’S NAME(Printed) DES CONTRACT NOTICES PERSON’S SIGNATURE PHONE NO. DES PROGRAM MAIL DROP DATE SIGNED
See reverse for EOE/ADA/LEP/GINA disclosures.
Completion Instructions for FES-1000AFORFF
CONTRACTOR’S EQUIPMENT LIST
(Capital and Stewardship Equipment Items) A. Purpose.
To facilitate the inventory control of capital and stewardship equipment purchased with Department contract funds.
B. Completion.
Thefollowingsectionsmustbecompletedbythecontractorwithin30daysofacquisitionofequipmentpurchasedwithcontractfundsandannuallythereafter until the contract’s termination. At the contract’s conclusion date, an end-of-contract inventory is completed. ALL INFORMATION IS TO BE TYPED.
All items are self-explanatory except:
CONTRACTOR’S NAME. Enter legal name and DBA(doingbusiness as)name.
FEI OR SSN. Enter the federal employer identificationnumber or social security number as applicable.
DES CONTRACT NO. Enter the contract number throughwhich the equipment was purchased or acquired.
INVENTORY DATE. Enter the date form is prepared.
ITEM DESCRIPTION. Enter the type of item and modelnumber.
ACQUISITION DATE. Enter the acquisition date ofpurchased equipment item.
PHYSICAL LOCATION. Enter the address where the equipmentis located. Do not use a “P.O. Box” designation.
TOTAL ITEM COST. Enter the total cost of the equipmentitem.
DES CONTRACT COST. Enter the amount of contractfunds used to acquire the item.
CONTRACTOR’S SIGNATURE. The individual delegatedauthority for the inventory control must sign the form.
Shaded area is to be completed by DES staff.
C. Routing.
The contractor submits the form to the DES Program Division/Administration Contract Unit within 30 days of the acquisition of the item and annually thereafter.
EqualOpportunityEmployer/Program•UnderTitlesVIandVIIoftheCivilRightsActof1964(TitleVI&VII),andtheAmericanswithDisabilitiesActof1990(ADA),Section 504 of the Rehabilitation Act of 1973, the Age Discrimination Act of 1975, and Title II of theGeneticInformationNondiscriminationAct(GINA)of2008;theDepartment prohibitsdiscriminationinadmissions,programs,services,activities,oremploymentbasedonrace,color,religion,sex,nationalorigin,age,disability,geneticsandretaliation.The Department must make areasonableaccommodationtoallowapersonwithadisabilitytotakepartinaprogram,serviceoractivity.Forexample,thismeansifnecessary,the Departmentmustprovidesignlanguageinterpretersforpeoplewhoaredeaf,awheelchairaccessiblelocation,orenlargedprintmaterials.ItalsomeansthattheDepartmentwill takeanyotherreasonableactionthatallowsyoutotakepartinandunderstandaprogramoractivity,includingmakingreasonablechangestoanactivity.Ifyoubelievethatyou willnotbeabletounderstandortakepartinaprogramoractivitybecauseofyourdisability,pleaseletusknowofyourdisabilityneedsinadvanceifatallpossible.Torequestthis document in alternativeformatorforfurtherinformationaboutthispolicy,contactyourlocaloffice;TTY/TDDServices:7-1-1.•FreelanguageassistanceforDESservicesis available upon request. • Ayuda gratuita con traducciones relacionadas con los servicios del DES está disponible a solicitud del cliente.
File details come from the government source that posted it. Updated .