OS-501 (1) (4).pdf

PDF 727 KB Posted

Attached to
Pike and Wayne Secondary Herbicide Services
Solicitation number
6100065046
Issued by
Philadelphia County, Pennsylvania

About this file

Written by GovTribe AI ·

This is a Confirmation of Service form (OS-501) used by the Pennsylvania Department of Transportation (PennDOT) to document and approve payment for services rendered by vendors under existing purchase orders. The form serves as the official record that services have been satisfactorily received and authorizes payment processing. Vendors complete the form with details including the date(s) services were rendered, vendor contact information, the purchase order number, SAP vendor number, and a complete itemization of line items matching those on the original purchase order, including quantity, unit of measure, unit price, and total amount for each item. The form requires signatures from both the vendor and the appropriate PennDOT project manager to confirm receipt and approval, followed by certification from the Goods Receiver that a Goods Receipt has been entered in SAP within 48 hours of receipt per Management Directive 310.31.

The OS-501 form is a multi-page document accommodating numerous line items across two pages, with calculated totals for each page and a grand total. All key information must be entered exactly as it appears on the fully executed purchase order, including vendor name, phone number, address, and item descriptions and product IDs. Once completed and signed by the vendor, the form is forwarded to the responsible PennDOT representative for approval, who then transmits it to the Goods Receiver for SAP entry and documentation. The completed and fully signed form is subsequently provided to the PennDOT representative for placement in the procurement file, establishing a complete audit trail for payment authorization and receipt verification.

View the file

Other files

File Type Posted
Worker Protection and Investment Cert Form (BOP 2201).docx DOCX document
Terms and Conditions Luzern.pdf PDF
Domestic Utilization Form (1).pdf PDF
2026 Pike and Wayne Secondary Herbicide Contract Specs_FINAL PDF.pdf PDF
Trade Secret Form (2).pdf PDF

On GovTribe

Work with this file

  • Download the original file
  • Contacts named in this file
  • Similar government files
  • Ask GovTribe AI about this file
Try for free Login

Text version

The file's text, extracted by GovTribe without its formatting.

OS-501 (7-16)

CONFIRMATION OF SERVICE

www.penndot.gov

Date(s) Service Rendered:________________ - _______________ Vendor Name: __________________________________________ Phone: ________________________________________________

PURCHASE ORDER #:___________________________________

SAP Vendor Number:_____________________________________ Address (1): ____________________________________________ Address (2): ____________________________________________ City: ____________________ State: _______ Zip Code: ________

(Reference line items on purchase order that match the services that were performed.)

PO Line # Description / Product ID Quantity U.O.M. Unit Price Item Total

PENNDOT USE ONLY

I certify the services represented by the confirmation of service form above were received satisfactorily. Therefore, I approve payment be made.

Project Manager Signature Date (mm/dd/yyyy)

I certify that I have entered a Goods Receipt in SAP for this service. This should occur within 48 hours of receipt (per Management Directive 310.31).

SRM/R3 Receiver Signature Date (mm/dd/yyyy) SRM Confirmation # / R3 Material Document #

Vendor Signature:_______________________________________________________________ Date:__________________________

Total of Page 1 Total of Page 2 Grand Total

Continued on page 2

PO Line # Description / Product ID Quantity U.O.M. Unit Price Item Total

Total of Page 1 Total of Page 2 Grand Total

Instructions:

Complete the OS-501 form in accordance with the instructions below.

1. The Vendor completes the OS-501 form, then forwards the signed/dated form to the appropriate PennDOT representative for approval (may be done electronically via email). Explanations for fields on the form are listed below.

Date Service Rendered: Provide the date of service (i.e., Date or date range).

Vendor Name*: Enter name.

Phone*: Area code and phone number.

PURCHASE ORDER #*: The ten digit number in the upper right corner.

SAP Vendor Number*: This is the vendor’s six digit vendor number (e.g. 412345).

Address (1)*: Vendor's street address.

Address (2)*: Enter the Floor, Suite, etc. of the vendors address, if applicable.

City*: Vendor's City.

State*: Vendor's State.

Zip Code*: Vendor's Zip Code.

PO Line #: Enter the PO line item number(s) in this column. Many PO’s contain numerous line items.

Use separate lines to account for each item that was delivered.

Description/Product ID*: Enter the exact description from the PO line item Description/Product ID column.

Quantity: Enter the quantity delivered for the time period.

U.O.M.*: This is the unit of measure for the service/material rendered (e.g. hours, days, number, etc).

Unit Price*: Cost per individual unit of measure.

Total: Calculated Amount of the Quantity x Unit Price.

*Enter information exactly as it appears on the fully executed Purchase Order.

2. The PennDOT Representative confirms services were received satisfactorily and approves payment to be made by signing and dating on the “Project Manager Signature” line. The PennDOT Representative forwards the signed/dated form to their Goods Receiver.

3. The Goods Receiver certifies that a Goods Receipt has been entered in SAP for the by signing, dating, and providing the SRM Confirmation Number/R3 Material Document Number.

4. The Goods Receiver provides a copy of the completed and signed/dated form to the PennDOT Representative for placement in the Procurement file.

Item #, Row 1:
0:
1:
2:
3:
4:
5:
6:
7:
8:
9:
10:
11:
12:
13:
14:
15:
16:
17:
18:
19:
20:
21:
22:
23:
24:
25:
0:
1:
2:
3:
4:
5:
6:
7:
8:
9:
10:
11:
12:
13:
14:
15:
16:
17:
18:
19:
20:
21:
22:
23:
24:
25:
26:
27:
28:
29:
30:
31:
32:
33:
34:
35:
36:
37:
38:
39:
40:
41:
42:
43:
44:
ItemTotal1:
0: 0
1: 0
2: 0
3: 0
4: 0
5: 0
6: 0
7: 0
8: 0
9: 0
10: 0
11: 0
12: 0
13: 0
14: 0
15: 0
16: 0
17: 0
18: 0
19: 0
20: 0
21: 0
22: 0
23: 0
24: 0
25:
0: 0
1: 0
2: 0
3: 0
4: 0
5: 0
6: 0
7: 0
8: 0
9: 0
10: 0
11: 0
12: 0
13: 0
14: 0
15: 0
16: 0
17: 0
18: 0
19: 0
20: 0
21: 0
22: 0
23: 0
24: 0
25: 0
26: 0
27: 0
28: 0
29: 0
30: 0
31: 0
32: 0
33: 0
34: 0
35: 0
36: 0
37: 0
38: 0
39: 0
40: 0
41: 0
42: 0
43: 0
44: 0
Description Product ID, Row 1:
0:
1:
2:
3:
4:
5:
6:
7:
8:
9:
10:
11:
12:
13:
14:
15:
16:
17:
18:
19:
20:
21:
22:
23:
24:
25:
0:
1:
2:
3:
4:
5:
6:
7:
8:
9:
10:
11:
12:
13:
14:
15:
16:
17:
18:
19:
20:
21:
22:
23:
24:
25:
26:
27:
28:
29:
30:
31:
32:
33:
34:
35:
36:
37:
38:
39:
40:
41:
42:
43:
44:
Quantity 1:
0:
1:
2:
3:
4:
5:
6:
7:
8:
9:
10:
11:
12:
13:
14:
15:
16:
17:
18:
19:
20:
21:
22:
23:
24:
25:
0:
1:
2:
3:
4:
5:
6:
7:
8:
9:
10:
11:
12:
13:
14:
15:
16:
17:
18:
19:
20:
21:
22:
23:
24:
25:
26:
27:
28:
29:
30:
31:
32:
33:
34:
35:
36:
37:
38:
39:
40:
41:
42:
43:
44:
UOM, Row 1:
0:
1:
2:
3:
4:
5:
6:
7:
8:
9:
10:
11:
12:
13:
14:
15:
16:
17:
18:
19:
20:
21:
22:
23:
24:
25:
0:
1:
2:
3:
4:
5:
6:
7:
8:
9:
10:
11:
12:
13:
14:
15:
16:
17:
18:
19:
20:
21:
22:
23:
24:
25:
26:
27:
28:
29:
30:
31:
32:
33:
34:
35:
36:
37:
38:
39:
40:
41:
42:
43:
44:
Unit Price 1:
0:
1:
2:
3:
4:
5:
6:
7:
8:
9:
10:
11:
12:
13:
14:
15:
16:
17:
18:
19:
20:
21:
22:
23:
24:
25:
0:
1:
2:
3:
4:
5:
6:
7:
8:
9:
10:
11:
12:
13:
14:
15:
16:
17:
18:
19:
20:
21:
22:
23:
24:
25:
26:
27:
28:
29:
30:
31:
32:
33:
34:
35:
36:
37:
38:
39:
40:
41:
42:
43:
44:
PURCHASE ORDER:
Contractor Name:
Phone:
SAP Vendor Number:
Check Box3: Off
Date:
Date mmddyyyy:
Confirmation Number:
Date mmddyyyy_2:
Total Page 1: 0
Total Page 2: 0
Grand Total: 0
Date Service Rendered:
Date Service Rendered2:
Address 1:
Address 2:
City:
State:
Zip Code:

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