Purchase_Order TC~3.xlsx
XLSX spreadsheet 634 KB Posted
- Attached to
- Fertilizer
- Solicitation number
- S-63500-00000767
- Issued by
- Clatsop County, Oregon
About this file
The document is a purchase order form used by the Oregon Department of Fish & Wildlife (ODFW) to procure goods and services. It provides instructions for properly filling out the purchase order, including entering vendor information, item descriptions, quantities, unit prices, special instructions, and funding details. The purchase order form can be used for standard state terms and conditions or for purchases made through a state price agreement or participating addendum. Special instructions indicate that federal terms and conditions must be incorporated when using federal funds, and the appropriate grant terms and conditions should be used when non-federal grant funds are involved.
The related state and local contract opportunity is for the procurement of fertilizer by Clatsop County and the City of Salem, Oregon. The contract appears to be for a statewide opportunity that local jurisdictions can utilize. No further details are provided about the specific products, quantities, response requirements, or contract term.
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Text version
Instructions Use of Purchase Order
Hover over a cell to see Comments and Instructions for that cell
1 Insert PO number from your Office's list of PO numbers.
2 Enter date PO is being written.
3 Enter the Delivery Date - date that the vendor/contractor promised delivery of Goods or completion of Services.
| 4 | Enter complete vendor/contractor information - legal business name, address, phone, etc. |
| Check Secretary of State website to verify business registration (for Oregon Businesses). http://egov.sos.state.or.us/br/pkg_web_name_srch_inq.login | |
| Check Federal System for Award Management (SAM) website to make sure vendor/contractor has not been excluded (if using federal money for the purchase): https://www.sam.gov/SAM/pages/public/searchRecords/search.jsf |
5 Enter your location where Goods or Services will be delivered.
6 Enter the item number, description, quantity, unit of measure, unit price and total price for each item being purchased. Use continuation sheet if necessary.
| 7 | SPECIAL INSTRUCTIONS: Use the appropriate federal terms and conditions (available on ASD/Contract Services Intranet page) |
| **Insert the following language in the "Special Conditions" cell: Attachment A - Federal Terms & Conditions is incoporated into and made a part of this Purchase Order. In the event of a conflict between the terms and conditions found in Attachment A and the Purchase Order terms and conditions, the Attachment A terms and conditions shall take precedence. | |
| ***Contact Contract Services when non-federal Grant funds are being used (ex: PSMFC, PSC, etc.) to get terms & conditions for the specific Grant, and whenever a contractor will be on site performing services to ensure appropriate insurance is requested. | |
| 8 | TERMS & CONDITIONS (Yellow highlighted area): If using State funding, select the first paragraph and use the standard PO T&C's. If purchasing off of a State Price Agreement, use the second paragraph and enter the Price Agreement, and Participating Addendum number(s). If using federal funding you must contact Contract Service to ensure the appropriate language and terms and conditions attachment are included with your Purchase Order. |
9 Get appropriate signatures of person placing the order, approving the [budgetary] expenditure, authorizing the purchase (see ASD Policy ASD_250_01 for Contract Authority information), and person receiving the Goods or Services.
10 Enter complete funding information for all items being purchased.
Make sure you send the complete purchase order, including all terms and conditions, to the vendor/contractor.
PO
| STATE OF OREGON | PO No. | PO Date: | |
| PURCHASE ORDER | P |
Melody L Waight: Melody L Waight:
Insert PO number from list for your office.
Melody L Waight: Melody L Waight:
Date PO is issued
| FOB: | Fiscal Year | Page No. | |
| Delivery Date: | Destination |
Melody L Waight: Melody L Waight:
| Leave as "Destination" or if payment of freight is allowed, use drop-down to select "Destination, prepaid and add" | of | |||
| Vendor/Contractor: | Phone: | Agency Ship To Address: | ODFW | |
| Fax: | Specific Site: |
Melody L Waight: Melody L Waight:
| Insert entire legal name of vendor and physical address. | Street Address: | |||||||
| City/State/Zip: | ||||||||
| BILL TO: | Oregon Department of Fish & Wildlife, Accounts Payable | |||||||
| Contractor FEIN | 4034 Fairview Industrial Drive SE, Salem, OR 97302 | |||||||
| ITEM # | DESCRIPTION | QUANTITY | UNIT | UNIT PRICE | TOTAL PRICE | |||
| $ - 0 | 0.00 | |||||||
| $ - 0 | 0.00 | |||||||
| $ - 0 | 0.00 | |||||||
| $ - 0 | 0.00 | |||||||
| $ - 0 | 0.00 | |||||||
| $ - 0 | 0.00 | |||||||
| $ - 0 | 0.00 | |||||||
| $ - 0 | 0.00 | |||||||
| $ - 0 | 0.00 | |||||||
| $ - 0 | 0.00 | |||||||
| $ - 0 | 0.00 | |||||||
| $ - 0 | 0.00 | |||||||
| $ - 0 | 0.00 | |||||||
| $ - 0 | 0.00 | |||||||
| SPECIAL INSTRUCTIONS: | Page 1 Sub-Total | $ - 0 | 0.00 | |||||
| Continuation Page Sub Total | 0.00 |
THIS PURCHASE ORDER AND THE TERMS AND CONDITIONS ON PAGE 2 CONSTITUTE THE ENTIRE AGREEMENT BETWEEN THE PARTIES. THERE ARE NO OTHER UNDERSTANDINGS, AGREEMENTS OR REPRESENTATIONS, ORAL OR WRITTEN.
Melody L Waight: Melody L Waight:
Use if standard PO terms and conditions apply (when NOT using a State Price Agreement). If using a State Price Agreement, DELETE THIS LANGUAGE.
When using federal funding you must consult with Contract Services staff and get instruction on the language to inser in the Special Instructions, and federal attachments to the PO.
SHIPPING 0.00
Melody L Waight: Melody L Waight:
Use ONLY when freight is Destination, Prepaid and Add
OR THIS PURCHASE ORDER IS PLACED AGAINST STATE OF OREGON PRICE AGREEMENT #
Melody L Waight: Melody L Waight:
Use this language is purchasing under an existing State price agreement or participating addendum. Enter the specific price agreement or participating addendum number(s). DELETE THIS LANGUAGE IF STANDARD PO TERMS AND CONDITIONS APPLY.
When using federal funding you must consult with Contract Services staff and get instruction on the language to inser in the Special Instructions, and federal attachments to the PO.
| (or) PARTICIPATING ADDENDUM # | GRAND | $0.00 |
| THE TERMS AND CONDITIONS CONTAINED IN THE PRICE AGREEMENT (or) PARTICIPATING ADDENDUM APPLY TO THIS PURCHASE AND TAKE PRECEDENCE OVER ALL OTHER CONFLICTING TERMS AND CONDITIONS, EXPRESS OR IMPLIED. | TOTAL | |
| ORDERED BY: (Print) |
Melody L Waight: Melody L Waight:
Person placing the order.
Melody L Waight: Melody L Waight:
| Use ONLY when freight is Destination, Prepaid and Add | Phone #: | |
| Signature: | Date: | |
| APPROVED BY:(Print) |
Melody L Waight: Melody L Waight:
Budgetary Manger with authority for the cost code(s) being used. If multiple, all budgetary managers must sign.
Melody L Waight: Melody L Waight:
Insert required delivery date from solicitation or as negotiated with Contractor (for direct purchase) Melody L Waight: Melody L Waight:
Insert entire legal name of vendor and physical address.
Melody L Waight: Melody L Waight:
| Insert PO number from list for your office. | Phone #: | |
| Signature: | Date: | |
| AUTHORIZED AGENT: |
Melody L Waight: Melody L Waight:
Name and signature of person with Contract Authority for the purchase (see Policy ASD 150_01) Melody L Waight: Melody L Waight:
Leave as "Destination" or if payment of freight is allowed, use drop-down to select "Destination, prepaid and add" Melody L Waight: Melody L Waight:
| Date PO is issued | Date: |
| Signature: | |
| RECEIVED BY: |
Melody L Waight: Melody L Waight:
Person receiving the Goods or Services and verifying they are in compliance with the Purchase Order requirements.
Melody L Waight: Melody L Waight:
Enter Vendor/Contractor's federal tax ID number Melody L Waight: Melody L Waight:
Enter Item number(s) 1, 2, 3, etc.
Melody L Waight: Melody L Waight:
Describe Goods, including part numbers. Describe Services to be performed - be specific Melody L Waight: Melody L Waight: Do not use PO Box Melody L Waight: Melody L Waight:
Enter Unit: Each, Pkg, Box, Ft, SF, CF, Yd, CY, Lump Sum, etc.
Melody L Waight: Melody L Waight:
Enter any special instructions or incorporate Federal Terms & Conditions, additional Insurance, etc. Consult with Contract Services staff for required insurance or federal terms.
Melody L Waight: Melody L Waight:
Use if standard PO terms and conditions apply (when NOT using a State Price Agreement). If using a State Price Agreement, DELETE THIS LANGUAGE.
When using federal funding you must consult with Contract Services staff and get instruction on the language to inser in the Special Instructions, and federal attachments to the PO.
Melody L Waight: Melody L Waight:
Use this language is purchasing under an existing State price agreement or participating addendum. Enter the specific price agreement or participating addendum number(s). DELETE THIS LANGUAGE IF STANDARD PO TERMS AND CONDITIONS APPLY.
| When using federal funding you must consult with Contract Services staff and get instruction on the language to inser in the Special Instructions, and federal attachments to the PO. | DATE RECEIVED: | ||||||||
| COST DISTRIBUTION (Page 1) | |||||||||
| ITEM # | DESCRIPTION | INDEX | PCA | OBJ. CODE | AMOUNT | GRANT | PH | PROJECT |
| COST DISTRIBUTION TOTALS | ||
| PAGE 1 Sub-Total | CONTINUATION PAGE Sub-Total | COST DIST. GRAND TOTAL |
| $0.00 | $0.00 | $0.00 |
&8&K00-019Revised Date: 03/07/13
Continuation Sheet
| PURCHASE ORDER | PO NO. | PO DATE: | |||||
| CONTINUATION PAGE | P | From Pg 1 | From Pg 1 | ||||
| VENDOR NAME: | Page # | ||||||
| of | |||||||
| ITEM # | DESCRIPTION CONTINUATION PAGE | QTY | UNIT | PRICE | TOTAL |
Melody L Waight: Melody L Waight:
Item/line number. Continue from first page.
Melody L Waight: Melody L Waight:
Describe Goods, including part numbers. Describe Services to be performed - be specific Melody L Waight: Melody L Waight:
| Enter Unit: Each, Pkg, Box, Ft, SF, CF, Yd, CY, Lump Sum, etc. | 0.00 | 0.00 | ||||
| 0.00 | 0.00 | |||||
| 0.00 | 0.00 | |||||
| 0.00 | 0.00 | |||||
| 0.00 | 0.00 | |||||
| 0.00 | 0.00 | |||||
| 0.00 | 0.00 | |||||
| 0.00 | 0.00 | |||||
| 0.00 | 0.00 | |||||
| 0.00 | 0.00 | |||||
| 0.00 | 0.00 | |||||
| 0.00 | 0.00 | |||||
| 0.00 | 0.00 | |||||
| 0.00 | 0.00 | |||||
| 0.00 | 0.00 | |||||
| 0.00 | 0.00 | |||||
| 0.00 | 0.00 | |||||
| 0.00 | 0.00 | |||||
| 0.00 | 0.00 | |||||
| 0.00 | 0.00 | |||||
| ADDITIONAL NOTES: | CONTINUATION SUB-TOTAL | $0.00 | 0.00 | |||
| Return to Page 1 |
| COST DISTRIBUTION CONTINUATION PAGE | ||||||||
| ITEM # | DESCRIPTION | INDEX | PCA | OBJ. CODE | AMOUNT | GRANT | PHASE | PROJECT |
COST DISTRIBUTION SUB-TOTAL $0.00 Return to Page 1
&8&K00-020Revised Date: 03/07/13 image1.png image2.emf image3.png
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