Commonwealth of Vendor's Report of Sales

Contract Number Vendor Name Report Preparer Name Contact E-mail Contact Phone Report Start Date Report End Date

Instructions: 1. Enter the contract#, your company name, contact info, and the dates covered by this report above. 2. Fill in all the cells for each line-item purchased. Follow the example shown below. 3. Please ensure correct spelling of the Agency/Institution/Public Body and Division/Department (For State agency names, please use the State Agency Names tab). 4. Please note that Extended Actual Price and Surcharge Fee will be calculated automatically. 5. Please see next worksheet tab for definitions of column headings. 6. The report shall include invoiced sales data, which means all invoices issued within the reporting period. 7. If additional rows are needed, please copy a blank row and paste it to the number of rows needed. 8. The report shall be submitted to the Contract Officer and the email address [email protected] no later than the 15th of the next month following the end of the calendar quarter or month. 9. This report is used to support the SCA payment to the Division of Purchasing and Supply (DPS)

Total Sales for Reporting Period: $0.00 Surcharge Fee for Reporting Period: $0.00 $0.00 $0.00

Units of Invoice Purchase Order Vendor Catalog Measure Actual Price Surcharge Line # Order Date Number Invoice Date Number Agency/Institution/Public Bodey Item Description Item Number Manufacturer Name Manufacturer SKU# (UOM) Quantity Unit Price Extended Charge (SCA) Ex. 1/9/2014 307686 1/13/2014 EP756651 Department of General Services FUNNEL FILTER 43 MM 509037 XYZ Company 4212B23 CS 1 $150.00 $150.00 $2.94

Commonwealth of Virginia Usage Report Page 1 of 14 2/14/2019 Units of Invoice Purchase Order Vendor Catalog Measure Actual Price Surcharge Line # Order Date Number Invoice Date Number Agency/Institution/Public Bodey Item Description Item Number Manufacturer Name Manufacturer SKU# (UOM) Quantity Unit Price Extended Charge (SCA)

Commonwealth of Virginia Usage Report Page 2 of 14 2/14/2019 Units of Invoice Purchase Order Vendor Catalog Measure Actual Price Surcharge Line # Order Date Number Invoice Date Number Agency/Institution/Public Bodey Item Description Item Number Manufacturer Name Manufacturer SKU# (UOM) Quantity Unit Price Extended Charge (SCA)

Commonwealth of Virginia Usage Report Page 3 of 14 2/14/2019 Units of Invoice Purchase Order Vendor Catalog Measure Actual Price Surcharge Line # Order Date Number Invoice Date Number Agency/Institution/Public Bodey Item Description Item Number Manufacturer Name Manufacturer SKU# (UOM) Quantity Unit Price Extended Charge (SCA)

Commonwealth of Virginia Usage Report Page 4 of 14 2/14/2019 Units of Invoice Purchase Order Vendor Catalog Measure Actual Price Surcharge Line # Order Date Number Invoice Date Number Agency/Institution/Public Bodey Item Description Item Number Manufacturer Name Manufacturer SKU# (UOM) Quantity Unit Price Extended Charge (SCA)

Commonwealth of Virginia Usage Report Page 5 of 14 2/14/2019 Units of Invoice Purchase Order Vendor Catalog Measure Actual Price Surcharge Line # Order Date Number Invoice Date Number Agency/Institution/Public Bodey Item Description Item Number Manufacturer Name Manufacturer SKU# (UOM) Quantity Unit Price Extended Charge (SCA)

Commonwealth of Virginia Usage Report Page 6 of 14 2/14/2019 Definitions

Order Date Date the item listed was ordered by the purchasing agency Invoice Number A number assigned to invoice by the vendor Invoice Date Date the item listed was invoiced by the vendor Agency/Insutution/Public Body Name of the Agency, Institution of Higher Education, Municipality or Other Public Body purchasing the item listed Purchase Order Number State or locality-issued purchase order number Item Description Brief description that clearly identifies the item listed Manufacturer SKU# SKU or Part Number that uniquely identifies the item listed Vendor Item No Supplier's specific id number, distinct from the manufacturer SKU or Part Number Unit of Measure Unit by which quantity is measured (I.e. box, case, each, etc.) Quantity Quantity purchased of the item listed Unit Price Actual price charged for the item listed. Actual Price Extended Unit price multiplied by quantity SCA Surcharge Adjustment Fee Agency Names (Alphabetic Order)

Agency Name Agency Code Administration of Health Insurance 149 Appropriation Vetoes - Capital 991 Appropriation Vetoes – Operating 990 Attorney General - Division of Debt Collection 143 Attorney General and Department of Law 141 Auditor of Public Accounts 133 Augusta Correctional Center 754 Autism Advisory Council 871 Baskerville Correctional Center 761 Bland Correctional Center 718 Blue Ridge Community College 291 Board of Accountancy 226 Board of Bar Examiners 233 Brown v Board of Education Scholarship 858 Brunswick Correctional Center 730 Buckingham Correctional Center 749 Capital Square Preservation Council 820 Catawba Hospital 724 Central Appropriations - Capital Outlay 949 Central Appropriations - Debt Bonds 9(D) 951 Central Appropriations - Revenue Bonds 9(C) 950 Central Appropriations-Administration 995 Central Region Correctional Field Units 760 Central State Hospital 703 Central Virginia Community College 292 Central Virginia Training Center 707 Chesapeake Bay Commission 842 Chippokes Plantation Farm Foundation 319 Christopher Newport University 242 Circuit Courts 113 Citizen Advisory Commission - Executive 836 City and County Treasurers 998 Coffeewood Correctional Center 773 Combined District Courts 116 Commission on Civics Education 870 Commission on Electric Utility Restructuring 863 Commission on Prevention of Human 866 Commission on Unemployment 860 Commission on Virginia Alcohol Safety 413 Commissioners for Promotion of Uniformity 145 Commonwealth Center for Children and 708 Commonwealth’s Attorneys' Services Council 957 Compensation Board 157 Comprehensive Services for At-Risk Youth 200 Cooperative Extension and Agricultural 234 Corrections - Division of Institutions 756 Court of Appeals of Virginia 125 Dabney S. Lancaster Community College 287 Danville Community College 279 Deep Meadow Correctional Center 752 Deerfield Correctional Center 753 Department for the Aging 163 Department for the Blind and Vision Impaired 702 Department for the Deaf & Hard-of-Hearing 751 Department of Accounts 151 Department of Accounts Transfer Payments 162 Department of Accounts-Statewide Activities 997 Department of Agriculture and Consumer 301 Department of Alcoholic Beverage Control 999 Department of Aviation 841 Department of Business Assistance 325 Department of Charitable Gaming 173 Department of Conservation & Recreation 199 Department of Correctional Education 750 Department Of Corrections - Employee 742 Department of Corrections, Central Activities 799 Department of Corrections, Division of 795 Department of Corrections-Central 701 Department of Criminal Justice Services 140 Department of Education - Central Office 201 Department of Education - Direct Aid to 197 Department of Emergency Management 127 Department of Employment Dispute 962 Department of Environmental Quality 440 Department of Fire Programs 960 Department of Forensic Science 778 Department of Forestry 411 Department of Game and Inland Fisheries 403 Department of General Services 194 Department of Health 601 Department of Health Professions 223 Department of Historic Resources 423 Department of Housing and Community 165 Department of Human Resource 129 Department of Juvenile Justice 777 Department of Labor and Industry 181 Department of Medical Assistance Services 602 Department of Military Affairs 123 Department of Mines, Minerals and Energy 409 Department of Minority Business Enterprise 232 Department of Motor Vehicles 154 Department of Motor Vehicles Transfer 530 Department of Planning and Budget 122 Department of Professional and 222 Department of Rail and Public Transportation 505 Department of Rehabilitative Services 262 Department of Small Business and Supp 350 Department of Social Services 765 Department of State Police 156 Department of Taxation 161 Department of the Treasury 152 Department of the Treasury-Statewide 996 Department of Transportation 501 Department of Treasury-Trust Funds 994 Department of Veterans Services 912 Dept. of Behavioral Health and 720 Developmental Services Dillwyn Correctional Center 770 Division of Capitol Police 961 Division of Community Corrections 767 Division of Legislative Automated Systems 109 Division of Legislative Services 107 Dr. Martin Luther King, Jr. Memorial 845 Eastern Shore Community College 284 Eastern State Hospital 704 Eastern Virginia Medical School 274 Economic Development Incentive Payme 312 Enterprise Application Public-Private 861 Extension and Agricultural Experiment Fluvanna Women’s Correctional Center 743 Fort Monroe Authority 360 Frontier Culture Museum of Virginia 239 General District Courts 114 General Fund Resources 31 General Provisions 30 George Mason University 247 Germanna Community College 297 Green Rock Correctional Center 776 Greensville Correctional Center 769 Gunston Hall 417 Haynesville Correctional Center 772 Health and Human Resources Capital 900 Higher Education Research Initiative 989 Hiram W. Davis Medical Center 748 House of Delegates 101 Human Rights Council 170 Indian Creek Correctional Center 771 Indigent Defense Commission 848 Innovation and Entrepreneurship Investment 934 Institute for Advanced Learning and 885 Interstate Organization Contributions 921 J. Sargeant Reynolds Community College 283 James Madison University 216 James River Correctional Center 719 Jamestown-Yorktown Foundation 425 Jefferson Science Associates, LLC 936 John Tyler Community College 290 Joint Commission on Administrative Rules 865 Joint Commission on Health Care 844 Joint Commission on Technology and 847 Joint Legislative Audit & Review Commission 110 Judicial Department Reversion Clearing 104 Judicial Inquiry and Review Commission 112 Juvenile & Domestic Relations District Courts 115 Keen Mountain Correctional Center 768 Legislative Department Reversion Clearing 102 Lieutenant Governor 119 Longwood University 214 Lord Fairfax Community College 298 Lunenburg Correctional Center 774 Magistrate System 103 Manufacturing Development Commission 864 Marine Resources Commission 402 Marion Correctional Treatment Center 747 Mecklenburg Correctional Center 744 Mental Health Treatment Centers 792 Mental Retardation Training Centers 793 MHMRSAS - Grants to Localities 790 Motor Vehicle Dealer Board 506 Mountain Empire Community College 299 New College Institute 938 New River Community College 275 Norfolk State University 213 Community College 280 Northern Virginia Mental Health Institute 728 Northern Virginia Training Center 725 Nottoway Correctional Center 745 Office for Substance Abuse Prevention 853 Office of Commonwealth Preparedness 454 Office of Inspector General for Behavioral 722 Office of the Governor 121 Office of the State Inspector General 147 Old Dominion University 221 Opportunity Educational Institution 920 Patrick Henry Community College 285 Paul D. Camp Community College 277 Personal Property Tax Relief Act 850 Piedmont Geriatric Hospital 729 Piedmont Virginia Community College 282 Planned Reversions 992 Pocahontas State Correctional Center 775 Powhatan Correctional Center 709 Powhatan Reception and Classification 721 Public Safety Capital Clearing Account 901 Radford University 217 Rappahannock Community College 278 741 Richard Bland College 241 River North Correctional Center 785 Roanoke Higher Education Authority 935 Secretary of Administration 180 Secretary of Agriculture and Forestry 193 Secretary of Commerce and Trade 192 Secretary of Education 185 Secretary of Finance 190 Secretary of Health & Human Resources 188 Secretary of Natural Resources 183 Secretary of Public Safety 187 Secretary of Technology 184 Secretary of the Commonwealth 166 Secretary of Transportation 186 Senate 100 Sitter-Barfoot Veterans Care Center 922 Small Business Commission 862 Southampton Correctional Center 717 Southeastern Virginia Training Center 723 Southern Virginia Higher Education Center 937 Southern Virginia Mental Health Institute 739 Southside Virginia Community College 276 Southside Virginia Training Center 726 Southwest Virginia Community College 294 Southwest Virginia Higher Education Center 948 Southwestern Virginia Mental Health Institute 705 Southwestern Virginia Training Center 738 St. Brides Correctional Center 737 State Board of Elections 132 State Corporation Commission 171 State Council of Higher Education for Virginia 245 State Grants to Nonstate Agencies 986 State Lottery Department 172 State Water Commission 971 Supreme Court 111 733 Sussex II State Prison 734 The College of William and Mary in Virginia 204 The Library of Virginia 202 The Science Museum of Virginia 146 Thomas Nelson Community College 293 Tidewater Community College 295 Tobacco Indemnification & Revitalization 851 Towing and Recovery Operations 507 Treasury Board 155 Treasury Construction Financing 993 University of Mary Washington 215 University of Virginia Medical Center 209 University of Virginia’s College at Wise 246 University of Virginia-Academic Division 207 VA Bicentennial of the American War of 867 VA Sesquicentennial American Civil War 859 Va. Polytechnic Institute and State Univ., Va. 229 Virginia Agricultural Council 307 Virginia Baseball Stadium Authority 854 Virginia Board for People with Disabilities 606 Virginia Center for Behavioral Rehabilitation 794 Virginia Coal & Energy Commission 118 Virginia Code Commission 108 Virginia College Building Authority 941 Virginia College Savings Plan 174 Virginia Commercial Space Flight Author 509 Virginia Commission for the Arts 148 Virginia Commission on Intergovernmental 105 Virginia Commission on the Centennial o 869 Virginia Commission on Youth 839 Virginia Commonwealth University 236 Virginia Community College System 260 Virginia Community College System- System 261 Virginia Correctional Center for Women 716 Virginia Correctional Enterprises 711 Virginia Crime Commission 142 Virginia Criminal Sentencing Commission 160 Virginia Disability Commission 837 Virginia Economic Development Partnership 310 Virginia Employment Commission 182 Virginia Freedom of Information Advisory 834 Virginia Highlands Community College 296 Virginia Housing Commission 840 Virginia Information Technologies Agency 136 Virginia Institute of Marine Science 268 Virginia Military Institute 211 Virginia Museum of Fine Arts 238 Virginia Museum of Natural History 942 Virginia National Defense Industrial Authority 311 Virginia Office for Protection and Advocacy 175 Virginia Parole Board 766 Virginia Polytechnic Inst. and State University 208 Virginia Port Authority 407 Virginia Racing Commission 405 Virginia Rehabilitation Center for the Blind 263 Virginia Resources Authority 972 Virginia Retirement System 158 Virginia School for Deaf and Blind 218 Virginia School for Deaf, Blind and Multi- 219 Virginia State Bar 117 Virginia State University 212 Virginia Tobacco Settlement Foundation 852 Virginia Tourism Authority 320 Virginia Veterans Care Center 128 Virginia Western Community College 286 Virginia Workers' Compensation Commission 191 Virginia-Israel Advisory Board 330 Wallens Ridge State Prison 735 Western Region Correctional Field Units 757 Western State Hospital 706 Woodrow Wilson Rehabilitation Center 203 Workforce Council 326 Wytheville Community College 288