UM 1819: Price Supplier Justification Form

UM 1819: Price & Supplier Justification Form For Purchases of Standard Goods and Services $10,000-$49,999.99

Option E: Replacement for a PO that Closed Unexpectedly at Fiscal Year End

Instructions: 1. Send this form to the EFS requisition preparer, or procurement specialist if it involves a PO change order. 2. The EFS requisition preparer or procurement specialist must: a. Create a requisition or PO change order for this purchase. b. Type “See attached Form UM 1819” in a header-level comment’s text box. c. Upload this form into the associated header-level comment. Do NOT combine this form with any other attachments or files. d. Do NOT click the checkbox because this is an internal form. 3. The EFS approvers will review the requisition and the form to ensure compliance.

Questions? Contact Purchasing Services at: [email protected].

Requester’s name

Requester’s email

Supplier name

Total amount of new requisition or PO

Original (Closed) PO number

Original PO’s total amount at the time of closure

How was the supplier originally selected? List one of the following: U Wide Contract, Price Comparison, Sole Source, Non PO, or RFP/Bid This form’s last revision was made on 7/01/2016 by Purchasing Services.