Purchasing Authority Application Part D

Department of General Services
Procurement Division
Purchasing Authority Management Section

Purchasing Authority Application
Part D

Note: See the Purchasing Authority Manual, Chapter 13, Topic 4, for instructions on completing this Part D.

1. Policies and Procedures
   The department must maintain current procurement policies and procedures that support the type, category, and dollar threshold of purchasing authority requested and must submit its policies and procedures for review. The department's procurement policies and procedures must be attached to the Application and identified as Attachment D1.
   Yes  No   Has the department attached its procurement policies and procedures, identified as Attachment D1?

2. Conflict of Interest Statement
   The department may use either the sample conflict of interest statement provided by DGS/PD or a conflict of interest statement developed by the department. If the department uses a conflict of interest statement developed by the department, the statement must be attached to the Application and identified as Attachment D2.
   Yes  No   Does the department use the sample conflict of interest statement provided by DGS/PD?
   Yes No If no, has the department attached a copy of the department's conflict of interest statement, identified as Attachment D2.

3. Audits
   The department must submit a copy of any audit(s) of the department's procurement and/or contracting program(s) conducted since submission of the department's last Application. A copy of the audit(s) must be attached to the department's Application and identified as Attachment D3.
   Yes  No   Has there been an audit(s)?
   Yes  No   If yes, has the department attached a copy of the audit(s), identified as Attachment D3.
   Do not attach a copy of a purchasing program compliance review conducted by PAMS.

4. Reporting

   Transaction Reporting. The department must submit purchasing authority transactions to DGS/PD monthly. If the department has unreported transactions, a copy of the unreported transactions must be attached to the department's Application and identified as Attachment D4.
   Yes  No   Is the department submitting unreported transactions?
   Yes  No   If yes, has the department attached a copy of the transactions, identified as Attachment D4a?

   NCB Contract Quarterly Reporting.
   The department must submit an NCB Contract Quarterly Report to DGS/PD quarterly. If the department has unreported Reports, a copy of the unreported Reports must be attached to the department's Application and identified as Attachment D4b.
   Yes  No   Is the department submitting unreported NCB Contract Quarterly Reports?
   Yes  No   If yes, has the department attached a copy of the Reports, identified as Attachment D4b?

   Prescription Drugs
   Purchased Outside of the Prescription Drug Program Quarterly Reporting. The department must submit a Prescription Drugs Purchased Outside of the Prescription Drug Program Quarterly Report to DGS/PD quarterly. If the department has unreported Reports, a copy of the unreported Reports must be attached to the department's Application and identified as Attachment D4c.
   Yes  No   Is the department submitting unreported Prescription Drugs Purchased Outside of the Prescription Drug Program Quarterly Reports?
   Yes  No   If yes, has the department attached a copy of the Reports, identified as Attachment D4c?

5. Purchase Document
   Yes  No   Does the department use the State's STD.65?
   Yes  No   If no, has the department's alternate version been approved by DGS/PD's Forms Coordinator?
   Yes  No   If no, has the department attached a copy of the unapproved alternate version, identified as Attachment D5?

6. DGS Bill Codes
   The department must submit a list of all DGS bill codes it will use under this purchasing authority.
   Yes  No   Has the department attached a list of the DGS bill codes, identified as Attachment D6?