Okaloosa County BOCC — April 27, 2013 — Okaloosa County Purchasing Manual-5 — reading text

850-689-5970 Wireless Communication Device: Mfr Model Serial #: Wireless Telephone #: 59  CONFLICT OF INTEREST DISCLOSURE FORM For purposes of determining any possible conflict of interest, all bidders/proposers, must disclose if any Okaloosa Board of County Commissioner, employee(s), elected officials(s), or if any of its agencies is also an owner, corporate officer, agency, employee, etc., of their business. Indicate either “yes” (a county employee, elected official, or agency is also associated with your business), or “no”. If yes, give person(s) name(s) and position(s) with your business. YES______________ NO______________ NAME(S) POSITION(S) FIRM NAME: _____________________________________ BY (PRINTED): _____________________________________ BY (SIGNATURE): _____________________________________ TITLE: _____________________________________ ADDRESS: _____________________________________ _____________________________________ PHONE NO. _____________________________________ E-MAIL _____________________________________ 60  NO CONTACT CLAUSE The Board has established a solicitation silence policy (No Contact Clause) that prohibits oral and written communication regarding all formal solicitations for goods and services (formal bids, Request for Proposals, Requests for Qualifications) issued by the Board through the County Purchasing Department. The period commences when the procurement document is received and terminates when the Board approves an award. When the solicitation silence period is in effect, no oral or written communication is allowed regarding the solicitation between prospective bidders/proposers and members of the Board, the County Administrator or members of the Board Approved Review Committee. All questions or requests for information regarding the solicitation must be directed to the designated Purchasing Representative listed in the solicitation. Any information thought to affect the committee or staff recommendation submitted after bids are due, should be directed to the Purchasing Director or his appointed representative. It shall be the Purchasing Director’s decision whether to consider this information in the decision process. Any violation of this policy shall be grounds to disqualify the proposer from consideration during the selection process. All proposers must agree to comply with this policy by signing the following statement and including it with their submittal. I representing Signature Company Name hereby agree to abide by the County’s “No Contact Clause” and understand violation of this policy shall result in disqualification of my proposal/submittal. 61  SELECTION COMMITTEE MEMBER INSTRUCTIONS You have been selected to serve on a Board-approved Review and Recommendation Committee for services for Okaloosa County. 1. You will be given a copy of all proposals received for this service. 2. You are required to read and review each proposal, make written notes as to the proposal meeting the following criteria: a. Did the response meet the requested format? b. Did the proposal include all required documentation? c. Does this firm seem capable of producing the services requested? 3. Fill out the provided ranking sheet for each firm. 4. At a duly noticed meeting, all Committee Members will discuss the strengths and weaknesses of each firm. No discussion may be conducted between Committee Members related to the proposals except during the duly noticed meeting. 5. All Committee Members will submit their signed ranking sheet to the Committee Chair or the Purchasing representative. 6. A consensus ranking will be prepared for attachment to the Board agenda recommendations to be presented at the next Board meeting. 7. Upon approval by the Board, the Purchasing Director shall notify all firms submitting proposals of the Board action. Note: Any questions directed to any Committee Member by a proposer should be directed to the Purchasing Director. 62  SOLE SOURCE PURCHASE DATA SHEET Date: PR No.: Requestor: Phone No.: Department/Division: Item Description: Requesting Department's Suggested Vendor: Vendor's Address: Vendor's Telephone No.: Point of Contact: Sole Source Justification: ___________________________________________ ______________________ Requesting Department Director Signature Date ------------------------------------------------------------------------------------------------------------ REVIEW BY PURCHASING DEPARTMENT VERIFY IF OTHER SOURCES OF SUPPLY MEETS THIS NEED Vendor #1 Contact: Phone No.: Vendor #2 Contact: Phone No.: Vendor #3 Contact: Phone No.: Buyer Comments: _____________________________________________ _____________________ Signature of Buyer Who Reviewed Date Purchasing Services Coordinator Comments: Purchasing Services Coordinator Signature Date ------------------------------------------------------------------------------------------------------------ PURCHASING MANUAL - SOLE SOURCE DETERMINATION Comments: Approve: Disapprove: Amount of Purchase: Date: __________________________________ _____________________ Purchasing Director Signature Date 63  OKALOOSA COUNTY PURCHASING CARD EXPENDITURE REPORT Below is an account of all Purchasing Card expenditures for: Name of Employee/Department _________________________________________________________________________ Purchasing Card Number ________________________________________________________________________________ For the month of ________________________________________________________________________________________ DESCRIPTION OF ITEMS PURPOSE OF DATE GOODS/ DATE VENDOR PURCHASED AMOUNT DEPT. ACCOUNT TRANSACTION SERVICES RECEIVED NUMBER NUMBER I HEREBY CERTIFY THAT ALL PURCHASES CONTAINED HEREIN WERE FOR OFFICIAL OKALOOSA COUNTY BUSINESS, WERE MADE IN ACCORDANCE WITH RULES AND DIRECTIVES, AND THAT I HAVE REVIEWED THIS LOG AND IT CORRECTLY REFLECTS THE CARD RECEIPTS ENCLOSED. _____________________________________________________ _______________________________________________________________ SIGNATURE OF CARDHOLDER DATE SIGNATURE OF REVIEWER DATE DELIVER TO: OKALOOSA COUNTY COURTHOUSE - FINANCE OFFICE, 302 N. Wilson Street, Suite 203 Crestview FL 32536 64  LOST OR STOLEN PURCHASING CARD REPORTING FORM TO: PURCHASING DEPARTMENT FAX: 850-689-5037 FROM: PHONE: URGENT MESSAGE PLEASE DELIVER THIS FACSIMILE IMMEDIATELY --------------------------------------------------- EMPLOYEE NAME: PURCHASING CARD NO.: DATE CARD WAS LOST/STOLEN: (If unknown, report today’s date) TIME CARD WAS LOST/STOLEN: (If unknown, report time this form was completed)) LAST KNOWN LOCATION OF CARD: LAST KNOWN TIME CARD WAS USED: (Indicate location and date of last charge) REMARKS: 65  PURCHASING CARD MAINTENANCE FORM DATE: DEPARTMENT: PHONE $ AMOUNT EMPLOYEE’S NAME NUMBER CARD NUMBER REQUESTED MAINTENANCE REQUESTED (Circle as needed) ADD CARDHOLDER (Fill out above) DELETE/CANCEL ACCOUNT (Account #) RAISE/LOWER LIMIT (Existing amount) OTHER (explain) Authorized By (Department Director) Fax Back To: 689-5037 (Purchasing Department) 66 Approved by: ________________________________ Cardholder Signature: ________________________ OKALOOSA COUNTY BOARD OF COUNTY COMMISSIONERS PURCHASING CARD DISPUTE FORM Company Name: Cardholder Name: Cardholder Account Number: Statement Date Transaction Date Merchant Name/Description Amount Posting Date Reference Number Check the description most appropriate to your dispute. If you have any questions, contact . 1. Alteration of Amount: The amount of the sales draft has been altered from $ to $ . (Please include copy of sales draft) 2. Unauthorized Mail or Phone Order: I certify the charge listed above was not authorized by me or any person authorized by me to use this account. I have not ordered merchandise by phone or mail or received goods and services as represented above. 3. Cardholder Dispute: I did participate in the above transaction; however, I dispute the entire charge, or a portion, in the amount of $_____________because: 4. Credit Not Received: The merchant has issued me a credit slip for the transaction listed above; however, the credit has not been posted to my account. The date on the voucher is between 30 and 90 days old. (Please include a copy of the credit voucher.) 5. Imprinting of Multiple Slips: The above transaction represents multiple billing to my account. I only authorized one charge from this merchant for $ . I am still in possession of my card. 6. Merchandise Not Received: My account has been charged for the above transaction, but I have not received this merchandise. I have contacted the merchant. 7. Merchandise Not Received: My account has been charged for the above transaction, but