Violation of Personal Services Contract by tou16202


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									Revised 05/2006

                  Violation Warning (VW)
                  Colorado School of Mines
                  Procurement Services Procurement Card Administration

  Used to document and report a transaction in violation of Procurement Card Program policies. Violations may result in card revocation.

                                                           Cardholder/Transaction Information
          Cardholder Name:                                                                                    Approving Official Name:

                  Department:                                                                                            Today's Date:

              Transaction ID:
                                                                                                                     Transaction Date:
          Merchant (Vendor)                                                                                                Transaction
                     Name:                                                                                                    Amount:
                                                        Type of Violation
          This transaction has been found to be in violation of Procurement Card Program policy, as indicated below,
                         and no written waiver from Procurement Card Administration has been given.
                                Cash or cash-type transaction
                                Contract without authorized signature
                                Documentation failure
                                Inadvertent personal purchase (attach proof of repayment or credit transaction)
                                Inappropriate purchase (per Sensitive Expenditures policy)
                                Liquor store purchases
                                Non-mandatory price agreement vendor
                                Phone cards/long distance/pay phone calls (no itemized billing available)
                                Services from an individual or a sole proprietor/1099-reportable services
                                Sharing the card or card number
                                Suspected card abuse/employee fraud (report immediately to Procurement Card Administration & Internal Audit)
                                Split purchase (item or group of items totaling over cardholder's single purchase limit not to exceed $3,999)
                                Taxes being consistently charged (Cardholder does not inform vendors of tax-exempt status)
                                Travel/travel-related expenses
                                Unallowable purchase under terms of applicable sponsored project
                                             Cardholder Explanation of Purchase
             Why this transaction was made on a School credit card and what has been done to correct the situation

                                   Cardholder Acknowledgment & Certification of Signature:
I hereby acknowledge that the above transaction is in violation of Procurement Card Program policies and that repeated violations
could result in revocation of my Procurement Card. I further acknowledge that I have been warned of this through the use of this
form. I understand that I am permitted to make only those purchases that are in compliance with Procurement Card Program

                                 Cardholder Signature                                           Date
                                    (not required)
                                                    Approving Official (AO) Determination & Action
                                The Cardholder has been warned of Procurement Card Program policy violation through the use of this form.
                                  No further action is requested at this time.
                                I hereby request that Procurement Card Administration suspend this Cardholder's card for ___________ months.
                                I hereby request that Procurement Card Administration permanently revoke this Cardholder's card.

                                     AO Signature                                               Date
                                                          Give a copy of this form to the Cardholder.

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