Revised 05/2006 Violation Warning (VW) Colorado School of Mines Procurement Services Procurement Card Administration Purpose: 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 Other (specify): 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 policies. 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.