Report on Commodities ROC by AID

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									  H
                                                                                                                                                                                             AID-1570-14
         complete this section before recording
         acquisitions in the ROC                                                             REPORT ON COMMODITIES (ROC)
  APPROVED MASTER SET (MS)                                                                  PURCHASING OF COMMODITIES                                                         FINAL LOCATION
                                                                                                                lowest                                                       such as room
                                                       estimated                                                                          countries of…


                                                EACH




                                                                                    EACH
               Purchase Order                                          date                (*) (!) actual costs price?                                                     number, wing, floor,
                                                         costs
ID No.                                                                                                           Y N             source        origin      purchase         department, et al        ID
 01                                                                                                                                                                                                  01
 02                                                                                                                                                                                                  02
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             Estimated subtotal this page $                              Subtotal this page $                       NOTES:
                        Cumulative total $                                Cumulative total $
                       (signature for the Grantee)                 (*) - Indicate with an "X" whether a notice of procurement was submitted to the OSDBU/MRC (Std.Prov. Attachment 3-p12)
                                                                   (!) - show the number of quotations obtained or indicate with a "P" any proprietary acquisition (Std.Prov. Attachment 3-p14)

         Submitted: __/__/____                                     CERTIFICATION: I certify, to the best of my knowledge and belief, that this report is correct                    QPR No. ___
                                                                   and complete and that all commodities are for the purpose set forth in the award documents
                      (signature for USAID/ASHA)                   and project implementation letters.                                                                    from: __/__/____
                                                                   signed by                                                                 ASHA
         Approved:   __/__/____                                    (for the Grantee):
                                                                                                                         date:   __/__/____                                  to: __/__/____
                                                                                                                                          Grant No.
 INSTRUCTIONS FOR THE MASTER-SET/REPORT ON COMMODITIES
                        (MS/ROC)
     (Each form must be labeled progressively as A, B, C, …, ZZ in the box at all four corners)
                 A computer spreadsheet replica of this form may also be used

A report on commodities is due after each calendar quarter. Before submitting a report, a
“master-set” must be created listing the purchase orders that will be placed with this grant. For
this purpose, the recipient will
         Complete only the block named APPROVED MASTER SET (MS);
         Make two copies, date, and sign the APPROVED MASTER SET (MS); and
         Mail them to ASHA

If accepted, ASHA will approve the proposed MS by signing both copies and retaining one while
returning the other to the recipient. Once the approved master-set signed by ASHA is received,
the grantee will report acquisitions by
          Using this form to record all purchases as they occur in the section named
           REPORT ON COMMODITIES (ROC);
                 (If known, the section named FINAL LOCATION may also be completed at this
                   time – else, it may be completed in the future, but not later than the due date
                  of the final report;
          Making a copy of it after the end of each calendar quarter;
          Dating and signing the reproduced MS/ROC; and
          Filing it, along with other progress report forms and documents, as directed by ASHA


PARTIAL LISTS

Recipient may submit a partial list and/or amend the master-set in the future. In fact,
ASHA's acceptance of an approved list does not obligate recipient to place every single
purchase order in that list. Recipient may eliminate or reduce the quantity of individual items
within the budgetary limitation, without further ASHA approval. However, recipient shall neither
change the definition nor increase the number of acquisitions under approved purchase orders.
The master-set may be amended as needed by
          Appending a new form or forms showing additional proposed purchase orders,
          Reproducing two copies of the appended forms, and
          Mailing them to ASHA

Once the appended forms have been approved, recipient will submit progress reports using the
new master-set/report on commodities MS/ROC Form

Books, periodicals, software, miscellaneous tools and furnishings (which may be listed by
purchase order), may be identified by “LS (Lump Sum)” instead of a specific number under the
column titled [EACH]
  H
                                                                                                                                                                                            AID-1570-14
         complete this section before recording
         acquisitions in the ROC                                                            REPORT ON COMMODITIES (ROC)
  APPROVED MASTER SET (MS)                                                                  PURCHASING OF COMMODITIES                                                       FINAL LOCATION

 A                                                                                                                                                                                                  A
                                                                                                              lowest                                                       such as room
                                                     estimated                                                                          countries of…



                                              EACH




                                                                                  EACH
                Purchase Order                                       date                (*) (!) actual costs price?                                                     number, wing, floor,
                                                       costs
ID No.                                                                                                         Y N              source        origin     purchase         department, et al         ID
 01                                                                                                                                                                                                 01
 02                                                                                                                                                                                                 02
 03                                                                                                                                                                                                 03
 04                                                                                                                                                                                                 04
 05                                                                                                                                                                                                 05
 06                                                                                                                                                                                                 06
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 19                                                                                                                                                                                                 19
 20                                                                                                                                                                                                 20
              Estimated subtotal this page $                 0         Subtotal this page $                 0.00
                                                                                                                 NOTES: The small purchase threshold is exceeded at $______
                         Cumulative total $                  0          Cumulative total $                  0.00
                       Signature for the Grantee                 (*) - Indicate with an "X" whether a notice of procurement was submitted to the OSDBU/MRC (Std.Prov. Attachment 3)
                                                                 (!) - show the number of quotations obtained or indicate with a "P" any proprietary acquisition (Std.Prov. Attachment 3)

         Submitted: __/__/____                                   CERTIFICATION: I certify, to the best of my knowledge and belief, that this report is correct
                                                                                                                                                                                   QPR No.
                                                                 and complete and that all commodities are for the purpose set forth in the award documents
                                                                 and project implementation letters.                                                                    from: __/__/____

 A       Approved: __/__/____
                                                                           signed by
                                                                       (for the Grantee):
                                                                                                                        date:   __/__/__
                                                                                                                                            ASHA
                                                                                                                                           Grant No
                                                                                                                                                        0000-000            to: __/__/____
                                                                                                                                                                                                    A
  H
                                                                                                                                                                                            AID-1570-14
         complete this section before recording
         acquisitions in the ROC                                                            REPORT ON COMMODITIES (ROC)
  APPROVED MASTER SET (MS)                                                                  PURCHASING OF COMMODITIES                                                       FINAL LOCATION

 A                                                                                                                                                                                                  A
                                                                                                              lowest                                                       such as room
                                                     estimated                                                                          countries of…



                                              EACH




                                                                                  EACH
                Purchase Order                                       date                (*) (!) actual costs price?                                                     number, wing, floor,
                                                       costs
ID No.                                                                                                         Y N              source        origin     purchase         department, et al         ID
 01      Commodities for Activity 1
 02      Personal Computer Pentium IV         20       25,000                                                                                                                                       02
 03      Microscope                           10       10,000                                                                                                                                       03
 04
 05      Commodities for Activity 2                                                                                                                                                                 05
 06      Personal Computer Pentium IV         10       12,500                                                                                                                                       06
 07      Server Pentium IV                     2        9,000                                                                                                                                       07
 08      CD tower for 12 CD's                  1        8,000                                                                                                                                       08
 09      Hubs for Internet connections        LS        3,000                                                                                                                                       09
 10      software & licensing                 LS        7,550                                                                                                                                       10
 11      Notebook Pentium IV                   9       25,000                                                                                                                                       11
 12      smart board                           9       11,000                                                                                                                                       12
 13      library books                        LS       50,000                                                                                                                                       13
 14      LCD projector                         9       25,000                                                                                                                                       14
 15      video cassette recorder               9        2,100                                                                                                                                       15
 16      DVD                                   9        2,800                                                                                                                                       16
 17                                                                           LEGEND                                                                                                                17
 18                                                                     CD = Compact Disk                                                                                                           18
 19                                                                    DVD = Digital Versatile Disk (formerly Digital Video Disc)                                                                   19
 20                                                                    LCD = Liquid Crystal Display
              Estimated subtotal this page $          190,950          Subtotal this page $          0.00
                                                                                                          NOTES: The small purchase threshold is exceeded at $3,000
                         Cumulative total $           190,950           Cumulative total $           0.00
                       Signature for the Grantee                 (*) - Indicate with an "X" whether a notice of procurement was submitted to the OSDBU/MRC (Std.Prov. Attachment 3)

                                         Signature               (!) - show the number of quotations obtained or indicate with a "P" any proprietary acquisition (Std.Prov. Attachment 3)

         Submitted: mm/dd/yyy                                    CERTIFICATION: I certify, to the best of my knowledge and belief, that this report is correct                    QPR No.9
                                Signature
                                                                 and complete and that all commodities are for the purpose set forth in the award documents
                                                                 and project implementation letters.                                                                    from: 07/01/2004


 A       Approved: mm/dd/yyyy
                                                                           signed by
                                                                       (for the Grantee):
                                                                                                                        date:   10/25/2004
                                                                                                                                              ASHA
                                                                                                                                             Grant No
                                                                                                                                                         0000-XXX           to: 09/30/2004
                                                                                                                                                                                                    A

								
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