Purchase Used Equipment by wcq24132


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									                                 Equipment Purchase Form Instructions

Step #1: Complete the top section of the form with the following information:

        Provider/Payee: Enter the name as it appears on the Agreement.

        Grant No.: Enter the number as it appears in the Agreement.

        Description of item: Provide the name of the item to be purchased (i.e., computer/monitor/hardware
        package, etc.).

        Estimated Total Equipment Cost: Provide the estimated cost of the equipment item.

        VOCA Usage: Provide the percentage of time to be used by VOCA employee(s).

        Estimated VOCA Cost: Provide the estimated cost for VOCA based on the percentage of VOCA usage.

        Explanation/Justification: Provide an explanation on how this equipment will be used to provide services to
        crime victims.

        Certification: Include the signature, printed name, title and date of the person who has signature authority.

Step #2: Submit the completed form to your Grant Manager.

        Grant Manager Information: OAG staff will review the request make a determination and return the form.

Step #3: If approved, purchase the equipment and complete the bottom section of the form.

        Date Equipment Received: Provide the date the equipment is received.

        Assigned Inventory Control #: Provide the number assigned by your agency - if no number is assigned,
        please provide the method of identifying equipment.

        Model/Description and Serial #: Provide the manufacturer's information.

        Certification: Include the signature, printed name, title and date of the person who has signature authority.

Step #4: Make a copy for your records and send the completed form to your Grant Manager.

                                   Submit form via facsimile, e-mail or mail to:
                                         Office of the Attorney General
                                  Bureau of Advocacy and Grants Management
                                               PL-01, The Capitol
                                        Tallahassee, Florida 32399-1050

                                               Fax No.: 850-487-3013

                          Questions? Call your OAG Grant Manager at (850) 414-3300
                               (Refer to the instructions)
Provider/Payee:                                                                           Grant No. V
Complete this section and forward the request to the OAG, Bureau of Advocacy and Grants Management, for
prior approval of any equipment purchase of $1,000 or more.

Description of item to be purchased

Estimated total equipment cost $                                                   VOCA usage                  %

Estimated VOCA cost         $

Explanation/Justification of how this equipment relates to the delivery of direct services to crime victims.

I certify that proper purchasing procedures have been followed as outlined in the VOCA Agreement.

Authorized Signature

Printed Name/Title                                                                                 Date

The Grant manager will return this form to the Provider after review.

                                Approve________________            Disapprove______________
Approval is given for the purchase of equipment which will be used in accordance with the final program
guidelines (i.e., enhance services to crime victims, used only by victim service staff employed by the provider
and not used for investigative or prosecution activities or other non allowable activities pursuant to the VOCA
Federal Guidelines).

OAG Grant Manager                                                                                  Date

If the request is approved, upon receipt of the equipment, complete this section and return the form to the OAG,
Bureau of Advocacy and Grants Management.

Date equipment received                                            Assigned Inventory Control #

Model/Description                                                                       Serial #

Location of item                                                         Actual VOCA cost $

I certify that proper inventory control procedures are in place in accordance with the OJP Final Program
Guidelines and Financial Guide.

Authorized Signature                                                                               Date

Printed Name/Title


Entered in Database?            YES      NO          GM Initials                                   Date


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