PROCUREMENT APPROVAL FORM

Purpose of Request:

If this is a hotel contract, has this facility been certified by the Florida Green Lodging Program? ___YES ___NO

Written justification as to why this facility was selected, if NO is checked, must be attached.

1. Amount: $ 2. Vendor’s Name:

3. Requestor’s Name:

4. Requestor’s Address & Phone No.:

5.___________________________________________________

Budget Officer’s Approval Date

ORG CODE

FLAIR Account Code:

FID

IBI

CAT

DIV

BUR

SEC

OBJECT

CODE(S)

AMOUNT

VENDOR I.D. or

JOURNAL TRANSFER NO.

GRANT

NUMBER

ENC ENC

GL LN

000

94100 0001

000

94100 0001

6. Submitted By: Date: Telephone No.:

A.) Contract Administrator	Comments
Signature Date
B.) Program Director’s Approval	Comments
Signature Date Cabinet Member’s Approval if Required Signature Date
C.) Office of the General Counsel – Legal Review	Comments
Approve Disapprove Subject To
Signature Date
D.) Bureau Chief Contracts/Procurement	Comments
Signature Date
E.) Assistant Deputy Commissioner	Comments
Signature Date
F.) Deputy Commissioner/Finance and Operations	Comments
Signature Date
G.) Obtain Commissioner’s Approval

Rev. 4-19-2011