5. Contract Manager’s Name/Title/Division

6. Contract Manager’s Address & Phone No., and E-mail Address

7. Method of Payment

8. Service Desc and Class/Group

9. Method of Procurement      

Yes Exempt

18.

ORG CODE

FLAIR Account Code:

GF

SF

FID

BE

48

48

IBI

00

00

CAT

DIV

L2

BUR

L3

SEC

L4

L5

EO

OBJECT

CODE(S)

AMOUNT

VENDOR I.D. or

JOURNAL TRANSFER NO.

GRANT

NUMBER

ENC ENC

GL LN

000

94100 0001

000

94100 0002

000

94100 0003

000

94100 0004

A. Contract Administrator

Comments

Signature Date

B. Program Director’s Approval

Comments

Signature Date

C. Cabinet Member’s Approval

Comments

Signature Date

D. Office of the Comptroller, Contract Section

Comments

Signature Date

E. Office of the General Counsel – Legal Review

Comments

Approve Disapprove Subject To

Signature Date

F. Obtain Contractor’s Approval of Contracts

G. Assistant Deputy Commissioner

Comments

H. Deputy Commissioner/Finance and Operations

Comments

Signature Date

I. Obtain Commissioner’s Approval of Contracts

J. Contract Administrator

Contract Distributed Date:

1.

The Contract Manager will indicate if the contract is an original contract, amendment, renewal or extension. The Contract Administrator will provide each division with a block of numbers to be used when contracts are initiated. This number will also be used when processing an amendment.

2.

Enter the total dollar amount of the Contract. If amending to increase or decrease, enter the amended amount. If the contract is not capped, enter “open ended.”

3.

Enter the Contractor’s Name as it appears in the contract.

4.

Vendor Code (minority/non-minority code): This will be completed by the Contract Administration Department.

5, 6.

Enter the Contract Manager’s Name, Title, Division, Address, Phone Number and E-mail Address.

7.

Check the appropriate box to identify the Method of Payment:

Fixed Unit Rate: Specified Unit and Rate (may be multiple units & rates)

Fixed Price: Agreement must show minimum performance standards for deliverables

Lump Sum: Specified partial payment criteria or one lump sum, deliverable(s)

Cost Reimbursement: – Budget Schedule is Required. If State Agency or Community College, 216.346, F.S. must be complied with.

Cost Plus: Any combination of the above

Advance Funded: If yes, compliance with 216.181(16)(b), F.S. or 215.422(14), F.S., and Rule 69I-40.120(3), F.A.C must be documented

8.

Service Desc and Class/Group: This is a six-digit number assigned to commodities and services and the description of the products or services that is found on the State Purchasing System (SPURS). This will be completed by the Contract Administration Department.

9.

Identify the Method of Procurement:

Single Source: Enter Number Assigned by the Procurement Office, and provide Cost Analysis

RFP, ITB, ITN, RFQ: Enter Number Assigned by the Procurement Office

Exemption: Cite the number to identify the exemption, and provide Cost Analysis

Emergency: Check the appropriate box. If yes, provide documentation.

State Term Contract: Enter the Contract Number if the purchase is from a state term contract and provide three quotes (RFQ).

Required By Law: Enter General Appropriation Act #, Florida Statute #, etc. and provide copy. Also, provide a Cost analysis.

Contracts less than or equal to $35,000: Provide quotes, documentation and explanation of selection method as applicable

10.

Please mark whether purchase falls under the Florida Single and/or Federal Single Audit Acts. CFDA is a number assigned to a federal program in the catalog of Federal Domestic Assistance; CSFA – The catalog of State Financial Assistance is a comprehensive listing of state projects determined by the Executive Office of the Governor. If a CFDA or CSFA number is assigned, then the box for Vendor or Recipient/Subrecipient must be checked.

11.

If contract falls under requirements of the State or Federal Single Audit Act, the DOE Comptroller Audit Section will need to review, sign and date. If not applicable, mark as N/A.

12.

Budget Officer checks for available budget authority and correct payment coding. Signs and dates form.

13.

Chief Technology Officer will review for all technology (Information Resource Management) purchases. Signs and dates form.

14.

Risk Assessment: Check the one that applies:

A.) Score - Please indicate the Risk Assessment Score.

B.) Direct will be used when the contract provider deals directly with a client or a group of clients.

      Indirect will be used for all other contract, except

      Pass-through is when a non-Federal entity provides a Federal award to a subrecipient to carry out a Federal program.

Characteristics of a Pass-through are when DOE determines the procurement method and is responsible for monitoring the

performance of the contract - the risk level is determined by the criteria of the contract.

      Directed Appropriation is when State funds are appropriated to an individual who is specifically named in the proviso language

of the General Appropriations Act or other law. Characteristics of a Specific Appropriation are that little or no funding is retained

by the fiscal agent and that usually limited oversight or control by DOE is involved.

15.

The Contract Manager will complete the Beginning Date and the Ending Date as specified in the Contract.

16.

Disclosure Statement: Check the appropriate box and attach signed form certifying no conflict of interest.

17.

18.

Provide the term of the contract and the contract renewal period(s) (e.g., 3 year term with 1, 3 year renewal).

Complete the FLAIR budget coding: organization code, expansion option, object code, amount, Vendor ID or Journal Transfer No., grant number, and FLAIR Account Code. If the contract crosses fiscal years, show the encumbrance coding for each year on page 2 of the Contract Approval Form.

19.

Enter the name, date and phone number of the contract manager or associate preparing and routing the Contract.

INSTRUCTIONS FOR CONTRACT APPROVAL FORM Page 2 of 2

20.

Use this section to provide any comments or explanation relating to the contract.

21.

Provide a summary of any time constraints that applied to the procurement. If necessary, attach summary.

22.

Provide a justification for not using competitive solicitation. If necessary attach justification.

A.

Contract Administrator will ensure that steps 1. through 20. have been completed, that all required documentation is attached and that all attachments are labeled. Signs and dates approval form.

B.

Program Director completes review. Signs and dates approval form, forward for appropriate Cabinet Member approval.

C.

Cabinet Member will complete review, if applicable. Signs and dates approval form.

D.

Office of the Comptroller, Contract Section completes fiscal review. Signs and dates approval form.

E.

Office of the General Counsel will complete legal review. Signs and dates approval form.

F.

The originator will obtain the Contractor’s signature and date of signing on the 2 original contracts. Approval form will be checked when completed.

G.

The Contract Administration Department will obtain the Assistant Deputy Commissioner‘s signature.

H.

The Contract Administration Department will obtain the Deputy Commissioner of Finance and Operation’s signature.

I.

The Contract Administration Department will obtain the Commissioner’s signature and date of signing on the 2 original contracts. Approval form will be checked when completed.

J.

Contract Administration Department will distribute the contract. Approval form will be dated.