VENDOR SELECTION FORM

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VENDOR SELECTION FORM
For Requisition Number R___________________________
This form is required and must be submitted to the Purchasing Department for every requisition of $25,000 or
more. All sections are to be completed. Fill in the requested information and check the appropriate boxes.
The purpose of this requisition is to, Check One:
A. Establish a New Purchase Order and a legal contract for the purchase of goods and to encumber funds
to facilitate payment of vendor invoices.
OR
B. Only to encumber funds to facilitate payment of vendor invoices in support of an underlying and active
contract initiated in a prior fiscal year. The underlying contract is :
IIT contract number:
Signed by:
Date signed:
Expiration Date:
Department holding the
contract:
Date:
•
Requisitioner’s Name:
Department:
Total amount of order:
$
Requisitions totaling $25,000 or more must be supported by documentation of the solicitation effort and evaluation of 3
Written Proposals. This documentation is to be available for audit review. This documentation must be retained in your
department for seven 7 years per Record and Email Retention policy - Q.4. issued 08/07.
If the order is for over $100,000, Check One:
Contract is non-standard and has been
reviewed by IIT General Counsel
Date of review:
Contract is made using an approved
IIT standard construction or consulting
form.
Purchase is of a standard nature and
should be made using the IIT purchase order
terms and conditions.
Name of IIT person who obtained the quotes:
Item/Service Description:
Summary of written competitive quote information (List the three most competitive quotes received):
Vendor Name
Quote number
Quote Date
Total delivered
price quoted
Comments
$
$
$
Name of Vendor
Selected:
IF COMPETITIVE BIDS WERE NOT GATHERED, A SOLE SOURCE JUSTIFICATION FORM MUST ACCOMPANY
THIS VENDOR SELECTION FORM UNLESS THIS PURCHASE REQUISITION IS ENTERED ONLY TO ENCUMBER
FUNDS TO FACILITATE PAYMENT OF VENDOR INVOICES IN SUPPORT OF AN UNDERLYING AND ACTIVE
CONTRACT INITIATED IN A PRIOR FISCAL YEAR.
Print Your Name:
Sign Your Name:
Date:
By signing this form you are affirming that IIT Purchasing Policy has been followed and that records have been
retained and are on file in your department and available for future audit.
Rev. 06/30/2014