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dfhaoiihegsrg – ## PRFWeedKiller003.pdf **## PRFWeedKiller003.pdf** GOVERNMENT PURCHASE CARD REQUEST FORM Emergency request? Vendor accepts GPC? Tax exempt? Approving Official Control Number: GPC Acct 33638 Y N N Deliver to: 1 SOLRS / LGRM 514 Hamby Place Hurlburt Field, FL 32544 Vendor Name & Addre…
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– ## PRFWeedKiller003.pdf
**## PRFWeedKiller003.pdf**
GOVERNMENT PURCHASE CARD REQUEST FORM
Emergency request?
Vendor accepts GPC?
Tax exempt?
Approving Official
Control Number:
GPC Acct 33638
Y
N
N
Deliver to:
1 SOLRS / LGRM
514 Hamby Place
Hurlburt Field, FL 32544
Vendor Name
& Address:
Home Depot
414 Mary Ester Blvd NW
Fort Walton Beach, FL
32548
ECARS Required >$10 Commodities
Mandatory Source Available? N
N
Y
Y
Y
ADD/DEL ITEM NO SCHEDULE OF SUPPLIES/SERVICES QUANTITY UNIT AMOUNT
+
–
1 1 Gal. Dual Action Weed and Grass Killer
SKU 1008675765 3 EA $26.9700 $80.91
TOTAL $80.91
COORDINATION/APPROVAL REQUIRED PER AFI 64-117
Base Communications (e.g. IT/comms equipment/service related
https://eitaas.servicecenter.af.mil/esc N/A
Base Safety Office (e.g. ATV, new equipment, etc)
1sow.se@us.af.mil N/A
Civil Engineering (CE)(e.g. construction, HAZMAT, Temp Storage)
1soces.cstsvc@us.af.mil N/A
Base Library (e.g. magazines, text books, subscriptions, etc)
1SOFSS.FSDL@us.af.mil N/A
Logistics (e.g. vehicles, vehicle-related service, lease, etc)
850-884-5311
N/A
Public Affairs (e.g. visual info, electronic digital imaging, etc)
1SOW.PA1@us.af.mil N/A
Medical Group (e.g. Medical Supplies)
usaf.hurlburt.1-somdg.mbx.1-somdg-medical-logistics-customer-ser@mail.mil
N/A
Base Education Office (e.g. training-related services/SF-182)
1SOFSS.FSDE.CT@us.af.mil N/A
Remarks
Version 20240213
Victor, Gabrielle L.
NAME OF APPROVING OFFICIAL SIGNATURE
By Signing below I am certifying this is not a split purchase
Cardholder Checklist:
Prior to purchase
___Utilize a purchase request form to obtain approval
___Are there mandatory sources (Department of the Air Force Launchpad – Home (dps.mil))
___Check for any required coordination (see 64-117 para 7.12)
___Verify the item(s) to be purchased are authorized using the GPC (see 64-117 para 8.1)
___Use a purchase log to track all purchases prior to expenditure to ensure fund availability
___Submit an ECARS prior to purchase if purchase exceeds applicable MPT ($10K commodity/$2.5K services/$2K
construction) (https://www.afcontracting.hq.af.mil/gpcreport/index.cfm)
___Ensure no tax is paid
After purchase
___Require requester to print/sign their name, date and write “received” on purchase receipt
___Notify appropriate agencies of pilferable/sensitive items and individual items valued over $5K
___Upload receipt and all supporting documentation (889, purchase request, any coordination) into US Bank
___Create/match orders and review/reconcile monthly statements three business days after each billing cycles close
(19th of each month)
___Retain records for the required 10 years
Approving Official Checklist:
Prior to purchase
___Review and approve all purchases to ensure sufficient funds are available and purchases are legal, proper, mission
essential and correct (purchase request form)
___Utilize the Express Contract Action Reporting System (ECARS) to review/approve purchases over the applicable
micro purchase threshold (MPT) ($10K commodity/$2.5K services/$2K construction)
After purchase
___Ensure all supporting documentation is loaded by CHs for each purchase in US Bank
___Ensure flagged transactions are addressed within the required 30 days in Insights on Demand (IoD)
___Review and approve managing account statements in US Bank within five business days after the billing cycles
close (19th of each month)'
___Ensure this form is uploaded by CHs for each purchase in US Bank
GOVERNMENT PURCHASE CARD REQUEST FORM
Emergency request?
Vendor accepts GPC?
Tax exempt?
Mandatory Source Available?
ADD/DEL
ITEM NO
SCHEDULE OF SUPPLIES/SERVICES
QUANTITY
UNIT
AMOUNT
TOTAL
COORDINATION/APPROVAL REQUIRED PER AFI 64-117
Base Communications (e.g. IT/comms equipment/service related
https://eitaas.servicecenter.af.mil/esc
Base Safety Office (e.g. ATV, new equipment, etc)
1sow.se@us.af.mil
Civil Engineering (CE)(e.g. construction, HAZMAT, Temp Storage)
1soces.cstsvc@us.af.mil
Base Library (e.g. magazines, text books, subscriptions, etc)
1SOFSS.FSDL@us.af.mil
Logistics (e.g. vehicles, vehicle-related service, lease, etc)
850-884-5311
Public Affairs (e.g. visual info, electronic digital imaging, etc) 1SOW.PA1@us.af.mil
Medical Group (e.g. Medical Supplies)
usaf.hurlburt.1-somdg.mbx.1-somdg-medical-logistics-customer-ser@mail.mil
Base Education Office (e.g. training-related services/SF-182)
1SOFSS.FSDE.CT@us.af.mil
Version 20240213
NAME OF APPROVING OFFICIAL
SIGNATURE
By Signing below I am certifying this is not a split purchase
Cardholder Checklist:
Prior to purchase
___Utilize a purchase request form to obtain approval
___Are there mandatory sources (Department of the Air Force Launchpad – Home (dps.mil))
___Check for any required coordination (see 64-117 para 7.12)
___Verify the item(s) to be purchased are authorized using the GPC (see 64-117 para 8.1)
___Use a purchase log to track all purchases prior to expenditure to ensure fund availability
___Submit an ECARS prior to purchase if purchase exceeds applicable MPT ($10K commodity/$2.5K services/$2K
construction) (https://www.afcontracting.hq.af.mil/gpcreport/index.cfm)
___Ensure no tax is paid
After purchase
___Require requester to print/sign their name, date and write “received” on purchase receipt
___Notify appropriate agencies of pilferable/sensitive items and individual items valued over $5K
___Upload receipt and all supporting documentation (889, purchase request, any coordination) into US Bank
___Create/match orders and review/reconcile monthly statements three business days after each billing cycles close
(19th of each month)
___Retain records for the required 10 years
Approving Official Checklist:
Prior to purchase
___Review and approve all purchases to ensure sufficient funds are available and purchases are legal, proper, mission
essential and correct (purchase request form)
___Utilize the Express Contract Action Reporting System (ECARS) to review/approve purchases over the applicable
micro purchase threshold (MPT) ($10K commodity/$2.5K services/$2K construction)
After purchase
___Ensure all supporting documentation is loaded by CHs for each purchase in US Bank
___Ensure flagged transactions are addressed within the required 30 days in Insights on Demand (IoD)
___Review and approve managing account statements in US Bank within five business days after the billing cycles
close (19th of each month)'
___Ensure this form is uploaded by CHs for each purchase in US Bank
11.0.1.20130826.2.901444.899636
01. TextField2:
02. TextField6: 33638
03. :
04. TextField3: Home Depot
414 Mary Ester Blvd NW
Fort Walton Beach, FL 32548
05. ECARS: >$10 Commodities
06. cmd_add:
07. cmd_del:
08. Cell2: N/A
09. Cell3: 1 Gal. Dual Action Weed and Grass Killer
SKU 1008675765
10. Cell4: 3.00000000
11. Cell5: EA
12. Cell6: 26.97000000
13. Cell7: 80.91000000
14. total_cell: 80.91000000
15. DropDownList3: N/A
16. TextField5:
17. TextField7: Victor, Gabrielle L.
18. SignatureField7:
**## PRFWeedKiller003.pdf**
GOVERNMENT PURCHASE CARD REQUEST FORM
Emergency request?
Vendor accepts GPC?
Tax exempt?
Approving Official
Control Number:
GPC Acct 33638
Y
N
N
Deliver to:
1 SOLRS / LGRM
514 Hamby Place
Hurlburt Field, FL 32544
Vendor Name
& Address:
Home Depot
414 Mary Ester Blvd NW
Fort Walton Beach, FL
32548
ECARS Required >$10 Commodities
Mandatory Source Available? N
N
Y
Y
Y
ADD/DEL ITEM NO SCHEDULE OF SUPPLIES/SERVICES QUANTITY UNIT AMOUNT
+
–
1 1 Gal. Dual Action Weed and Grass Killer
SKU 1008675765 3 EA $26.9700 $80.91
TOTAL $80.91
COORDINATION/APPROVAL REQUIRED PER AFI 64-117
Base Communications (e.g. IT/comms equipment/service related
https://eitaas.servicecenter.af.mil/esc N/A
Base Safety Office (e.g. ATV, new equipment, etc)
1sow.se@us.af.mil N/A
Civil Engineering (CE)(e.g. construction, HAZMAT, Temp Storage)
1soces.cstsvc@us.af.mil N/A
Base Library (e.g. magazines, text books, subscriptions, etc)
1SOFSS.FSDL@us.af.mil N/A
Logistics (e.g. vehicles, vehicle-related service, lease, etc)
850-884-5311
N/A
Public Affairs (e.g. visual info, electronic digital imaging, etc)
1SOW.PA1@us.af.mil N/A
Medical Group (e.g. Medical Supplies)
usaf.hurlburt.1-somdg.mbx.1-somdg-medical-logistics-customer-ser@mail.mil
N/A
Base Education Office (e.g. training-related services/SF-182)
1SOFSS.FSDE.CT@us.af.mil N/A
Remarks
Version 20240213
Victor, Gabrielle L.
NAME OF APPROVING OFFICIAL SIGNATURE
By Signing below I am certifying this is not a split purchase
Cardholder Checklist:
Prior to purchase
___Utilize a purchase request form to obtain approval
___Are there mandatory sources (Department of the Air Force Launchpad – Home (dps.mil))
___Check for any required coordination (see 64-117 para 7.12)
___Verify the item(s) to be purchased are authorized using the GPC (see 64-117 para 8.1)
___Use a purchase log to track all purchases prior to expenditure to ensure fund availability
___Submit an ECARS prior to purchase if purchase exceeds applicable MPT ($10K commodity/$2.5K services/$2K
construction) (https://www.afcontracting.hq.af.mil/gpcreport/index.cfm)
___Ensure no tax is paid
After purchase
___Require requester to print/sign their name, date and write “received” on purchase receipt
___Notify appropriate agencies of pilferable/sensitive items and individual items valued over $5K
___Upload receipt and all supporting documentation (889, purchase request, any coordination) into US Bank
___Create/match orders and review/reconcile monthly statements three business days after each billing cycles close
(19th of each month)
___Retain records for the required 10 years
Approving Official Checklist:
Prior to purchase
___Review and approve all purchases to ensure sufficient funds are available and purchases are legal, proper, mission
essential and correct (purchase request form)
___Utilize the Express Contract Action Reporting System (ECARS) to review/approve purchases over the applicable
micro purchase threshold (MPT) ($10K commodity/$2.5K services/$2K construction)
After purchase
___Ensure all supporting documentation is loaded by CHs for each purchase in US Bank
___Ensure flagged transactions are addressed within the required 30 days in Insights on Demand (IoD)
___Review and approve managing account statements in US Bank within five business days after the billing cycles
close (19th of each month)'
___Ensure this form is uploaded by CHs for each purchase in US Bank
GOVERNMENT PURCHASE CARD REQUEST FORM
Emergency request?
Vendor accepts GPC?
Tax exempt?
Mandatory Source Available?
ADD/DEL
ITEM NO
SCHEDULE OF SUPPLIES/SERVICES
QUANTITY
UNIT
AMOUNT
TOTAL
COORDINATION/APPROVAL REQUIRED PER AFI 64-117
Base Communications (e.g. IT/comms equipment/service related
https://eitaas.servicecenter.af.mil/esc
Base Safety Office (e.g. ATV, new equipment, etc)
1sow.se@us.af.mil
Civil Engineering (CE)(e.g. construction, HAZMAT, Temp Storage)
1soces.cstsvc@us.af.mil
Base Library (e.g. magazines, text books, subscriptions, etc)
1SOFSS.FSDL@us.af.mil
Logistics (e.g. vehicles, vehicle-related service, lease, etc)
850-884-5311
Public Affairs (e.g. visual info, electronic digital imaging, etc) 1SOW.PA1@us.af.mil
Medical Group (e.g. Medical Supplies)
usaf.hurlburt.1-somdg.mbx.1-somdg-medical-logistics-customer-ser@mail.mil
Base Education Office (e.g. training-related services/SF-182)
1SOFSS.FSDE.CT@us.af.mil
Version 20240213
NAME OF APPROVING OFFICIAL
SIGNATURE
By Signing below I am certifying this is not a split purchase
Cardholder Checklist:
Prior to purchase
___Utilize a purchase request form to obtain approval
___Are there mandatory sources (Department of the Air Force Launchpad – Home (dps.mil))
___Check for any required coordination (see 64-117 para 7.12)
___Verify the item(s) to be purchased are authorized using the GPC (see 64-117 para 8.1)
___Use a purchase log to track all purchases prior to expenditure to ensure fund availability
___Submit an ECARS prior to purchase if purchase exceeds applicable MPT ($10K commodity/$2.5K services/$2K
construction) (https://www.afcontracting.hq.af.mil/gpcreport/index.cfm)
___Ensure no tax is paid
After purchase
___Require requester to print/sign their name, date and write “received” on purchase receipt
___Notify appropriate agencies of pilferable/sensitive items and individual items valued over $5K
___Upload receipt and all supporting documentation (889, purchase request, any coordination) into US Bank
___Create/match orders and review/reconcile monthly statements three business days after each billing cycles close
(19th of each month)
___Retain records for the required 10 years
Approving Official Checklist:
Prior to purchase
___Review and approve all purchases to ensure sufficient funds are available and purchases are legal, proper, mission
essential and correct (purchase request form)
___Utilize the Express Contract Action Reporting System (ECARS) to review/approve purchases over the applicable
micro purchase threshold (MPT) ($10K commodity/$2.5K services/$2K construction)
After purchase
___Ensure all supporting documentation is loaded by CHs for each purchase in US Bank
___Ensure flagged transactions are addressed within the required 30 days in Insights on Demand (IoD)
___Review and approve managing account statements in US Bank within five business days after the billing cycles
close (19th of each month)'
___Ensure this form is uploaded by CHs for each purchase in US Bank
11.0.1.20130826.2.901444.899636
01. TextField2:
02. TextField6: 33638
03. :
04. TextField3: Home Depot
414 Mary Ester Blvd NW
Fort Walton Beach, FL 32548
05. ECARS: >$10 Commodities
06. cmd_add:
07. cmd_del:
08. Cell2: N/A
09. Cell3: 1 Gal. Dual Action Weed and Grass Killer
SKU 1008675765
10. Cell4: 3.00000000
11. Cell5: EA
12. Cell6: 26.97000000
13. Cell7: 80.91000000
14. total_cell: 80.91000000
15. DropDownList3: N/A
16. TextField5:
17. TextField7: Victor, Gabrielle L.
18. SignatureField7:
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