Transcription of Supplier Price Justification and Conflict Information ...
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Page 1 of 3 10/18/2011 Supplier Price Justification and Conflict Information ( spjci ) Form Required for UR, URMC & HH Purchases Date: _____Requisition #: _____Vendor: _____Requested by:_____Phone: _____ Department must submit a completed spjci Form with each 312 Requisition or Request For Payment for equipment, supplies, and/or services expected to exceed $25,000, or any Sole or Single Source request, and whenever a perceived or actual Conflict of Interest per the University s policies exists. Complete all applicable sections, sign and attach all supporting documentation (proposed contract, all quotes, analyses, etc.) Note: Departments are responsible for retention of all Justification and supporting documentation needed to support a compliance audit for all Purchases, whether the Purchases are greater or less than $25,000, internal and/or direct made via Contract, Requisition, Request for Payment, SOLO, P-Card, Petty Cash, etc.
spj.doc Page 2 of 3 10/18/2011 UNIVERSITY OF ROCHESTER Supplier Price Justification and Conflict Information (SPJCI) Form SECTION D Conflict of Interest Information 1R &RQIOLFW RI ,QWHUHVW ([LVWV Name of University affiliated individual with Conflict of Interest:_____ Title:_____
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