for Contractors/Vendors for Government Entities for State Employees for the Public
 
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Request To Purchase

This form is for use by Ohio governmental entities only, Vendors are not to complete or submit this form. Cooperative entities should only complete this form if anticipated purchase is more than $50,000.

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NOTE: If this request is for an IT supply or service please submit your request to the Information Technology Procurement Services office at https://itrelease.ohio.gov.
Please click here for Frequently Asked Questions
Section 1 Contact Information

* - Required Field

*Date of Request: 12/10/2017
*Government Entity:
*Business Unit:
*Street Address:
*City:
*State: Ohio
*Zip:  
Contact Person:
*First Name:
*Last Name:
*Email:  (username@domain.com)     
*Phone No.:  (xxx-xxx-xxxx)    

Section 2 Request Information
*Provide a description of the project including supplies, services, duration, etc. that captures the general scope of the work and/or the items to be purchased.

If this request is for the purchase of used equipment, please indicate such in the description.

(Specific details can be attached).

*Provide any project requirements (certifications, bonding, capital expenditures, education, project specific experience, etc.) necessary for the vendor to successfully perform the requested services.
*Included on Agency MBE Projection Plan?
If yes, please enter the line item number of where it appears on your spending plan: 
*Is there an existing contract for similar items/services?
(If Yes, please explain why the existing contract cannot be utilized)
*Please enter the date on which you will need this purchase.
(If this is an emergency purchase, please enter your reason/description.)
*Vendor quotes must be attached to the request.
Failure to attach may delay the determination of this request.  (please attach price quotations)  (please explain why not below)
*Is this a one time purchase or an on going need?
*Is this an MBE set-aside Purchase?
Note: Every request to purchase will be reviewed by OPS as a potential minority set-aside opportunity.
*Estimated Dollar Amount:

(e.g., $52,000.00)
Previous Annual Expenditure:

(e.g., $42,000/12 months)
*OAKS Account Code For Payment:
 
*Fiscal Year(s):

 
*Funding Sources:


Section 3 List Known Available Sources:
Vendor Name:  (please put full vendor name) 
OAK ID No.  
Address:  
City:
State:
Zip Code:  
Email Address:
This vendor is a:
Vendor Name:  (please put full vendor name)
OAK ID No.  
Address:  
City:
State:
Zip Code:  
Email Address:
This vendor is a:
Vendor Name:  (please put full vendor name)
OAK ID No.  
Address:  
City:
State:
Zip Code:  
Email Address:
This vendor is a:
Fiscal Contact:
*First Name:
*Last Name:
*E-Mail Address  
*Phone No.  (xxx-xxx-xxxx)
Attachments:
           
        
*Please upload attachments with a .pdf, .doc, .docx, .xls or .xlsx extensions.
*Allow ten business days to receive a determination of this request.*
      
      

                   
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