LARAMIE COUNTY COMMUNITY COLLEGE
Acquisition Review Worksheet
(To be completed for purchase or donation of electronic/computer materials,
furniture, xtures, equipment and items requiring LCCC Logos/Trademarks)
Department Date
Requestor/
Contact person
Phone Ext.
Description of
Purchase or Donation
(Attach location drawing,
catalog and vendor information,
power and environmental
requirements, cut sheets, etc.)
Requestor’s
estimated cost
Budget
Account
Date to be
completed
Location
(Include building
and room numbers)
Criteria “A” — Acquisition Requirements
Requires engineering or design assistance ........................................ Y N
Access by individuals w/disabilities or ADA accommodation ........................ Y N
Requires alteration of walls, ceiling or oor or physical buildings .................... Y N
Hazardous Conditions involved ................................................. Y N
Utilities required (Check all that apply) .......................................... Y N
electricity water sewer drain lighting wiring ventilation network
Requires special operating requirements (licenses, training, etc) ...................... Y N
Network connection and/or server access ........................................ Y N
Meets current Public Relations image, logo and trademark criteria ................... Y N N/A
Criteria “B” — LCCC Service Requirements
Installation By (Check all that apply)
Requestor Physical Plant Vendor Contractor ITS Other________________________
Pickup/Delivery by LCCC ...................................................... Y N
Requires relocation of LCCC property ............................................ Y N
Storage required .............................................................. Y N
Purchase involves trade-in of old equipment ...................................... Y N
Purchase involves disposal of old equipment ...................................... Y N
ITS Sta review
Signature Date
Public Relations review
Signature Date
Physical Plant review
Signature Date
DSS or Human Resource review
Signature Date
Purchasing Oce review
Signature Date
Notes:
1. LCCC Acquisition Review Worksheet to be completed by Requestor, including review and approval by ITS, PR, HR and/
or the Physical Plant when required; then forwarded to the Purchasing Oce along with supporting documentation.
2. Requestor shall submit detailed equipment specication and product sheets with this Form.
3. Any purchase that exceeds $20,000 in value shall be competitively quoted or bid by Purchasing.
4. In reference to Criteria “A” and “B” above, questions that are answered “Yes” shall be supported with applicable written
data and submitted with this Form.
5. LCCC Acquisition Review Worksheet shall be completed for all computers, peripherals, software, computer/
AV equipment, phone equipment, other electronic equipment; furniture, furnishings and equipment (FF&E);
and materials, goods or equipment that require an LCCC trademarked logo or image; in accordance with LCCC
Procurement Procedure Manual.
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PRS 13021 7/17
