Procurement Noncompliance Form
Date: Document No:
Department: Department Head:
Process: When a department discovers that a purchase was made without following the Procurement Code, policies
and procedures, the Department Head, Dean, or Director or authorized designee must attach this form along with an
approved invoice to a requisition or expense report to request approval of the improper purchase from Procurement
Services. Noncompliance approval is granted as a one-time exception in order to facilitate payment to the supplier
for goods/services rendered.
1) Explain the circumstances surrounding the purchase and the reason procedures were not followed.
2) Describe corrective action measures implemented to prevent recurrence.
3) Advise if supplier is unwilling to accept the return of goods, or if items have been already used or disbursed.
I hereby declare the information herein to be true and accurate to the best of my knowledge. I understand any false or
misleading information may be considered a violation under the University Procurement Code and can subject me to
prosecution and penalty under Louisiana Revised Statute 39:1679.
Purchaser Name Signature
Telephone Number
Email
Address Date
Department Head Signature
Date
If approved, a purchase order will be issued or email approval will be sent to Accounts Payable & Travel to
reconcile expense report. If it is not approved, the requisition will be returned, or an email will be sent to the
department instructing purchase is to be paid with non-University Funds.
REPEAT VIOLATIONS MAY CAUSE LOSS OF PROCUREMENT PRIVILAGES.
Rev 10/2017
