FRM-U525.A.25
Rev. 06/17
USED EQUIPMENT JUSTIFICATION FORM
Date: Requisition Number:
Department: Department Head:
1. State Relevance of Purchase to your Mission, Purpose, Research, or Study:
2. Identify Items to be Approved for Used Equipment (Note: New equipment demo’d by University will
not be considered “used equipment” for this purchase.)
3.
Name of Supplier:
Mailing Address:
Phone: Fax: Email:
4. Price for used equipment (supplier quote
required):
5.
Price for new equipment (supplier quote
required):
6. Maintenance and Repair Plan:
7. Savings accrued to University:
8.
If total amount exceeds $10,000, would following normal Purchasing procedures result in loss of this
specific equipment? If so, explain and provide supplier confirmation.
NOTE: Firm price quotation from vendor pricing the product(s) identified in section 2 must be supplied.
Quoted prices shall be firm for 30 days and inclusive of all costs including transportation. Quote FOB
must be FOB LSU.
By signing below all parties hereby declare the information provided herein to be true and
accurate to the best of their knowledge. They understand any false or misleading information
may be a violation under the La. Procurement Code and can subject them to prosecution under
Louisiana Revised Statute 39: 1679.
Print Name of Requestor: ______________________ Signature: _______________________
Telephone Number: __________________________ Fax Number: _____________________
Email Address: ______________________________
Department Head Signature: ________________________________
ATTACH TO REQUISITION WITH SUPPLIER QUOTE
FINANCE & ADMINISTRATIVE
Procurement Services
213 Thomas Boyd Hall • Baton Rouge, LA • 70803 • P (225) 578-2176 • F (225) 578-2292
www.lsu.edu/administration/ofa/procurement • purchase@lsu.edu
