Fillable GPC Purchase Request Purchase Request / LOA / (Arizona)

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GPC Purchase Request Purchase Request / LOA / (Arizona)

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The GPC Purchase Request Purchase Request / LOA / (Arizona) form is 1 page long and contains:

  • 9 signatures
  • 3 check-boxes
  • 74 other fields

Country of origin: US
File type: PDF

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Accountable
Item(s):
GPC Purchase Request
Purchase Request /
LOA / 4009 Number
1. Name of Authorized Government Official (Requester)
2. Phone Num
3. Date
4. Urgency of Need
5. Screening for Proper Procurement Method
6. Type of Supplies or Services
Office Supplies Information Technology Printing Furniture Other Supplies/Services
7. Special Instructions for Type of Supplies or Services Selected:
8. Description of Supplies or Services
9. Part Number
10. Quantity
12. Total Price
$
$
$
$
$
$
Shipping, Handling, & Tax
(if applicable)
$
Sum Total Purchase Price
$
13. Suggested Sources
14. Identified Legitimate Government Need (Purpose/Why):
Item(s) requested for purchase are NOT PROHIBITED as defined in AFARS Appendix EE,
Att. C, Prohibited Purchases, and are mission essential requirements, fulfilling a bona fide need
as defined in 31 U.S.C. 1502, 1551, & 1552
15. Determination of Price Reasonableness:
Price Competition: (Vendor 1) ___________
__________ (
Vendor 2
) _____________________
(
Vendor 3
) _____________________
$
______________
$
______________
$
______________
OtherReasonable Basis:
Organization Approvals (Approver Name/ Position boxes may be tailored)
Approver Name / Position
Signature
Approver Name / Position
Signature
Organizational Property Record Verification
16. Supply Officer .
(POC that answered block 6)
17. Supply Officer Signature
(POC that answered block 6)
Independent Receipt and Acceptance
20. Name of Authorized Government Representative (Receiver)
**Property
Book Officer shall be notified of Receipt of Items in writing within 5 days**
21. Date Received
22. Signature
AZNG USPFO GPC Form, July 2020
System
Funds Available/
Remaining Funds
Requester:
Supervisor:
Cardholder:
Approving /
Billing Official:
State Tax Information: – https://smartpay.gsa.gov/content/state-tax-information
AZ Intrastate Commerce- Subject to AZ Privilege Tax, Interstate- Subject to Half-Tax
This requirement ________ be filled by supply ordering system, or agency inventory IAW FAR 8.002(a)(1)
Mandatory Source, refer to Block #6
Open Market (last resort), refer to Abstract in Block #15
GSA, refer to Abstract in Block #15
18 . Property Book Officer - ARMY
Equipment Custodian - Air Force
YES
NO
$
19 .Property Book Officer Signature - ARMY
Equipment Custodian Signature - Air Force
-- select --
-- select --
GPC (Micro-Purchase): Within Cardholder Appointment Letter Limit; No Purchase Terms and/or Conditions
CANNOT
Mandatory Source. Cardholders must purchase office supplies from a local Ability One Base Supply Store, Ability One Distributor, or from a
GSA Global Supply Center where such stores exist. Cardholders may also purchase directly from FedMall (https://www.fedmall.mil).
Exceptions: Cardholders may purchase (1) Directly from a FedMall vendor when FedMall is down for more than 24 hours, or (2) from another
source if (a) an urgent need exists, or (b) the purchase is outside the continental United States.
0.00
0.00
0.00
0.00
0.00
0.00
0.00
-- select --
✔
-- select --
Cardholder
Supervisor
Billing Official
-- select as needed --
-- select as needed --
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PURPOSE: This form is used to request, purchase and account for supplies and services up to the micro-
purchase threshold. Cardholders should verify the micro-purchase threshold prior to making any purchases to
ensure this amount is not exceeded. As of 1 Apr 19, the micro-purchase threshold is $10,000, with
exceptions. For services subject to Contract Labor Standards, the threshold is $2,500; and for construction,
the threshold is $2,000. To verify the current threshold or other exceptions, refer to the Federal Acquisition
Regulation (http://farsite.hill.af.mil/vmfara.htm), part 2.101.
FORM INSTRUCTIONS
Select the system GFEBS Army or DEAMS Air Force. PR
Number: Internally assigned number for accountability.
1. Name of Authorized Government Official (Requester).
Department of the Army Civilian (or equivalent) / Soldier
requesting supplies or services; not the Cardholder, Billing Official,
or a Government Contractor.
2. Phone Number. Contact information of the person identified in
block 1.
3. Date. Date of purchase request.
4. Urgency of Need. Use the pull-down menu to select the most
appropriate Urgency of Need. Using Unit Supply System (Manual
Procedures), Section 2-2 to determine the most suitable Urgency
of Need. Refer to DA Pamphlet 710-2-1
5. Screening for Proper Procurement Method. Use the drop-
down menu to select the most appropriate procurement method
used for this purchase. Note: for some Procurement Methods, this
Purchase Request Form may not be used.
6. Type of Supply or Services. Select the most appropriate type
of supply or service requested. Selection of one of the boxes is
MANDATORY whether the remainder of the form is filled out
electronically or manually.
7. Special Instructions for Type of Supplies or Services
Selected. This field will auto-populate with instructions for
procedures based on selection in box 6. Cardholders must
comply with the noted Special Instructions.
8. Description of Supplies or Service. Brief Description as
applicable. Multiple lines can be used for different items, but must
be from the same vendor. Note: Purchases from multiple
vendors, will require multiple forms
9. Part Number. National Stock Number, Unit Product Code, or
other manufactures Item Identifying number.
10. Quantity. The number of items requested in block 8.
11. Unit Price. The individual price of each item listed in block 8.
12. Total Price. This amount will auto-populate based on the
information provided in blocks 10 and 11
Shipping, Handling & Tax. Amount of cost attributable to
the vendors pricing for shipping and handling; AZ Privilege
Tax for Intrastate Commerce or Interstate Half-Tax Bulk
Funding.
System. Select the system GFEBS Army or DEAMS Air
Force
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21. Date Received. Date of Supply/Services receipt.
22. Signature. Signature of the person identified in block 18.
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GPC Purchase Request Purchase Request LOA (Arizona)

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Completed 27 January 2021

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