Procurement Noncompliance Form
Date: Requisition No:
Department: Department Head:
Process: When a department discovers that a purchase was made without following the procurement code, rules
and regulations, or small purchases executive order, the Department Head, Dean, or Director or authorized
designee must submit this form along with an approved invoice and requisition to the Executive Director of
Procurement Services requesting approval of the improper purchase.
1) Explain the circumstances surrounding the purchase and why procedures were not followed
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
2) Describe corrective action measures implemented to prevent recurrence
_______________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
3) Advise if vendor 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 LA Procurement Code and can subject me to
prosecution and penalty under Louisiana Revised Statute 39:1679.
Name____________________________ Signature_________________________ Date____________________
Telephone Number ____________________________ Fax Number __________________________
Email Address __________________________
Department Head Signature _________________________________ Date ______________________
If approval is authorized, the paperwork will be sent to Accounts Payable. If it is not approved, it will be
returned to the department to be paid with non-University Funds.
Request: [ ] Approved [ ] Denied ____________________________________ Date:____________________
Executive Director
--Office of Purchasing Use Only—
