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Pur525 (Louisiana State University)

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PUR525 Rev. 10/08
Departmental instructions for Use of the Authorized Dealer Certification Form:
Enter the name of the proposed authorized dealer in the blank which is indicated
with an asterisk.
Enter the information regarding the equipment needing repair and/or repair parts
in the box labeled “Specified Equipment.”
Send the form to the MANUFACTURER of the specified equipment for completion,
OR attach other documentation from the manufacturer that confirms vendors
authorized dealer status, such as: a printout from the manufacturer’s website, an
email from the manufacturer, or a current letter from the manufacturer.
Once certification is obtained, you can proceed with purchase via LaCarte, direct
charging to AP, or by releasing a requisition to purchasing. Regardless of the
method used for purchase, the completed authorized dealer form and/or other
documentation must accompany the LaCarte bf, direct charge invoice, or
requisition.
PUR525 Rev. 10/08
Authorized Dealer Certification
~ Equipment Repairs / Maintenance / Parts ~
Louisiana procurement law permits the non-competitive purchase of equipment repairs and/or associated repair
parts directly from an Original Equipment Manufacturer (OEM) or any OEM-Authorized Dealer.
[R.S. 39:1655; Executive Order No. BJ 08-67, 5.A.1 & 2]
To ensure University compliance for such purchases, the signature of a duly authorized Agent of your Company is
required to certify the current status of OEM-Authorized Dealers to perform repairs/maintenance and/or to sell
OEM-parts for the equipment specified below. By signature, your Company fully acknowledges and agrees to the
Terms and Conditions stated herein.
Specified Equipment [OEM / Equipment Types / Brands / Series / Models / Serial #’s/ LSU tag #’s]:
I hereby certify that *_________________________________ is a duly OEM-Authorized Dealer for the
above-specified equipment:
to perform repairs/maintenance only on the specifically referenced equipment above.
to perform repairs/maintenance on any and all of this Manufacturer’s equipment types, brands,
models, series, etc. (unless specifically excluded by my attachment hereto).
to sell/distribute OEM-repair parts only for the specifically referenced equipment above.
to sell/distribute OEM-repair parts for any and all of this Manufacturer’s equipment types,
brands, models, series, etc. (unless specifically excluded by my attachment hereto).
Manufacturer’s Name: ___________________________________________________ Phone: ________________________
Title & Printed Name: ____________________________________________________ Fax: __________________________
Signature: ______________________________________________________________ Email: ________________________
OEM/Authorized Dealer Terms and Conditions:
The University may reproduce, accept and use this executed ‘Authorized Dealer Certification’ form as supporting file
documentation as deemed appropriate in future, relative procurements; unless a singular use and application is expressly
designated by the Authorized Dealer’s Signatory. However, the University reserves the right to request an ‘Authorized
Dealer Certification’ form for any and all related purchases.
The University, at its sole discretion and occasion, reserves the right to solicit competitive bids from multiple OEM-
Authorized Dealers.
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Pur525 (Louisiana State University)

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Completed 20 July 2020

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