REQUEST TO PURCHASE, DISPOSE OR RETAIN STATE-OWNED VEHICLES
From: _________________________________ To: State Budget and Control Board
________________________________ State Fleet Management
________________________________ 1430 Senate Street 3
rd
Floor
Date: ____________________________ Columbia, South Carolina 29201-3710
SECTION I
Request to Purchase
Bid Out ______________________ Yes No Vendor name(s) ____________________________
(submit up to three quotes) ___________________________________
___________________________________
Fleet Addition _________________ Yes No (If Yes, reference step E or If No, reference Section II)
New: Description - _____________________ Procured from: ______________________________
(i.e. Sedan, Van, Truck, Trailer…) (i.e., dealer name)
Purchase Order #_______________
Used: Description - _____________________ Procured from: _______________________________
(i.e. Sedan, Van, Truck, Trailer…) (i.e. Surplus Property, Bid, Contract Vendor )
Serial #_______________________ Tag #_________ Mileage____________ Empty Weight______________
A.
Make __________________ Model ____________________ Body Style Year_____________
B. This vehicle is to be assigned to: _______(Agency #), ____________________(Agency Name ), Agency Division #____
C. Annual Official Miles (estimated amount of miles to be traveled with this vehicle?) ______________________________
D. Source used to procure this vehicle are available from: State Appropriations: $________(Actual) $________(Estimated)
Federal: $________(Actual) $________(Estimated) Other: (i.e. USSA Vehicle, Loan, Gift: $______________
E. Give complete justification in accordance with Chapter 7, State Motor Vehicle Management Manual. If a fleet addition,
agency director must certify that no vehicle is available to reassign to fill this need. (For multiple or fleet purchases give
required information on additional sheets).________________________________________________________________
____________________________________________________________________________________________________
F. The State standard fleet sedan or station wagon is a compact model. Requests for special fleet sedans or station wagons
(Intermediate model) must be justified in writing. Please attach justification.
SECTION II
Request for Disposal/Retention
Disposal Retention**
Tag Number _________Make ____________________ Model_______________ Body Style _________ Year __________________
Serial Number _________________________________ Mileage ______________________ New Cost $ ______________________
Present Estimated Value $ ______________________________________________________________________________________
Name and telephone number of person to contact: ___________________________________________________________________
**Old vehicle must be disposed of within 90 days of placement in service of replacement vehicle, unless one-year retention is approved
by SFM. Submit on separate page detailed justification why your agency needs to retain this vehicle.
SECTION III
Special Instructions for procured vehicle(s)
Request for vehicle tag exemption (a.k.a., Confidential Tag):
Yes No (Must attach a completed SFM Form 1-79)
Request for vehicle to be permanently assigned to a driver: Yes No (Must attach a completed SFM Form 980-R)
Agency or Institution Head
SECTION IV
Action By Budget & Control Board
Approved Disapproved
Date Signature
SFM Form 6-77 Revised 12/2013
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