Procurementand Contract Services
P.O.Box425439/BralleyAnnex
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Denton,TX76204‐5439
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P
:
(940)898‐3812
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F
:
(940) 898‐3519 Rev:10/16
JustificationforEmergencyPurchase
Req#:______________
PO#: ______________
Thisformhasbeendesignedtoassistfacultyandstaffinprovidinginformationnecessaryintheprocessingof
emergencyrequisitionsfortheprocurementofproducts orservices.Pleasecompleteandforwardtothe
PurchasingOffice.Ifmorespac eisneeded , pleaseattachadditionalpage(s).
PURCHASEINFORMATION
1. Stateth
ereasonfortheemergency purchasebyexplainingwhattheemergencyisandwh atcausedthe
emergencysituation:
2. Statethefactsthatle
adtotheconclusionthatf inancialoroperationaldamageorriskofdamagewilloccur
ifneeds arenotsatisfiedimmed iately (dono tsimplysaythatth ere willbedamageorriskofdamage):
3. Statewh
ytheneedswerenotorcouldnotbeanticipatedsothatgoodsorservicescouldnothavebeen
purchasedfoll owing standardprocedures:
4. Stateth
ereasonandprocessusedforselectingthevendor (Attachallquotes/proposals received
fromothersources,ifapplicable:
Icertifytha t theabove statemen ts aretrueandcorrect, andthatno othermater i a lfactor considerationofferedor
givenhasinfluencedth is recommendationforaneme rgenc yprocurement.
Print/TypeName Print/TypeTitle Department
DepartmentAuthorizedSignature Date TelephoneNumber
PURCHASINGUSEONLY
Reviewedby: Date:
Appro
vedby: Date:
AVP for Procurementand Contract Services(or designee)