CERT TRAINING---PURCHASE REQUEST FORM, FOOD ITEMS

CERT TRAINING---PURCHASE REQUEST FORM, FOOD ITEMS
(Use this form to request the purchase of food items) ATTACH ALL VENDOR QUOTES!
Please fill out, print, & return to:
Anna Giacomini
East-West Gateway Council of Governments
1 S. Memorial Dr., Suite 1600
St. Louis, MO 63102
UASI GRANT
Line Number
(Office Use Only)
Today's Date
SHIP TO THE FOLLOWING ADDRESS:
Name
Point of Contact
Address
Agency
Agency & Title
City, State, & Zip
Address
Team/Depart.
Phone Number
City, State, & Zip
The costs provided on this form can be estimated costs.
Phone Number
ITEM INFORMATION (enter all requested information)
VENDOR INFORMATION (enter all requested information)
ITEM #1
Type
Category
Sole Vendor*
State Contract*
Total Cost
Quantity
Company Name
Producer/Business*
Description**
Justification
Company Contact
Address
City, State, Zip
Phone
*Unless documentation is provided that a particular producer/business is needed,
we reserve the right to purchase acceptable equivalents.
**Put additional description information in "Additional Notes."
*Sole Vendor is defined as the only company that manufactures/sells a particular item.
Supporting documentation must be provided verifying the sole vendor status.
*Supporting documentation must be provided (i.e. copy of state contract or web
reference).

CERT TRAINING---PURCHASE REQUEST FORM, FOOD ITEMS, con't.
(Use this form to request the purchase of food items) ATTACH ALL VENDOR QUOTES!
ITEM INFORMATION (enter all requested information)
VENDOR INFORMATION (enter all requested information)
ITEM #1, con't.
Additional Notes
Sole Vendor*
State Contract*
Total Cost
Company Name
Company Contact
Phone
Address
City, State, Zip
Sole Vendor*
State Contract*
Total Cost
Company Name
Company Contact
Phone
Address
City, State, Zip
*Sole Vendor is defined as the only company that manufactures/sells a particular item.
Supporting documentation must be provided verifying the sole vendor status.
*Supporting documentation must be provided (i.e. copy of state contract or web
reference).

CERT TRAINING---PURCHASE REQUEST FORM, FOOD ITEMS, con't.
(Use this form to request the purchase of food items) ATTACH ALL VENDOR QUOTES!
ITEM INFORMATION (enter all requested information)
VENDOR INFORMATION (enter all requested information)
ITEM #2
Type
Category
Sole Vendor*
State Contract*
Total Cost
Quantity
Company Name
Producer/Business*
Description**
Justifcation
Company Contact
Address
City, State, Zip
Phone
Additional Notes
Sole Vendor*
State Contract*
Total Cost
Company Name
Company Contact
Phone
Address
City, State, Zip
*Unless documentation is provided that a particular producer/business is needed,
we reserve the right to purchase acceptable equivalents.
**Put additional description information in "Additional Notes."
*Sole Vendor is defined as the only company that manufactures/sells a particular item.
Supporting documentation must be provided verifying the sole vendor status.
*Supporting documentation must be provided (i.e. copy of state contract or web
reference).

CERT TRAINING---PURCHASE REQUEST FORM, FOOD ITEMS, con't.
(Use this form to request the purchase of food items) ATTACH ALL VENDOR QUOTES!
ITEM INFORMATION (enter all requested information)
VENDOR INFORMATION (enter all requested information)
ITEM #2, con't.
Additional Notes
Sole Vendor*
State Contract*
Total Cost
Company Name
Company Contact
Phone
Address
City, State, Zip
ITEM #3
Type
Category
Sole Vendor*
State Contract*
Total Cost
Quantity
Company Name
Producer/Business*
Description**
Justifcation
Company Contact
Address
City, State, Zip
Phone
*Unless documentation is provided that a particular producer/business is needed,
we reserve the right to purchase acceptable equivalents.
**Put additional description information in "Additional Notes."
*Sole Vendor is defined as the only company that manufactures/sells a particular item.
Supporting documentation must be provided verifying the sole vendor status.
*Supporting documentation must be provided (i.e. copy of state contract or web
reference).

CERT TRAINING---PURCHASE REQUEST FORM, FOOD ITEMS, con't.
(Use this form to request the purchase of food items) ATTACH ALL VENDOR QUOTES!
ITEM INFORMATION (enter all requested information)
VENDOR INFORMATION (enter all requested information)
ITEM #3, con't.
Additional Notes
Sole Vendor*
State Contract*
Total Cost
Company Name
Company Contact
Phone
Address
City, State, Zip
Sole Vender*
State Contract*
Total Cost
Company Name
Company Contact
Phone
Address
City, State, Zip
*Sole Vendor is defined as the only company that manufactures/sells a particular item.
Supporting documentation must be provided verifying the sole vendor status.
*Supporting documentation must be provided (i.e. copy of state contract or web
reference).
IF YOU HAVE ADDITIONAL ITEMS USE THE ADDITIONAL ITEMS SHEETS FOR EACH ADDITIONAL ITEM.

CERT TRAINING---PURCHASE REQUEST FORM, FOOD ITEMS, con't.
(Use this form to request the purchase of food items) ATTACH ALL VENDOR QUOTES!
ITEM INFORMATION (enter all requested information)
VENDOR INFORMATION (enter all requested information)
Addtional Items
Type
Category
Sole Vendor*
State Contract*
Total Cost
Quantity
Company Name
Producer/Business*
Description**
Justifcation
Company Contact
Address
City, State, Zip
Phone
Additional Notes
Sole Vendor*
State Contract*
Total Cost
Company Name
Company Contact
Phone
Address
City, State, Zip
*Unless documentation is provided that a particular producer/business is needed,
we reserve the right to purchase acceptable equivalents.
**Put additional description information in "Additional Notes."
*Sole Vendor is defined as the only company that manufactures/sells a particular item.
Supporting documentation must be provided verifying the sole vendor status.
*Supporting documentation must be provided (i.e. copy of state contract or web
reference).

CERT TRAINING---PURCHASE REQUEST FORM, FOOD ITEMS, con't.
(Use this form to request the purchase of food items) ATTACH ALL VENDOR QUOTES!
ITEM INFORMATION (enter all requested information)
VENDOR INFORMATION (enter all requested information)
Additional Items, con't.
Additional Notes
Sole Vendor*
State Contract*
Total Cost
Company Name
Company Contact
Phone
Address
City, State, Zip
*Sole Vendor is defined as the only company that manufactures/sells a particular item.
Supporting documentation must be provided verifying the sole vendor status.
*Supporting documentation must be provided (i.e. copy of state contract or web
reference).