August 20, 2010 CHIEF FINANCIAL OFFICER MEMORANDUM NO. 02 ( )

Transcription

1 August 20, 2010 CHIEF FINANCIAL OFFICER MEMORANDUM NO. 02 ( ) SUBJECT: CONTRACT SUMMARY FORM Chief Financial Officer Memorandum No. 1 (10-11) issued a revised Contract Summary Form that must be properly completed and submitted with all contractual services and grant payment requests. The purpose of this memorandum is to disseminate an updated Contract Summary Form and to clarify when it is to be used. Except for contracts and grants which have no total amount or the total amount is $1 million or more, the Bureau of Auditing does not require the agreement (including direct orders/purchase orders) to be submitted to the Bureau. The Contract Summary Form is submitted in lieu of the actual agreement when the agreement does not meet the established threshold. For payments processed through MyFloridaMarketPlace, agencies must provide only the amount paid to date and the contract manager s written certification as shown on the Contract Summary Form. The Contract Summary Form may be attached to the Invoice Reconciliation to provide this information or the contract manager s certification statement (contained on the Contract Summary Form) and the paid to date information may be entered in the MyFloridaMarketPlace comment field by the contract manager along with his/her name. Alternately, this information may be provided on the invoice itself. Payments processed directly in FLAIR must be supported by a properly completed Contract Summary Form unless the agreement is either on file with the Bureau or is attached to the payment request. If the agreement is on file or is attached to the payment request, only the invoice number, invoice period, paid to date amount and the contract manager s certification will need to be provided. While the contract manager s certification must be signed for each individual invoice, the agency management certification does not need to be signed for each invoice. The agency management certification must be provided initially for agreements. Thereafter, the agency management certification will be required to be updated at the time the agreement is amended or renewed. Questions regarding this memorandum may be addressed to Laura Anderson at , Laura.Anderson@myfloridacfo.com or Cheri Greene at , Cheri.Greene@myfloridacfo.com.

2 SUMMARY OF CONTRACTUAL SERVICES AGREEMENT/PURCHASE ORDER Contract/PO #: Telephone #: Contract Start TYPE OF SERVICES: Contract Signed by Contract End Method of Payment: Fixed Rate Lump Sum Cost Reimbursement Cost Plus (any combination) Advance Funded YES NO Deliverables Including Minimum Performance Standards Payment Amount METHOD OF PROCUREMENT: ITB RFP ITN REF # Single/Sole Source Emergency Certification Other (Specify) *AGENCY MANAGEMENT CERTIFICATION: I certify, by evidence of my signature below, the above information is true and correct; and accurately reflects the terms and conditions of the executed contract document on file. I understand that the office of the State Chief Financial Officer reserves the right to require additional documentation and/or to conduct periodic post-audits of any agreements. Management Name printed: Management Signature: Invoice Number: Invoice Period: Total Amount of Previous Payments: CONTRACT MANAGER CERTIFICATION: I certify, by evidence of my signature below, the above information is true and correct; the goods and services have been satisfactorily received and payment is now due. I understand that the office of the State Chief Financial Officer reserves the right to require additional documentation and/or to conduct periodic post-audits of any agreements. Contract Manager Name printed: Contract Manager Signature:

3 Attachment A Amendments/Renewals Contract/PO #: Telephone #: Original Contract Original Contract Start End AMENDMENT 1 RENEWAL AMENDMENT 2 AMENDMENT 3

4 Instructions to complete the Summary of Contractual Services Agreement/Purchase Order Form: This form should be completed in its entirety, signed and dated by the appropriate agency personnel and submitted with each payment request. Please ensure each field on the form is completed according to the guidance provided. Telephone #: Total Amount of Previous Payments: Contract/Agreement/PO/DO#: Contract Start Contract End Type of Services: Method of Payment: Invoice Number: Invoice Period: Deliverables Min Performance: Payment Amount Method of Procurement: *Agency Management Certification: Agencies numeric identifier (i.e /Department of Health). Agency designated personnel to answer questions regarding payment. Designated personnel phone number. Provide the contract amount; amount must equal the total amount of the contract; including amendments and/ or renewals. Provide the cumulative total of the payments to date, excluding current invoice amount (s). Identify number assigned to agreement. Identify Vendor/Payee (including d/b/a if applicable). Identify date contract begins. Identify date contract ends. Identify date of execution. Identify the individual who executed the contract. Identify the job title of the individual who executed the contract. Provide a brief description of the services being provided. Check the appropriate method of payment. Identify the invoice number associated with this payment request. Identify the invoice period this payment request covers. All deliverables and minimum performance standards as stated in the agreement must be provided. Pages from the agreement referencing the deliverables and minimum performance standards may be attached. Identify the payment criteria (compensation) for each deliverable. Check the appropriate procurement method; identify specific ITB, RFP or ITN number. If first payment is being submitted on a competitively procured agreement, provide documentation evidencing procurement (e.g. bid tab). If Other is selected provide the specific exemption, statute, CSFA, CFDA or GAA line item. This section is to be completed by the level of management Bureau Chief (or equivalent) or higher that has direct knowledge of the contract document and can attest to the information provided on this form is true and correct and accurately reflects the terms and conditions in the executed contract document.

5 Management Management Signature: Contract Manager Certification: Contract Manager Contract Manager Signature: Print name of the appropriate agency personnel. Print job title of the appropriate agency personnel signing form. Signature of the appropriate agency personnel. Enter the date signed by the appropriate agency personnel. This section is to be completed by the employee designated by the agency to function as the contract manager and is approving the identified invoice for payment based on direct knowledge of satisfactory receipt of the goods or services. If the individual completing this section is not the designated contract manager, please provide justification or delegation of authority for the individual to sign this form. Print name of the appropriate agency personnel. Signature of the appropriate agency personnel. Enter the date signed by appropriate agency personnel. ATTACHMENT A AMENDMENTS/RENEWAL: This page is to be used to identify any amendments that have been executed. Additional records may be entered as necessary. Identify date of execution. Identify the individual who executed the contract. Identify the job title of the individual who executed the contract. Provide the contract amount; amount must equal the total amount of the contract; including amendments and/ or renewals.