Supplier Price Justification Conflict Information (SPJCI) Form

Transcription

1 Supplier Price Justification Conflict Information (SPJCI) Form

2 What is it? A Supplier Price Justification Conflict Information Form is a 3-page form provides justification and supporting documentation needed to support a compliance audit for purchases. The form must be submitted with each 312 Purchase Requisition or Payment Request Form for equipment, supplies, and/or services based on the following. Sole Source (no other company with known capability, proprietary or patented product/service) Cost exceeds $25,000 Grants, Contracts & All Federal Funds >$25,000 Whenever a perceived or actual Conflict of Interest, per the University s policies, exists. Note: Departments are responsible for retention of all justification and supporting documentation needed to support a compliance audit for all Purchases, whether the Purchases are greater or less than $25,000, internal and/or direct made via Contract, Requisition, Payment Request Form, SOLO, P-Card, Petty Cash, etc.

3 Why do I need to complete and submit this? This form is required as justification for the transaction based on the following reasons: (1) To support the selection of the supplier for the transaction (2) To identify reasonableness of pricing Additionally, any transaction that is purchased using federal grant or contract funds, must comply with FAR and 2 CFR 200 guidelines. The University s interpretation of the 2 CFR 200 required file documentation is as follows: Grants, Contracts & all Federal Funds >$25,000 Require basis for supplier selection; justification of selected/sole source or lack of competitive bid; reasonable price, Complete A or B & C Contracts $2,500 & > FAR requires competitive bidding for each purchase $2,500 or greater. Complete A or B & C. >$150,000 FAR requires additional documentation to support small business opportunities (Complete Page 3) Note: Most University awards are grants; contact ORPA if you need clarification of Grant versus Contract.

4 Where do I find it? The Supplier Price Justification Conflict Information Form (SPJCI) is located on the Purchasing Website in the Forms Bank. How do I complete it? The form is a 3-page PDF fillable form that can be filled out on-line. The departmental requestor must complete the SPJCI Form. The next several screens will provide additional detail in filling out the form. Please note that incomplete forms will be returned and will delay your request. What are the next steps after completing it? Upon completing the SPJCI Form and obtaining appropriate signatures based on the University Signature Authority Policy, submit it along with your 312 requisition and other supporting documentation (i.e. quote, Independent Contractor Forms, Contracts etc.) to Purchasing by fax at , intramural mail at Box or Helpdesk_Purchasing@urmc.Rochester.edu

5 Date: Enter the date you are completing the form Req#: Enter the 312 requisition that will accompany this completed form. Vendor: Enter the name of the supplier you would like to contract with. Note: Purchasing may change the supplier based on contracts currently in place. Requested By: Identify the person who is requesting the supply, equipment or service. Phone: Identify the phone number of the person requesting the supply, equipment or service. Section A: If competitive bids were submitted to support the selection of the supplier, please indicate the supplier name and total quoted price. Attach the quote and identify if the supplier is a small business. If the supplier is a University or Hospital contracted standard supplier, identify the name of the supplier, their quoted price and if they are a small business

6 Section B: Identify by checking the appropriate box if the selected supplier is: a Sole Source (no other company with capability, proprietary or patented product/service) Or a Selected Source (alternative suppliers exist but selection was based on technical requirements or other justification. Section C Cost/Price Analysis: Select all that support the determination that the purchase is fair and reasonable. A detailed explanation to support your selection is required.

7 Conflict of Interest Information: Identify if there is a conflict of interest with this transaction. Check No Conflict of Interest if one does not exist. If there is a conflict, please identify name and title of the individual affiliated with the conflict. In addition, identify the process utilized to manage it. If a conflict exists, the University s Sr. VP of Administration and Finance or their designee, must approve the purchase. A person, with signature authority based on University Signature Policy to commit funds for the department and can certify the information is correct, is required to sign the SPJCI Form.

8 Additional Documentation of Purchases/Subcontracts over $150,000: Page 3 is only required for purchases >$150,000. Identify, based on the categories listed, the number of suppliers solicited and the reason they were not selected based on the designated key. Additional comments can be identified to support the information provided. An authorized department representative is required to sign to certify the information provided is accurate.

9 What are the next steps after completing the form? After completing the SPJCI Form, print a copy, have the appropriate staff with signature authority in the department, sign on Page 2 and 3 and submit the form along with your 312 Purchase Requisition and other supporting documentation (i.e. quote, Independent Contractor Forms, contracts, etc.) to Purchasing by fax at , intramural mail at Box or Helpdesk_Purchasing@urmc.Rochester.edu