995 West Beardsley Place, Salt Lake City, UT 84119

Salt Lake City School District

Purchasing Department

995 West Beardsley Place, Salt Lake City, UT 84119

Phone: 801-974-8368 Fax: 801-974-8375

CONFIRMATION PURCHASE FORM

(UNAUTHORIZED PURCHASE)

This form is a ratification of an unauthorized purchase executed by a user department/school that does not comply with the Utah Procurement Code, Administrative Rules, District Policies, and/or Administrative Procedures. A confirmation purchase requires retroactive approval by the District Director of Purchasing for purchases up to $50,000, and by the Business Administrator for commitments exceeding that amount. PAYMENT FOR ANY UNAUTHORIZED PURCHASE MAY BE THE RESPONSIBILITY OF THE PERSON PLACING THE ORDER.

The department administrator or principalwith responsibility over the unauthorized purchase shall provide to the DistrictDirector of Purchasing a complete written justification for the unauthorized purchase to include a description of the corrective action taken to prevent future incidents. A copy of this completed form shall be submitted with the purchase requisition submitted in BusinessPLUS.

NOTE: Multiple unauthorized purchases by employees/departments/schools may result in disciplinary actions. Please reference Board Policy F-2 and its accompanying Administrative Procedures.

Please provide the information requested below and submit this Form and attachments to the Purchasing Department:

DATE:Click here to enter text.DEPARTMENT/SCHOOL: Click here to enter text.

VENDOR: Click here to enter text.AMOUNT: $Click here to enter text.

NAME OF ALL DISTRICT STAFF INVOLVED IN THE UNAUTHORIZED PURCHASE:

Click here to enter text.

DESCRIPTION OF GOODS OR SERVICES AND DISTRICT/SCHOOL NEED:

Click here to enter text.

Please include:i.Written statement from employee who made unauthorized purchase explaining why appropriate purchasing policies/procedures was not followed.

ii. Information on thecorrective action taken to prevent recurrence.

iii.Copy of the proper invoice from the vendor.

iv.Other attachments as may be applicable.

SUBMITTED BY ADMINISTRATOR/PRINCIPAL:

SignatureDate

REVIEWED BY DISTRICT PURCHASING AGENT:

SignatureDate

APPROVED:NOT APPROVED:

DIRECTOR OF PURCHASINGDateDIRECTOR OF PURCHASINGDate

1 Revised 12/20/16