Office of Homeland Security and Justice Programs

FRANKLIN COUNTY

OFFICE OF HOMELAND SECURITY AND JUSTICE PROGRAMS

PROCUREMENT PROCESS VERIFICATION FORM

Jurisdiction/Agency: ______

Grant Application Number: ______

By signing the form below, it is affirmed that the procurement procedure has been completed for the equipment listed below in accordance with local statutes and regulations regarding standard procurement processes. The authorized official of the above jurisdiction/agency has approved this purchase procedure. Please attach a copy of the final quote to be referenced in the opening of a purchase order by the Franklin County Office of Homeland Security & Justice (OHS&JP) Programs.

Once signed, please submit to the Franklin County Office of Homeland Security & Justice Programs. Your agency is NOT authorized to order equipment until notification has been given and a purchase order provided by the OHS&JP. Once the approval has been provided, it is the responsibility of your agency to order equipment. Please notify all potential vendors that payment for products and/or services purchased with Homeland Security grant funds can take up to 90 days.

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Authorized Official (Please Print Name) Title

______

Signature of Authorized Official Date

Equipment to be purchased

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Quantity

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Cost

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Total Cost:

373 South High Street, 25th Floor Columbus, Ohio 43215-6314

Tel: 614-525-5577 Fax: 614-525-5549 www.FranklinCountyOhio.gov