NAVCONBRIG CHARLESTON/CHESAPEAKE GOVERNMENT AND COMMERCIAL PURCHASE CARD PROGRAM

PURCHASE REQUEST WORKSHEET (PRW)

DEPT: DOCUMENT #: JON:
RPPO INFO SOURCE OF SUPPLY
RPPO SIGNATURE: VENDOR NAME:
PRINT NAME:
ADDRESS:
EXT:
DATE SUBMITTED PHONE:
DEPT HEAD APPROVAL POC:
SIGNATURE: EMAIL:
PRINT NAME: WEB ADDRESS:
SCREENING PROCESS
HAZMAT SIGNATURE: HAZMAT ITEM: YES NO

SUPPO SIGNATURE: IF YES, PROVIDE AUL#/SFR:

IT SIGNATURE: IT/ADP ITEM: YES NO

IF YES, ATTACH ITPR AUTHORIZATION
SAFETY SIGNATURE: ELECTRICAL TOOL: YES NO

PROVIDE DETAIL JUSTIFICATION TO SUPPORT THE PURCHASE:

FA BESA CAC BRC RON RBC FC

MILSTRIP
MANDATORY SOURCES
YES FUNDS REVIEWED YES
SCREENING
REQUIREMENT HAS OBLIGATED PROHIBITED
NOT BEEN SPLIT ITEM LIST
NO NO JWOD/NIB/NISH

APC NAME: LT D. FINNERAN UNICOR/FPI

THREE-WAY SEPARATION OF FUNCTION

CARDHOLDER NAME: CARDHOLDER SIGNATURE: DATE:

APPROVING OFFICIAL ** ( TYPE / PRINT NAME ): LSCS W. JARAMILLO APPROVING OFFICIAL SIGNATURE : DATE:

RECEIVING AGENT ( TYPE / PRINT NAME ): RECEIVING AGENT SIGNATURE: DATE:

MINOR PROP TAG# DATE:

MINOR PROPERTY/PILFERABLE ITEMS
RECORDER NAME

MANDATORY SOURCES
A print out must be included with this request to ensure mandatory sources were solicited

ALL ITEMS FOLLOW THIS PRIORITY

1.- JWOD/ABILITY ONE http://www.abilityone.gov
2.- LCI/SERVMART 757-451-8030
3.- UNICOR http://www.unicor.gov (Furniture only)

ALTERNATE SOURCES
4.- FED MALL https://www.fedmall.mil
5.- GSA https://www.gsaadvantage.gov
GSA CONTRACT#_______________________