BOR SRC Intake Form FillableProcurement Request
SRC Date:
Department Information:
Department:
Contract Manager:
The Contract Manager is responsible for monitoring, compliance, and
enforcing the contract terms and budget. The Contract Manager shall help
ensure the contract and its administation meet the goals of the department
in a fiscally and ethically responsible manner. Changes to the Contract
Manager must be communicated immediately to Purchasing.
Contract Manager Signature:
Ext: Email:
Type of Purchase:
☐New
☐ Renewal ☐ Existing Contract #:
☐ Equipment ☐ Capital Improvement ☐ Commodity
☐ Service ☐ Technology
☐ Professional Services ☐ Other:
Contract Term: One‐Time Buy? Public Works?
☐ Yes ☐ No ☐ Yes ☐ No
Type of Solicitation:
☐ RFP ☐ RFQ ☐ IFB ☐ IFB‐BV ☐ Co‐op
☐Sole Source (Attach Justification Form)
Solicitation Name:
Description/Caption:
Other Department(s) to be Notified (example: Software
requires IT approval, if software includes cash, check or card at point
of sale, also notify Finance; other departments that purchase the
same item):
Timeline:
Desired Council Agenda Date:
(min. 90 days from request date)
Advertising Period:
Commodity/Service = 14 Day Minimum, Construction = 30 Day Minimum
PUB Approval Required? ☐ Yes ☐ No
Other Committee Approval Required? ☐ Yes ☐ No
Committee Name:
Financial:
Estimated Contract Value:
Funding Source:
Funding Account:
Home Business Unit for Contract Tracking: _______________
Advertising Account:
NIGP Code:
Grant Funds Being Used? ☐ Yes ☐ No
If yes, grant name:
Attachments:
☐ Pricing Sheet ☐ Plans ☐ Sole source Justification
☐ Technical Specifications ☐ Technical Drawings
☐ Supplier/Contractor E‐mail Addresses ☐ Co‐op Quote
☐ Scope of Work
Evaluation Requirements for RFP or RFQ only:
☐ Pre‐Submittal Conference ☐ Interview Top Firms
☐ Product Literature ☐ Equipment Schedule
☐ Safety Record
Evaluation Criteria (Standard Shown):
Criteria RFP
Standard %
RFQ
Standard %
Proposed %
Project
Schedule
10‐20% 20‐30%
Specifications
20‐30% 20‐40%
Price
30‐50%
Probable
Performance
10‐20% 30‐40%
Other:
20‐30%
Evaluation Criteria must total 100%
Proposed Evaluation Team (3 or 5 members):
Please provide additional information regarding the procurement. Information provided should/will be
used on future Agenda Information Sheets and as justification to Council:
Background/Prior Action:
'ŽǀĞƌŶŵĞŶƚĂů&ƵŶĐƚŝŽŶŽĨŽŶƚƌĂĐƚ͗
Explanation of Sustainable Purchase or Sustainable Evaluation Criteria:
Alternative Options Considered: