Business Equipment Justification Form

Business Equipment Justification Form

Requestor Name:    Department:

Company/Entity:    Date of Request:

WHEREAS

WHEREAS, the Requestor represents that the equipment described in this form is necessary for the performance of duties within the Requestor's Department and will materially support the operational objectives and productivity of the Company; and

WHEREAS, the Company requires a written justification and procurement authorization prior to purchase or lease commitments exceeding the applicable procurement threshold; and

WHEREAS, by completing and submitting this form the Requestor certifies the accuracy of the information provided and acknowledges that funds will be encumbered in accordance with approved budget and procurement policies upon authorization by the Authorizing Party.

Scope of Work / Equipment Description

Payment Terms

Purchase Amount (Total): $

One-time purchase    Lease / Finance    Installments

Late Payment Fee / Interest:    Account / Budget Code:

Term and Termination

Agreement Start Date:    Agreement End Date (if applicable):

Notice Period for Termination (days):

Confidentiality

The Requestor and the Authorizing Party acknowledge that certain information exchanged in connection with procurement, configuration, and support of the equipment may constitute Confidential Information. "Confidential Information" includes non-public technical, commercial, financial, and personnel information disclosed in written, electronic, or oral form.

Each party shall: (a) hold Confidential Information in strict confidence; (b) use Confidential Information solely to evaluate and execute the procurement and performance obligations; and (c) restrict disclosure to employees, contractors, or agents with a need to know and who are bound by confidentiality obligations at least as protective as those herein. Confidentiality obligations do not apply to information that: (i) is or becomes publicly known other than by breach; (ii) was already rightfully known by the receiving party; (iii) is independently developed; or (iv) is required to be disclosed by law, provided the disclosing party is given prompt notice to seek protective measures.

Remedies for breach of confidentiality include equitable relief, injunctive relief, and recovery of actual damages and reasonable attorneys' fees. The confidentiality obligations survive termination of any procurement authorization for a period of three (3) years, or for such longer period as required by applicable law.

Representations, Certifications and Compliance

The Requestor certifies that the information provided on this form is true and accurate to the best of their knowledge, that funds are available or will be requested through the appropriate budget process, and that the procurement conforms to Company procurement policies and any applicable law. Any false statements or material omissions may subject the Requestor to disciplinary action and financial liability.

Governing Law

This form and any resulting procurement authorization shall be governed by and construed in accordance with the laws of the state in which the Company maintains its principal place of business, without regard to conflict of law principles.

Entire Agreement

This document, together with any vendor quotes, attachments, and authorized purchase orders, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior negotiations, representations, and agreements, whether written or oral. Any amendment must be in writing and signed by an authorized representative of the Authorizing Party.

Approvals and Administrative Use

Manager Approval (printed name):

Manager Approval (date):

Finance Review (initials):    Finance Comments:

Procurement Recommendation:

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