Quotation Evaluation Report

University of Vermont Procurement Services
Quotation Evaluation Form

This form must be completed for all purchases greater than $25,000, but less than $50,000. A minimum of three quotes should be obtained and attached to this form. If this purchase is determined by your department to be a Sole or Single Source, please complete a Single/Sole Source Justification Form instead. This form can be found on the Procurement Services website.

Req ID#

Prepared by:   Department:   Phone:

Purchase Description:

Required Delivery Date:

Company 1.)   2.)   3.)

Total Price $   $   $

After evaluating all of the above, please make your supplier recommendation below. If the decision is based on anything other than price, please describe the reasoning and value for the selection.

Recommended Supplier:

Basis for Recommendation:

The information provided above is accurate and represents a fair and impartial evaluation of quotations received.

Please scan and attach to your requisition in PeopleSoft or fax to 656-8684 referencing your requisition ID#.

Procurement Services Review:   Date:

Vendor Information Forms

W-9 Information

Federal law requires that we have on file a W-9 form with the Employer ID number or Social Security number and signature for each person to whom the University makes payment. Please complete this form and fax it to the Procurement office at (802) 656-8684.

We require either the individual’s name/Social Security number or the company’s name/Federal Employer ID number, as they appear on your income tax return.

PLEASE PRINT LEGIBLY

Company Name:

DBA Name:

Federal EIN or Social Security #:

Address to send QUOTE:

Address to send PURCHASE ORDER:

Address to send INVOICE PAYMENTS:

PO Box:   Street Address:

City:   State, Zip:

Website:

Name:   Phone Number:   E-mail address:

Contact Person for ORDERS:

Contact Person for BILLING:

Does your company accept MasterCard? (Please circle) YES NO

What are your standard invoicing terms? Net days / Discount percent % / Discount Days Other

Business Description: (Please circle) CORPORATION NOT-FOR-PROFIT PARTNERSHIP SOLE PROPRIETORSHIP

Business Classification: (Please circle) LARGE SMALL

If Small Business, please circle if 51% or more of your company is owned by: WOMEN MINORITY DISADVANTAGED

Certification: Under penalties of perjury, I certify that: (1) The number shown above is my correct taxpayer identification number; (2) I am not subject to backup withholding because: (a) I am exempt from backup withholding or (b) I have not been notified by the IRS that I am subject to backup withholding and (3) I am a U.S. person (including a U.S. resident alien).

FEDERAL LAW REQUIRES THAT YOU PROVIDE US WITH AN ACCURATE REPLY

ACH Vendor Payment Enrollment Form

This form is used for Automated Clearing House (ACH) vendor payments. Please provide us with the information below to accept the Automated Clearing House (ACH) electronic funds transfer.

Bank Name:

Bank Address:

Routing Number:

Account Name:

Account Number:

Check One: Checking Account Savings Account

Name:   Phone Number:   E-mail address:

Contact Person for Bank:

Contact Person for ACH:

Contact Person for Receivables:

I authorize the University of Vermont’s Procurement Services to electronically transfer my vendor payment via ACH to the financial institution designated above. I certify that the ACH payment is being made to a domestic financial institution and will not be transferred in its entirety to a foreign institution as part of a back to back transaction.

OFAC Compliance Form for Vendor Payments

As a US entity, the University of Vermont is obligated to comply with the requirements of the United States Department of Treasury Office of Foreign Assets Control (OFAC), which oversees payments sent outside the territorial jurisdiction of the United States. This includes automated clearing house (ACH) payments, such as electronic vendor payments. Effective with NACHA rules that were implemented September 18, 2009, the University is obligated to identify as an “International ACH Transaction” (IAT) any electronic vendor payment that is (1) made by the University to a financial institution located outside the U.S., or (2) made by the University to a domestic financial institution if that financial institution immediately transfers the full electronic payment amount to a financial institution outside of the U.S. in a “back-to-back” transaction.

If you elect to receive your payment from the University via an ACH transaction and think you are affected by these IAT requirements, please fill out the information requested below. You will be contacted regarding an alternative method of payment.

Yes, I do electronically transfer all of the funds received via electronic payment to another financial institution outside the U.S. in a “back-to-back” transaction.

ACH Vendor Payment Enrollment Form