+---------------------------------------+------------------------------+
| **PURCHASE CARD/CONVENIENCE CHECK -   |                              |
| CHECK LIST**                          |                              |
|                                       |                              |
| **Purchase Card File Documentation**  |                              |
+=======================================+==============================+
| **Vendor Name:**                      | **Dollar Amount: \$          |
| \_\_\_\_\_\_\_\_\                     | \_\_                         |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ | \_\_\_\_\_\_\_\_\_\_\_\_\_** |
|                                       |                              |
| \_\_\_\_                              |                              |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |                              |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |                              |
+---------------------------------------+------------------------------+

+-----------------------------------------------------+-----+----+----+
| **PURCHASE CARD/CONVENIENCE CHECK ACTIONS**         |     |    |    |
+-----------------------------------------------------+-----+----+----+
| 1\. Type of Purchase: (Circle response)             |     |    |    |
|                                                     |     |    |    |
| Purchase Card Convenience Check                     |     |    |    |
+-----------------------------------------------------+-----+----+----+
| 2\. File documentation: (Circle response)           |     |    |    |
|                                                     |     |    |    |
| AD-700 Receipts                                     |     |    |    |
|                                                     |     |    |    |
| AD-287-2 Quotes                                     |     |    |    |
|                                                     |     |    |    |
| SF-1164 Packing Slips                               |     |    |    |
|                                                     |     |    |    |
| SF-182 Convenience Check Waiver No.                 |     |    |    |
|                                                     |     |    |    |
| AD-343                                              |     |    |    |
+-----------------------------------------------------+-----+----+----+
| 3\. Types of Purchase: (Circle Response)            |     |    |    |
|                                                     |     |    |    |
| Supply Local Travel                                 |     |    |    |
|                                                     |     |    |    |
| Service Tuition & Books                             |     |    |    |
|                                                     |     |    |    |
| Spot Cash Award Emergency Salary                    |     |    |    |
+-----------------------------------------------------+-----+----+----+
|                                                     | *   | ** | *  |
|                                                     | *YE | NO | *N |
|                                                     | S** | ** | /A |
|                                                     |     |    | ** |
+-----------------------------------------------------+-----+----+----+
| 4\. Required Source                                 |     |    |    |
+-----------------------------------------------------+-----+----+----+
| 5\. Repetitive Buy                                  |     |    |    |
+-----------------------------------------------------+-----+----+----+
| 6\. Notation of Goods or Services Received          |     |    |    |
+-----------------------------------------------------+-----+----+----+
| 7\. Reconciliation Timely in PCMS                   |     |    |    |
+-----------------------------------------------------+-----+----+----+
| 8\. Prohibited Source                               |     |    |    |
+-----------------------------------------------------+-----+----+----+
| 9\. Transaction over Single Purchase Limit          |     |    |    |
+-----------------------------------------------------+-----+----+----+

April 23, 2002

**PURCHASE CARD/CONVENIENCE CHECK**

**CARDHOLDER INTERVIEW**

**Cardholder's Name: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Single Purchase Limit: \_\_\_\_\_\_\_\_**\_\_\_\_

**Monthly Limit: \_\_\_\_\_\_\_\_\_\_\_\_**

+------------------------------------------------------+----+----+----+
| **PURCHASE CARD/CONVENIENCE CHECK - CHECKLIST**      | *  | ** | *  |
|                                                      | *Y | NO | *N |
|                                                      | ES | ** | /A |
|                                                      | ** |    | ** |
+------------------------------------------------------+----+----+----+
| 1\. Cardholder: (Circle response)                    |    |    |    |
|                                                      |    |    |    |
| Procurement Check writer                             |    |    |    |
|                                                      |    |    |    |
| Non-procurement                                      |    |    |    |
+------------------------------------------------------+----+----+----+
| 2\. Training Received:                               |    |    |    |
|                                                      |    |    |    |
| PCMS/Micro-Purchase Guide                            |    |    |    |
|                                                      |    |    |    |
| Purchase Card Tutorial                               |    |    |    |
|                                                      |    |    |    |
| Video                                                |    |    |    |
|                                                      |    |    |    |
| PCMS                                                 |    |    |    |
+------------------------------------------------------+----+----+----+
| 3\. Purchase Card Log Available                      |    |    |    |
+------------------------------------------------------+----+----+----+
| 4\. Reference Tools Available:                       |    |    |    |
|                                                      |    |    |    |
| DR 5013-6                                            |    |    |    |
|                                                      |    |    |    |
| REE Manual 213.3M                                    |    |    |    |
|                                                      |    |    |    |
| Cardholder PCMS Quick Guides                         |    |    |    |
+------------------------------------------------------+----+----+----+
| 5\. LAPC Oversight                                   |    |    |    |
+------------------------------------------------------+----+----+----+
| 6\. Purchase Card Secure                             |    |    |    |
+------------------------------------------------------+----+----+----+

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  Comments:

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April 23, 2002