Spreadsheet: 14b338bf-4e4b-4fe3-b579-7df7ff7bb545
Sheet: Sheet1

STATE PROCUREMENT OFFICE REPORT OF PROCUREMENT VIOLATION:          FINDINGS AND CORRECTIVE ACTIONS AND/OR      REQUEST FOR AFTER-THE-FACT PAYMENT APPROVAL | Unnamed: 1 | Unnamed: 2 | Unnamed: 3 | Unnamed: 4 | Unnamed: 5 | Unnamed: 6 | Unnamed: 7 | Unnamed: 8 | Unnamed: 9 | Unnamed: 10 | Unnamed: 11
TO: | Chief Procurement Officer
FROM:
 | Name of Requesting Department
REPORT OF FINDINGS AND CORRECTIVE ACTIONS for a procurement violation.
1.  Briefly describe the goods, services or construction procured.
;;
2.  Check applicable  procurement process used.
3.  [NAME] what occurred by providing facts that resulted in the violation.
4.  Explain what corrective action has been taken and what procedures have been implemented to prevent this violation from recurring.  Attach documentation to substantiate what corrective action has been taken and procedures that have been implemented to prevent this violation from recurring, i.e. minutes, procedures, written reprimand, etc.
5.  Provide name(s) of department personnel conducting/participating in the procurement and whether individuals complied with the written procurement delegation authority and mandatory training requirements.         (Please type in over example and delete cells not used.)
Department Personnel Name | Division/Agency | Specify involvement in this procurement. | Does individual have appropriate written delegated authority and attended the appropriate mandatory training? |  |  |  |  |  |  | If no, explain why individual was allowed to conduct/participate in procurement activities in #3.  (Yes of No)
Ex: Jane Doe | HTDC | Drafted specifications | Yes
Ex. [NAME] | HPHA | Prepared Contract | Yes
Ex: [NAME] | HPHA | Prepared contract | Yes
Ex:  [NAME] | PWD | Responsible for all postings | Yes
Ex: [NAME] | WDD | Prepared scope of work | Yes
Ex: [NAME] | DOH | Contract resolution | Yes
6.  Which individual from the list provided in No. 5 may SPO contact for follow up inquiry, if any?  This individual should be knowledgeable of the procurement and the violation and informed that they have been designated as the contact person.  If this person is not listed in No. 4, what is their involvement in the procurement?
Department Personnel Name and Their Involvement in the Procurement (If not explained in No. 5) |  |  | Phone Number |  |  |  |  | e-mail Address | e-mail
PART II - REQUEST FOR AFTER-THE-FACT PAYMENT APPROVAL, AS APPLICABLE.
7. |  |  |  |  |  |  |  |  |  | for
 |  | Vendor/Contractor/Service Provider |  |  |  |  |  |  |  |  | $ (dollar amount)
I certify that the information provided above is to the best of my knowledge, true and correct.
 | Department Head Signature |  |  |  |  |  |  |  |  | Date
For Chief Procurement Officer Use Only
Chief Procurement Officer (CPO) Comments:
Approved | Disapproved | No Action Required
 |  | ______________________________________________________________________
 |  | Chief Procurement Officer Signature |  |  |  |  |  |  |  | Date
For Chief Financial Officer Use Only
Chief Financial Officer (CFO) Comments:
* Approved | * Disapproved
 |  | Chief Financial Officer Signature |  |  |  |  |  |  |  | Date