Spreadsheet: 181d607b-e0ba-4f51-8850-7c7a664b1a5c
Sheet: Sheet1

Unnamed: 0 | Unnamed: 1 | Unnamed: 2 | Unnamed: 3 | Unnamed: 4 | Unnamed: 5 | Unnamed: 6 | Unnamed: 7 | Unnamed: 8 | Unnamed: 9 | Unnamed: 10 | Unnamed: 11 | Unnamed: 12 | Unnamed: 13 | Unnamed: 14 | Unnamed: 15 | Unnamed: 16 | Requisition Date | Unnamed: 18 | Unnamed: 19
 |  |  |  |  |  |  | PURCHASE REQUISITION
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Requisition No.
 |  |  |  | (Highlighted / Shaded areas  indicate required fields)
SHIP TO: |  |  |  |  |  | [NAME] (if different from "ATTN"): |  |  |  |  |  |  |  |  |  |  | Purchase Order No.
ATTN:
DEPT: |  |  |  |  |  |  |  |  |  |  |  | ADDITIONAL NOTES
BLDG/Rm #: |  |  |  |  |  | Need By Date: |  | Phone:
Project |  | Task | Award | Expenditure Type |  |  | Organization
 |  |  |  |  |  |  | 190
Vendor Name & Address |  |  |  | Alternate Vendors (if known): |  |  |  |  |  |  |  |  |  |  | IDENTIFY IF APPLICABLE
 |  |  |  | 2nd Vendor Name & Address |  |  |  |  |  |  | 3rd Vendor Name & Address
Name |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Radioactive Material
Address |  |  |  | Name |  |  |  |  | Name |  |  |  |  |  |  |  | (with Radiation Office Approval)
City, State, Zip |  |  |  | Address |  |  |  |  | Address
Contact Person |  |  |  | City, State, Zip |  |  |  |  | City, State, Zip |  |  |  |  |  |  |  | Chemical Requisition Form
Phone |  |  |  | Contact Person |  |  |  |  | Contact Person |  |  |  |  |  |  |  | (attached)
Fax |  |  |  | Phone |  |  |  |  | Phone
Federal ID # |  |  |  | Fax |  |  |  |  | Fax
SS # |  |  |  | Federal ID # |  |  |  |  | Federal ID #
Catalog # |  | Description |  |  |  |  |  |  |  |  |  |  | Quantity | UOM | Unit Price |  |  |  | Unit Total
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
 |  | Shipping Charges |  |  |  | Estimate |  |  |  | Actual |  |  | 1 | Lot |  |  |  |  | 0
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | TOTAL ORDER |  |  | 0
As Project Director, I certify that the items requested herein are allowable,
allocable, reasonable, and necessary for the grant.  I have listed optional
suppliers (if known) or have provided a sole or single source justification
(if applicable).
X
Project Director Signature (above) |  |  |  | Date |  |  | Additional Approval |  |  |  | Date |  | RF Authorized Signature |  |  |  |  |  | Date
Quote Information |  |  |  | OMB Circular A-110 |  |  |  |  |  | Purchasing Use Only |  |  |  |  |  | Internal Use Only
Quote #: |  |  |  | Expenditures of $10,000 or more involve a |  |  |  |  |  |  | Sole Source: |  |  |  |  |  | Women Owned Business
Phone Quote By: |  |  |  | bidding process as outlined in OMB Circular |  |  |  |  |  |  | Single Source: |  |  |  |  |  | Minority Owned Business
Written Quote By: |  |  |  | A-110. |  |  |  |  |  |  | Delivery Date Confirmed: |  |  |  |  |  | Small Business
Date: |  |  |  |  |  |  |  |  |  |  | NYS Contract #: