SEDRO-WOOLLEY SCHOOL DISTRICT Request for Issuance of Procurement Cards PURCHASE CARD (Please return this form to: Business Office)

Transcription

1 Request for Issuance of Procurement Cards PURCHASE CARD (Please return this form to: Business Office) 6212F-1 Number of Cards Requested: Cardholder's Name (one application per Cardholder): Card Custodian's Name (may be same as Cardholder) Business Office Use Only Number Accounting Fund GL # Program/ Activity Object Location Responsibility of Cards Name Sub-Program Signed: Building/Department Administrator Approved: Fiscal Coordinator Date: Date:

2 6212F-2 Sedro-Woolley School District Cardholder/Card Custodian Authorization Form Cardholder 1. I understand as the Cardholder I am responsible for all transactions on the procurement cards assigned to me. 2. There are occasions where the Card Custodian can and will make purchases using the procurement card on my behalf. 3. By signing this form I give permission to the card custodian, listed below, the authority to make purchases on behalf of my building or department. 4. There are occasions where cards assigned to me may be checked out to others in my department/school who have signed the Procurement Card User Agreement. 5. I understand that all transactions will be reviewed for approval by me after the fact on a weekly basis. 6. I authorize transactions up to the following dollar limit. 7. I acknowledge that I have signed and understand the Procurement Card User Agreement. Cardholder Name (printed) Cardholder Signature and Date Card Custodian 1. I recognize that as the Card Custodian I have been given authority to purchase items on behalf of my building or department. 2. As a part of my duties I will make sure that the building or department has budget capacity before making the purchase. 3. I will not purchase more per transaction than I am authorized to do so listed above. 4. I acknowledge that I have signed and understand the Procurement Card User Agreements Card Custodian Name (printed) Card Custodian Signature and Date Administrator Name (printed) Administrator Signature and Date

3 SEDRO-WOOLLEY SCHOOL DICTRICT 801 Trail Rd Sedro-Woolley, Washington 6212F-3 NOTE: PROCUREMENT CARD WILL NOT BE ISSUED UNTIL THIS AGREEMENT IS COMPLETED. SEDRO-WOOLLEY SCHOOL DISTRICT Procurement Card User Agreement I,, hereby acknowledge receipt of a Sedro-Woolley School District Procurement Card number. As a cardholder or card user, I agree to comply with the terms and conditions of this Agreement and the applicable provisions of the Procurement Card Policies and Procedures ( Policies ) provided (and as it may subsequently be revised). I acknowledge receipt of the Policies and confirm that I have read and understand its terms and conditions. I understand that the Sedro-Woolley School District is liable to the banking institution for all charges made by me. As the holder of this Procurement Card, I agree to accept responsibility for the protection and proper use of this card and to keep proper documentation for all purchases as outlined in this Agreement and the Policies. I understand that the Sedro-Woolley School District will audit the use of the Procurement Card. As a card user I further understand that improper use of this Procurement Card may result in disciplinary action up to and including TERMINATION OF EMPLOYMENT. Should I fail to use the Procurement Card properly, I authorize the Sedro-Woolley School District to deduct from my wages or from any other amounts payable to me, an amount equal to the total of the improper purchases. I also agree to take any steps necessary to permit the Sedro-Woolley School District to collect any amounts owed by me even if I am no longer employed by the Sedro-Woolley School District. If the Sedro-Woolley School District initiates legal proceedings to recover amounts owed by me under this Agreement, I agree to pay legal fees incurred by the Sedro-Woolley School District in such proceedings. I understand that the Sedro-Woolley School District may terminate my right to use this Procurement Card at any time for any reason. I agree to return the Procurement Card to the Sedro-Woolley School District immediately upon request or upon termination of employment. APPLICANT: Signature: _ Print Name: Date: Department: Updated: November 2010

4 6212F-4 Procurement Cards - Controls Assessment Building/Department: Number of Cards: As the Administrator and Card Custodian in charge of the procurement cards, Administrator Card you are aware that: Initials Custodian Initials All administrators,cardholders and procurement card users must review and sign a "Procurement Card User Agreement" form. A copy of the procedures will be provided to all cardholders and procurement card users. All Procurement cards at your building location must be signed. Procurement cards must be kept in a secure or locked location. If there are multiple users, a sign out log must be maintained. Original receipts are to be turned in to the cardholder or card custodian after each purchase. Original receipts must be used for reconciliation. The receipts are to be reviewed for appropriateness and approved by the cardholder on a weekly basis. Monthly budget status reports from the business office are to be matched to the procurement card transaction reports. Original records are retained at the building or department location for six (6) years in an orderly manner. In the seventh year records must be shredded for disposal. Cardholder, Card Custodian, and/or Card User must notify the Bank and the Business Office immediately if: (1) a card is lost, (2) an assigned employee is transferred or leaves, or (3) a card is misused. I, have received and take responsibility for Procurement Cards. The Procurement Cards in my possession have been signed. Cardholder's Name (Print) CardCustodian's Name (Print) Fiscal Coordinator (Print) Cardholder's Signature CardCustodian's Signature Fiscal Coordinator Signature Date Date Date

5 6212F-5 PROCUREMENT CARD SIGN OUT SHEET SCHOOL/DEPARTMENT Check-out Est./Actual Card # Account Code User's Signature Date Vendor's Name Purchase Receipt Return Card Custodian's Amt. Yes/No* Date Initials *If no receipts are turned in when the procurement card is returned, MAKE SURE THAT YOU FOLLOW-UP WITH USERS TO OBTAIN ORIGINAL RECEIPTS.