FORM 17 DIVISION OF RAIL AND MASS TRANSPORTATION FEDERAL PROCUREMENT MANAGEMENT BRANCH PROCUREMENT VEHICLE REVIEW FORM PROGRAM COMPLETES SECTIONS 1 THROUGH 3 1. SUBRECIPIENT CONTACT INFORMATION subrecipient : contact name: email: mailing ext: address: city: state: zip code: caltrans district: county: 2. GENERAL PROJECT INFORMATION date program received review date review form submitted to request from subrecipient: procurement branch: program liaison: grant program: total grant award: $ project amount: $ sa: project description: Program Requirement. Program determines a project is ITS when the equipment has the capability of transmitting data, includes most smart fare boxes. : its compliance form completed on file: Yes No Yes No & 3. SPECIFIC PROJECT INFORMATION type of bid: MV-1 Ford LF GM LF vehicle Small Medium Large Minivan Larger Largest Trolley Other* type: Class A Class B Class C Class D Class E Class H Class T Class F Class G Class M *for describe vehicle: “other” For complete details of piggybacking procedures and required documentation please see the on the Procurement webpage. piggyback procurement subrecipient conducted procurement joint procurement /mbta procurement purchasing prerequisite to buy--approval of worksheet attached: originating agency’s vehicle prerequisite to buy--approval of solicitation process by drmt: originating agency’s vehicle calact letter “assignment” solicitation process by drmt: completed caltrans piggybacking attached: worksheet attached: assignment letter from originating pre-award certifications pre-award certifications agency attached: attached: attached: pre-award certifications attached: price comparison and price comparison and selection selection justification price comparison and selection justification attached if (required attached if more justification attached if (required (required more than one manufacturer than one manufacturer more than one manufacturer provides vehicle type): provides vehicle type): provides vehicle type): signed draft vehicle quote floor signed draft vehicle quote signed draft vehicle quote & & & plan attached: floor plan attached: floor plan attached: procurement completes section 4 4. PROCUREMENT REVIEW log entry: initial review date:
FORM 17 DIVISION OF RAIL AND MASS TRANSPORTATION FEDERAL PROCUREMENT MANAGEMENT BRANCH PROCUREMENT VEHICLE REVIEW FORM PROGRAM COMPLETES SECTIONS 1 THROUGH 3 1. SUBRECIPIENT CONTACT INFORMATION subrecipient : contact name: email: mailing address: ext: city: state: zip code: caltrans district: county: 2. GENERAL PROJECT INFORMATION date program received review request from subrecipient: date review form submitted to procurement branch: program liaison: grant program: total grant award: $ project amount: $ sa: project description: Program Requirement. Program determines a project is ITS when the equipment has the capability of transmitting data, includes most smart fare boxes. : Yes No its compliance form completed & on file: Yes No 3. SPECIFIC PROJECT INFORMATION type of bid: vehicle type: Small Class A Medium Class B Large Class C Minivan Class D Larger Class E Ford LF Class F GM LF Class G Largest Class H MV-1 Class M Trolley Class T Other* *for “other” describe vehicle: For complete details of piggybacking procedures and required documentation please see the on the Procurement webpage. piggyback procurement subrecipient conducted procurement /mbta joint procurement prerequisite to buy--approval of originating agency’s vehicle solicitation process by drmt: prerequisite to buy--approval of originating agency’s vehicle solicitation process by drmt: procurement purchasing worksheet attached: calact “assignment” letter attached: completed caltrans piggybacking worksheet attached: assignment letter from originating agency attached: pre-award certifications attached: pre-award certifications attached: pre-award certifications attached: price comparison and selection justification attached (required if more than one manufacturer provides vehicle type): price comparison and selection justification attached (required if more than one manufacturer provides vehicle type): price comparison and selection justification attached (required if more than one manufacturer provides vehicle type): signed draft vehicle quote & floor plan attached: signed draft vehicle quote & floor plan attached: signed draft vehicle quote & floor plan attached: procurement completes section 4 4. PROCUREMENT REVIEW log entry: initial review date:
2016_procurement_review.docx