Note: This application form must be submitted, with all required substantiating documentation, at least 21 days before awarding the contract for such equipment. 1. a) Name of Agency: b) Address of Agency: c) Agency Contact: Phone: Email address: Fax: d) Agency Address and Contact Person (if different from above) e) Reviewed by Purchasing Office (signature): f) Submitted by (signature): 2. a) Equipment Description b) Proposed Location of Equipment: c) Equipment Vendor Name, Address: Equipment Vendor FEID No. d) Financing vendor name, address: Name: Banc of America Public Capital Corp. 555 California Street, 4th Floor Address: San Francisco, CA 94104 Financing Vendor FEID No. 48-1173664 3. Attach written justification based on public purpose served by acquisition, need, size of purchase, and financial benefit to the State for deferred payment purchase. Attach documentation supporting recurring funds requirement in Sections 287.063(5) and 287.064 (11) (i.e. Budget Officer letter) 4. FLAIR Account from which payments will be made: - - - - - - - 5. Vendor Selection Method State Term Contract # - – Other Selection Method * * Attach bid tabulation sheet or other appropriate document. 6. Were funds specifically appropriated to purchase or replace existing equipment with this equipment? No Yes Appropriation line item number Appropriation amount for current FY $ 7. If acquisition is for Information Technology Resources that have a purchase price more than threshold amount for Cat. THREE in §287.017, F.S., attach Chief Information Officer or Delegee Approval if required by your agency or university.
Note: This application form must be submitted, with all required substantiating documentation, at least 21 days before awarding the contract for such equipment. 1. a) Name of Agency: b) Address of Agency: c) Agency Contact: Phone: Email address: Fax: d) Agency Address and Contact Person (if different from above) e) Reviewed by Purchasing Office (signature): f) Submitted by (signature): 2. a) Equipment Description b) Proposed Location of Equipment: c) Equipment Vendor Name, Address: Equipment Vendor FEID No. d) Financing vendor name, address: Name: Banc of America Public Capital Corp. Address: 555 California Street, 4th Floor San Francisco, CA 94104 Financing Vendor FEID No. 48-1173664 3. Attach written justification based on public purpose served by acquisition, need, size of purchase, and financial benefit to the State for deferred payment purchase. Attach documentation supporting recurring funds requirement in Sections 287.063(5) and 287.064 (11) (i.e. Budget Officer letter) 4. FLAIR Account from which payments will be made: - - - - - - - 5. Vendor Selection Method – State Term Contract # - Other Selection Method * * Attach bid tabulation sheet or other appropriate document. 6. Were funds specifically appropriated to purchase or replace existing equipment with this equipment? No Yes Appropriation line item number Appropriation amount for current FY $ 7. If acquisition is for Information Technology Resources that have a purchase price more than threshold amount for Cat. THREE in §287.017, F.S., attach Chief Information Officer or Delegee Approval if required by your agency or university.
2cefpapplication.docx