OHCS

Vehicle Purchase Request Form

 

If purchasing more than one vehicle, a separate form submission is required for each vehicle. No vehicle purchases may be made without prior approval from OHCS.


Guidelines for purchases are contained in 2 CFR Part 200, for vehicles purchased under OHCS Contracts.


You must include copies of "request for bids" used by the agency and copies of responses to bids in the Document Upload section at the end of this form.

 
 
 
 
Phone
 

Information of Vehicle Being Purchased

 
 
 
 
 
 
 

(Title of the vehicle must held by the organization who contracts directly with OHCS - subrecipients are not allowed to hold title. OHCS must NOT be named title holder.)

 
 

Please detail where the vehicle will be located when not in use. (provide physical address/location)

 
 
 
 
 
 
 

This is the quote/bid price you have selected, less any adjustments

 

Enter any adjustement to the quote/bid price you selected

 

This is the price you are requesting for approval. This total should equal the amount in the above two questions.

 

Quotes/Bids

All purchase requests must include copy of the bid solicitation, non-collusive bidding forms signed by the bidder and the actual bid documents. If a vehicle is being traded in, the trade-in value must be clearly indicated on the bid documents.

 
 
 
 
 

Enter the total quote/bid price from Quote #1

 

Enter the total quote/bid price from Quote #2

 

Enter the total quote/bid price from Quote #3

 

Please provide what grant source(s) and amounts will be utilized for the purchase of this vehicle

 
 

List the name of the other OHCS grant used for this purchase

 
 
 

I hereby certify that the above information is true and correct. By signing, I certify that Federal Procurement guidelines (2CFR 200 and either 2 CFR 255 or 2 CFR 230, as applicable) have been followed.

 
 
 
mm/dd/yyyy
 

Please upload the following documents:

  • Request for Bids
  • Responses to Bids
  • Lease Purchase Analysis
  • All documentation you wish to be considered for this purchase request
Drop your files here
 

SUBMISSIONS AFTER APPROVAL

a. Provide the following items to OHCS (depending on funding source)

(1) For Homeless Services grants, submit to hsd.homelessservices@hcs.oregon.gov

(2) For Housing Retention grants, submit to hsd.housingretention@hcs.oregon.gov

(3) For Weatherization grant, submit to hsd.energyservices@hcs.oregon.gov.


b. Copy of invoice/delivery receipt.

c. Copy of approved Purchase Request form.

d. Copy of the insurance certificate showing required minimum liability insurance levels.

e. License plate number.

f. Copy of the Vehicle Title.