Alabama Contract Review Form – Fill Out and Use This PDF

Contract Review Permanent Legislative Oversight Committee

Alabama State House --- Montgomery, Alabama 36130

C O N T R A C T R E V I E W R E P O R T

(Separate review report required for each contract)

Name of State Agency:________________________________________________________________________

Name of Contractor:__________________________________________________________________________

__________________________________________________	_________________________	________
Contractor’s Physical Street Address (No P.O. Box Accepted)	City	ST

Is Contractor a Sole Source? YES ______ NO ______ (IF YES, ATTACH LETTER)

Is Contractor organized as an Alabama Entity in Alabama? YES ______ NO ______

Is Contractor a minority and/or woman-owned business? YES ______ NO ______

If so, is Contractor certified as such by the State of Alabama? YES ______ NO ______

Check all that apply: ALDOT ______ ADECA ______ OTHER (Name) _____________________________________________

Is Contractor Registered with Alabama Secretary of State to do Business as a Corporation in Alabama? YES ______ NO ______

IF LLC, GIVE NAMES OF MEMBERS: _____________________________________________________________________

Is Act 2001-955 Disclosure Form Included with this Contract? YES ______ NO ______

Does Contractor have current member of Legislature or family member of Legislator employed? YES ______ NO ______

Was a Lobbyist/Consultant used to secure this Contract OR affiliated with this Contractor? YES ______ NO ______

IF YES, GIVE NAME: ________________________________________________________________________________

Contract Number: _C_ ___ ___ ___ ___ ___ ___ ___ ___ (See Fiscal Policies & Procedures Manual, Page 5-8)

Contract/Amendment Amount: $___________________ (PUT AMOUNT YOU ARE ASKING FOR TODAY ONLY)

% State Funds: ________ % Federal Funds: _________ % Other Funds: _________**

**Please Specify Source of Other Funds (Fees, Grants, etc.) __________________________________________

Date Contract Effective: __________________________	Date Contract Ends: __________________________
Type Contract: NEW: ______ RENEWAL: ______	AMENDMENT: ______
If Renewal, was it originally Bid? YES ______ NO ______
If AMENDMENT, Complete A through C:
[A] ORIGINAL contract amount	$ _________________________
[B] Amended total prior to this amendment	$ _________________________
[C] Amended total after this amendment	$ _________________________

Was Contract Secured through Bid Process? YES ______ NO ______ Was lowest Bid accepted? YES ______ NO ______

Was Contract Secured through RFP Process? YES ______ NO ______ Date RFP was awarded: ______________________

Posted to Statewide RFP Database at http://rfp.alabama.gov/Login.aspx? YES ______ NO ______

If NO, give a brief explanation as to why not: ________________________________________________________

Summary of Contract Services to be Provided: ____________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

Why Contract Necessary AND why this service cannot be performed by merit employee: __________________

__________________________________________________________________________________________

__________________________________________________________________________________________

I certify that the above information is correct.
___________________________________________	_________________________________________
Signature of Agency Head	Signature of Contractor
___________________________________________	_________________________________________
Printed Name of Agency Head	Printed Name of Contractor

Agency Contact: ________________________________________________ Phone:_____________________

Revised 8/2/17