Std 65 Form PDF Details

In the intricate landscape of procurement and bureaucratic navigation within the state of California, the Standard Form 65 (STD. 65), revised in July 2003, is a crucial document that facilitates the purchasing process between the State's General Services Procurement Division and its suppliers. This document not only streamlines procurement activities but also ensures that the legal and administrative frameworks governing state purchases are adhered to meticulously. It delineates detailed requirements ranging from the identification of the supplier and agency involved, down to the specifics of the purchase order including item descriptions, quantities, unit prices, and the total amount. By mandating the inclusion of contract registration numbers, agency order numbers, and detailed supplier information on both invoices and packing slips, the form underscores the importance of transparency and accountability in governmental transactions. Payment terms, certification numbers for small or microbusinesses and Disabled Veteran Business Enterprises (DVBEs), as well as the required delivery date and shipping instructions, are explicitly specified to facilitate a smooth transaction process. Furthermore, the form references the leverage of procurement agreements (LPA) and includes provisions for competitive and non-competitively bid exemptions, highlighting the State's commitment to fair and efficient procurement practices. With sections dedicated to certified correct signatures, this form not only serves as a purchase order but also as a compliance and regulatory tool, ensuring that every transaction not only meets the State's procurement needs but also adheres to legal and policy standards.

QuestionAnswer
Form NameStd 65 Form
Form Length9 pages
Fillable?No
Fillable fields0
Avg. time to fill out2 min 15 sec
Other namesE-MAIL, std 65, std 65 purchase order, CALIFORNIA

Form Preview Example

STATE OF CALIFORNIA - GENERAL SERVICES PROCUREMENT DIVISION

PURCHASING AUTHORITY PURCHASE ORDER

STD. 65 (REV. 7/2003)

CONTRACT REGISTRATION NUMBER

SUPPLIER: The numbers identified above MUST be shown on Invoice & Packing Slip.

AGENCY ORDER NUMBER

DATE

AMENDMENT NO.

PAGE OF PAGE

S H I P

T O

B

I

L L

T O

AGENCY BILLING CODE

PURCHASING AUTHORITY NUMBER

LEVERAGED PROCUREMENT AGREEMENT NO.

TO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

INFORMATION TECHNOLOGY PROJECT IDENTIFICATION NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SUPPLIER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AGENCY OR BUYER

AGENCY TRACKING/REQUISITION NUMBER (Optional)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ADDRESS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

INFORMATION

 

 

 

 

 

 

(Type or

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AGENCY NAME

 

CONTACT NAME

 

 

Print

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Legibly)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CONTACT E-MAIL ADDRESS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CONTACT PHONE NUMBER

 

CONTACT FAX NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SUPPLIER CONTACT NAME

 

 

 

 

 

 

 

SUPPLIER PHONE NUMBER

 

SUPPLIER FAX NUMBER

SUPPLIER E-MAIL ADDRESS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PAYMENT TERMS

CERTIFICATION NUMBER

 

 

Certified

Certified

 

EXPIRATION DATE

 

Certified

EXPIRATION DATE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Small Business

Microbusiness

 

 

 

 

 

DVBE

 

 

 

REQUIRED DELIVERY DATE

 

SHIPPING

 

 

F.O.B. Destination

 

F.O.B. Destination

 

 

F.O.B.

CITY OF ORIGIN

 

 

STATE

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

FRT. PPD/ADD

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

INSTRUCTIONS

 

 

FRT. PPD

 

Freight not to exceed cost stated on P.O.

 

ORIGIN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ITEM

 

QUANTITY

UNIT

 

COMMODITY CODE or PRODUCT CODE

RECYCLED

 

 

 

PRODUCT OR SERVICES DESCRIPTION

 

 

UNIT PRICE

 

EXTENSION TOTAL

NUMBER

 

 

or SERVICES ID NUMBER

 

PRODUCT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A-1

General Provisions are incorporated herein by reference to:

 

 

 

 

 

 

 

 

 

 

 

 

 

TAXABLE

 

 

Form GSPD - 401Non-IT Commodities (revision date

 

 

 

) OR

Form GSPD - 401IT (revision date

 

 

)

 

 

 

 

 

 

 

SUBTOTAL

TERMS

ATTACHED OR

Published at website: www.dgs.ca.gov/pd

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

This order is issued under a Department of General Services (DGS) Leveraged Procurement Agreement (LPA). Terms and Conditions set forth in

 

 

 

 

AND A-2

TAX RATE

 

SALES

that agreement (LPA number referenced in the block titled Leveraged Procurement Agreement No.) are incorporated herein by reference as if set

 

 

 

CONDITIONS

 

 

 

TAX

forth in full text.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B

Agency Special Provisions are attached and titled

 

 

 

 

 

 

 

.

 

* NOTE: If there are variable

* INSTALLATION

 

 

 

 

 

 

 

 

 

 

 

C

Any other attachments, such as specifications, Statement of Work, or Information Technology Model

charges for Installation,

 

 

 

 

 

*

SHIPPING/

 

Language Modules, are identified in the product or services description area or on continuation pages.

 

 

Shipping or Freight, or Other

PROCUREMENT METHOD

 

 

 

 

 

 

 

 

 

 

 

FREIGHT

 

 

 

 

 

 

 

 

 

 

Non-Taxable Services, detail

 

 

 

 

COMPETITIVE: Solicitation Number (if applicable)

 

 

 

 

 

 

 

 

* OTHER

 

 

 

 

 

 

 

 

 

 

 

 

 

per line item and enter total

 

 

LEVERAGED

DVBE / SMALL BUSINESS [GC 14838.5(a)]

NON-COMPETITIVELY BID

EXEMPT

here.

 

 

 

 

NON-TAXABLE

PROGRAM / CATEGORY (Code and Title)

FUND TITLE

 

 

 

VERIFIED NO STATE SURPLUS

PAID BY CAL-CARD

 

 

 

 

 

 

 

 

 

 

 

 

AVAILABLE

YES

NO

YES

NO

GRAND TOTAL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ITEM

CHAPTER

STATUTE

FISCAL YEAR OBJECT OF EXPENDITURE (CODE AND TITLE)

O.E.

EQ.

CERTIFICATION AND APPROVAL OF EXECUTIVE OFFICER

I HEREBY CERTIFY, on personal knowledge, that this order for purchasing the items specified above is issued in accordance with the procedure prescribed by law governing the purchase of such items for the State of California; and that all such legal requirements have been fully complied with.

AUTHORIZING NAME (Print or Type)

TITLE

 

 

AUTHORIZING SIGNATURE

Ｃ

UNENCUMBERED REMAINDER AFTER POSTING THIS ORDER TO ALLOTMENT EXPENDITURE LEDGER

ADJUSTMENT

INCREASING ENCUMBRANCES

ADJUSTMENT

DECREASING ENCUMBRANCES

CERTIFIED CORRECT (SIGNATURE)

Ｃ

DISTRIBUTION:

Copy 1 - Supplier; Copy 2 - DGS Procurement;

Copy 3 - Packing Slip;

Copies 4–6 - Agency Procurement File

STATE OF CALIFORNIA - GENERAL SERVICES PROCUREMENT DIVISION

PURCHASING AUTHORITY PURCHASE ORDER

STD. 65 (REV. 7/2003)

SUPPLIER INSTRUCTIONS

1.INVOICES: Unless otherwise specified, original invoices shall be sent to the "Bill To" address on the face of this document. Invoices shall be submitted in triplicate and shall include:

Contract registration number (if applicable),

Agency order number,

Item number,

Services or Product ID number,

Unit price,

Extended item price, and

Invoice total amount.

State sales tax, installation cost, shipping/freight costs, and/or other non-taxable costs shall be itemized separately and added to each invoice as applicable.

2.REQUIRED PAYMENT DATE: Payment will be made in accordance with the provisions of the California Prompt Payment Act, Government Code Section 927 et seq. Unless expressly exempted by statute, the Act requires state agencies to pay properly submitted, undisputed invoices not more than 45 days after (a) the date of acceptance of goods or performance of services; or (b) receipt of an undisputed invoice — whichever is later.

3.SHIPPING INSTRUCTIONS: When the Purchase Order or contract allows prepaid/add transportation charges, submit original receipted expense bills if freight charges are over $50.00. All shipments shall be F.O.B. Destination Freight Prepaid unless otherwise specified. All orders MUST include a copy of the packing slip inside the carton AND a copy securely attached to the OUTSIDE of the shipping carton.

STATE OF CALIFORNIA - GENERAL SERVICES PROCUREMENT DIVISION

PURCHASING AUTHORITY PURCHASE ORDER

STD. 65 (REV. 7/2003)

CONTRACT REGISTRATION NUMBER

SUPPLIER: The numbers identified above MUST be shown on Invoice & Packing Slip.

AGENCY ORDER NUMBER

DATE

AMENDMENT NO.

PAGE OF PAGE

S H I P

T O

B

I

L L

T O

AGENCY BILLING CODE

PURCHASING AUTHORITY NUMBER

LEVERAGED PROCUREMENT AGREEMENT NO.

TO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

INFORMATION TECHNOLOGY PROJECT IDENTIFICATION NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SUPPLIER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AGENCY OR BUYER

AGENCY TRACKING/REQUISITION NUMBER (Optional)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ADDRESS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

INFORMATION

 

 

 

 

 

 

(Type or

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AGENCY NAME

 

CONTACT NAME

 

 

Print

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Legibly)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CONTACT E-MAIL ADDRESS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CONTACT PHONE NUMBER

 

CONTACT FAX NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SUPPLIER CONTACT NAME

 

 

 

 

 

 

 

SUPPLIER PHONE NUMBER

 

SUPPLIER FAX NUMBER

SUPPLIER E-MAIL ADDRESS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PAYMENT TERMS

CERTIFICATION NUMBER

 

 

Certified

Certified

 

EXPIRATION DATE

 

Certified

EXPIRATION DATE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Small Business

Microbusiness

 

 

 

 

 

DVBE

 

 

 

REQUIRED DELIVERY DATE

 

SHIPPING

 

 

F.O.B. Destination

 

F.O.B. Destination

 

 

F.O.B.

CITY OF ORIGIN

 

 

STATE

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

FRT. PPD/ADD

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

INSTRUCTIONS

 

 

FRT. PPD

 

Freight not to exceed cost stated on P.O.

 

ORIGIN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ITEM

 

QUANTITY

UNIT

 

COMMODITY CODE or PRODUCT CODE

RECYCLED

 

 

 

PRODUCT OR SERVICES DESCRIPTION

 

 

UNIT PRICE

 

EXTENSION TOTAL

NUMBER

 

 

or SERVICES ID NUMBER

 

PRODUCT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A-1

General Provisions are incorporated herein by reference to:

 

 

 

 

 

 

 

 

 

 

 

 

 

TAXABLE

 

 

Form GSPD - 401Non-IT Commodities (revision date

 

 

 

) OR

Form GSPD - 401IT (revision date

 

 

)

 

 

 

 

 

 

 

SUBTOTAL

TERMS

ATTACHED OR

Published at website: www.dgs.ca.gov/pd

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

This order is issued under a Department of General Services (DGS) Leveraged Procurement Agreement (LPA). Terms and Conditions set forth in

 

 

 

 

AND A-2

TAX RATE

 

SALES

that agreement (LPA number referenced in the block titled Leveraged Procurement Agreement No.) are incorporated herein by reference as if set

 

 

 

CONDITIONS

 

 

 

TAX

forth in full text.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B

Agency Special Provisions are attached and titled

 

 

 

 

 

 

 

.

 

* NOTE: If there are variable

* INSTALLATION

 

 

 

 

 

 

 

 

 

 

 

C

Any other attachments, such as specifications, Statement of Work, or Information Technology Model

charges for Installation,

 

 

 

 

 

*

SHIPPING/

 

Language Modules, are identified in the product or services description area or on continuation pages.

 

 

Shipping or Freight, or Other

PROCUREMENT METHOD

 

 

 

 

 

 

 

 

 

 

 

FREIGHT

 

 

 

 

 

 

 

 

 

 

Non-Taxable Services, detail

 

 

 

 

COMPETITIVE: Solicitation Number (if applicable)

 

 

 

 

 

 

 

 

* OTHER

 

 

 

 

 

 

 

 

 

 

 

 

 

per line item and enter total

 

 

LEVERAGED

DVBE / SMALL BUSINESS [GC 14838.5(a)]

NON-COMPETITIVELY BID

EXEMPT

here.

 

 

 

 

NON-TAXABLE

PROGRAM / CATEGORY (Code and Title)

FUND TITLE

 

 

 

VERIFIED NO STATE SURPLUS

PAID BY CAL-CARD

 

 

 

 

 

 

 

 

 

 

 

 

AVAILABLE

YES

NO

YES

NO

GRAND TOTAL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ITEM

CHAPTER

STATUTE

FISCAL YEAR OBJECT OF EXPENDITURE (CODE AND TITLE)

O.E.

EQ.

CERTIFICATION AND APPROVAL OF EXECUTIVE OFFICER

I HEREBY CERTIFY, on personal knowledge, that this order for purchasing the items specified above is issued in accordance with the procedure prescribed by law governing the purchase of such items for the State of California; and that all such legal requirements have been fully complied with.

AUTHORIZING NAME (Print or Type)

TITLE

 

 

AUTHORIZING SIGNATURE

Ｃ

UNENCUMBERED REMAINDER AFTER POSTING THIS ORDER TO ALLOTMENT EXPENDITURE LEDGER

ADJUSTMENT

INCREASING ENCUMBRANCES

ADJUSTMENT

DECREASING ENCUMBRANCES

CERTIFIED CORRECT (SIGNATURE)

Ｃ

DISTRIBUTION:

Copy 1 - Supplier; Copy 2 - DGS Procurement;

Copy 3 - Packing Slip;

Copies 4–6 - Agency Procurement File

DEPARTMENT OF GENERAL SERVICES

Procurement Division

Data Entry Unit - Second Floor

P.O. Box 989052

West Sacramento, CA 95798-9052

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