CITY OF NOGALES, ARIZONA FIXED ASSET ACQUISITION FORM
CITY OF NOGALES, ARIZONA FIXED ASSET ACQUISITION FORM INVOICE WILL NOT BE PAID UNTIL THIS FORM IS COMPLETE & SUBMITTED & ASSET IS TAGGED & RECORDED
Name: __________________________Department: __________________Date: ________________________
1. ASSET DETAIL: Item Description: ____________________________________________________________PLEASE INCLUDE PICTURE(S) Manufacturer: ______________________________________________________________________________________ Year & Model: ______________________________________________________________________________________ Serial Number: _____________________________________________________________________________________ (If applicable)Fleet ID Number: ______________________ License Plate Number: _______________________________ Location (Building & room number): ____________________________________________________________________ Barcode Number: To be assigned by Finance Department ___________________________________________________
2. PURCHASE DETAIL: Purchase/Council Order Number: ______________________ Vendor: _____________________________________ Method of Acquisition: Circle appropriate method Purchase
Donation
Other: ______________________________________________
Date asset received by department: Month_________________________ Day_______________ Year 20________ Actual Asset Cost: Item $______________ Tax $___________ Freight $_________ Grand Total $ ________________
3. COMMUNICATION DETAIL: Submitted by (signature): ___________________________________________________
Date ________________
Finance received by (signature): ______________________________________________
Date________________
Asset created in accounting system (signature): __________________________________
Date________________
4. FINANCE DEPARTMENT DETAIL The following documents and number detail should be attached in the following order: 1. Purchase/Council Order (number): ___________________________ 2. Invoice (number): _____________________ Useful Life (yrs) _______________Asset Class#_________________ 3. Check (number): ______________________ G/L Account #:_________________ Grant/Contract#____________ 4. Insurance Company: _________________ Policy Name/#: _________________ Effective Date: _____________ Expiration Date: _________________ Policy Value: $_____________ Replacement Value: $_________________ 5. Certificate of Title (if applicable, number): _______________________________ 6. Bid documents (if applicable) 7. Picture(s) of asset
5. DISPOSAL DETAIL (WHEN APPLICABLE) Disposal Date: _____________Method of Disposal: _____________________Proceeds from Disposal: $______________ Finance Department Asset ACQUISITION Form Approved as of 6/5/2012
HOW TO: Fill out this fixed asset ACQUISITION form This form needs to be completed for ALL items purchased with a value of greater than $500, which are highly susceptible to theft, and/or can be used for more than one (1) year.
Put your name, department name, and today’s date on the first line 1. Asset Detail Section a. Item Description: Briefly and specifically describe what the asset is. (Ex. Pickup truck) b. Pictures: Please take a picture of the asset from a few different angles. Try to include in the picture identifying marks, such as fleet ID number, license plate number, etc. c. Manufacturer: The name of the company that manufactured the asset (Ex. Ford) d. Year & Model: The specific year & model of the asset (Ex. 2012, F250) e. Serial Number: The serial number should be found somewhere on the item, the length of the series of numbers/letters will vary. Please double check the number to make sure it is correct. Also check the number against the Vehicle title or other identifying document if applicable. f. Fleet ID number: This number has been assigned by the fleet department. g. License Plate number: This number has been assigned by the Motor Vehicle Division. h. Location: The building name and the room name and NUMBER where the asset is located (Ex. Public Works, Parking Lot, Stall 4) i. Barcode number: LEAVE EMPTY. This number is assigned by the Finance Department. 2. Purchase Detail Section a. Purchase Order Number: The number on the purchase order (PO) received back from Finance Department to proceed with ordering the asset. b. Vendor: The FULL name of the company selling the asset. If the vendor number is known, please include this number as well. c. Method of acquisition: Circle whether the asset was PURCHASED with City funds or if it was DONATED. If the asset was acquired by some other means, please write how in the OTHER line. d. Date asset received by department: The date the asset was delivered and/or received by the department. e. Actual asset cost: Include how much the asset cost, how much was charged for tax, and how much was charged for freight. Add the three items together for the GRAND TOTAL. Please verify this number against appropriate purchase documents to make sure they are the same. 3. Communication Detail Section: a. Please sign the form once completed. b. Write the date the form is completed. 4. SCAN AND EMAIL paperwork to PURCHASING AGENT within 10 business days: a. Make a copy of this form, all other necessary paperwork, and pictures and keep for your records. b. Scan as PDF the following documents and email them as a package to the Finance Department’s purchasing agent within 10 business days of receiving the new asset: i. This original fixed asset acquisition form ii. Picture(s) of the new asset iii. Other supporting documents in your possession
Finance Department Asset ACQUISITION Form Approved as of 6/5/2012
Name: __________________________Department: __________________Date: ________________________
1. ASSET DETAIL: Item Description: ____________________________________________________________PLEASE INCLUDE PICTURE(S) Manufacturer: ______________________________________________________________________________________ Year & Model: ______________________________________________________________________________________ Serial Number: _____________________________________________________________________________________ (If applicable)Fleet ID Number: ______________________ License Plate Number: _______________________________ Location (Building & room number): ____________________________________________________________________ Barcode Number: To be assigned by Finance Department ___________________________________________________
2. PURCHASE DETAIL: Purchase/Council Order Number: ______________________ Vendor: _____________________________________ Method of Acquisition: Circle appropriate method Purchase
Donation
Other: ______________________________________________
Date asset received by department: Month_________________________ Day_______________ Year 20________ Actual Asset Cost: Item $______________ Tax $___________ Freight $_________ Grand Total $ ________________
3. COMMUNICATION DETAIL: Submitted by (signature): ___________________________________________________
Date ________________
Finance received by (signature): ______________________________________________
Date________________
Asset created in accounting system (signature): __________________________________
Date________________
4. FINANCE DEPARTMENT DETAIL The following documents and number detail should be attached in the following order: 1. Purchase/Council Order (number): ___________________________ 2. Invoice (number): _____________________ Useful Life (yrs) _______________Asset Class#_________________ 3. Check (number): ______________________ G/L Account #:_________________ Grant/Contract#____________ 4. Insurance Company: _________________ Policy Name/#: _________________ Effective Date: _____________ Expiration Date: _________________ Policy Value: $_____________ Replacement Value: $_________________ 5. Certificate of Title (if applicable, number): _______________________________ 6. Bid documents (if applicable) 7. Picture(s) of asset
5. DISPOSAL DETAIL (WHEN APPLICABLE) Disposal Date: _____________Method of Disposal: _____________________Proceeds from Disposal: $______________ Finance Department Asset ACQUISITION Form Approved as of 6/5/2012
HOW TO: Fill out this fixed asset ACQUISITION form This form needs to be completed for ALL items purchased with a value of greater than $500, which are highly susceptible to theft, and/or can be used for more than one (1) year.
Put your name, department name, and today’s date on the first line 1. Asset Detail Section a. Item Description: Briefly and specifically describe what the asset is. (Ex. Pickup truck) b. Pictures: Please take a picture of the asset from a few different angles. Try to include in the picture identifying marks, such as fleet ID number, license plate number, etc. c. Manufacturer: The name of the company that manufactured the asset (Ex. Ford) d. Year & Model: The specific year & model of the asset (Ex. 2012, F250) e. Serial Number: The serial number should be found somewhere on the item, the length of the series of numbers/letters will vary. Please double check the number to make sure it is correct. Also check the number against the Vehicle title or other identifying document if applicable. f. Fleet ID number: This number has been assigned by the fleet department. g. License Plate number: This number has been assigned by the Motor Vehicle Division. h. Location: The building name and the room name and NUMBER where the asset is located (Ex. Public Works, Parking Lot, Stall 4) i. Barcode number: LEAVE EMPTY. This number is assigned by the Finance Department. 2. Purchase Detail Section a. Purchase Order Number: The number on the purchase order (PO) received back from Finance Department to proceed with ordering the asset. b. Vendor: The FULL name of the company selling the asset. If the vendor number is known, please include this number as well. c. Method of acquisition: Circle whether the asset was PURCHASED with City funds or if it was DONATED. If the asset was acquired by some other means, please write how in the OTHER line. d. Date asset received by department: The date the asset was delivered and/or received by the department. e. Actual asset cost: Include how much the asset cost, how much was charged for tax, and how much was charged for freight. Add the three items together for the GRAND TOTAL. Please verify this number against appropriate purchase documents to make sure they are the same. 3. Communication Detail Section: a. Please sign the form once completed. b. Write the date the form is completed. 4. SCAN AND EMAIL paperwork to PURCHASING AGENT within 10 business days: a. Make a copy of this form, all other necessary paperwork, and pictures and keep for your records. b. Scan as PDF the following documents and email them as a package to the Finance Department’s purchasing agent within 10 business days of receiving the new asset: i. This original fixed asset acquisition form ii. Picture(s) of the new asset iii. Other supporting documents in your possession
Finance Department Asset ACQUISITION Form Approved as of 6/5/2012
