ࡱ> WYVa }bjbj 8PhGbhGbo LLLLL```8<`#" "#$#$#$#$#$#$#$%K(bH#LH#LL]#LL"#"#"f"}2"#s#0#:",((f"(Lf"H#H##(> : Salary Packaging Services (CUA SPS2017) Pick and Buy Order Form (EMPLOYER TO CONTRACTOR) PART A: REQUEST TO SUPPLIER TO: ___________________________________________________________ (NAME OF CONTRACTOR) This Purchase Order incorporates the Department of Finance Request Conditions and General Conditions of Contract [August 2012] located at  HYPERLINK "http://www.finance.wa.gov.au" www.finance.wa.gov.au, and in accordance with the Common Use Arrangement established under Request CUA SPS2017. Purchase Order Number:Date:Service Period: (i.e. Services required for the dates inclusive)From: To: Service Period Extension:On expiration of Service Period, the Contractor will continue to provide the Service on a month by month basis, until it is cancelled by the Customer on 30 days notice. If CUA SPS2017 expires or is terminated, all Services that are being provided will continue until the Contract Authority directs otherwise on 30 days notice. Service ItemsDescriptionQuantityPrice $1. 2. 3. Contract Price $ (Tick ( appropriate box)( As per contracted rates CUA SPS2017*( Rates as negotiated: (as attached) *** Please indicate by placing yes in the appropriate box if the fees payable are as per the CUA SPS2017 and the Public Authority and Contractor have not negotiated a discount or any variation to the fees payable. ** If the Public Authority and the Contractor have negotiated any discount to the contract rates these must be specified and attached to this order. Public Authorities and/or Contractors cannot negotiate fees in excess of those specified in CUA SPS2017.Attachments (to this Pick and Buy Order):( YES (Details):  Customer Requirements / Specifications. [List Customer transition requirements, e.g. any non-standard specifications or better service levels negotiated. Add and refer to an attached document if needed]1. 2. 3. Special Conditions. [Specify any additional terms, agreed variations to standard terms and conditions, acceptance requirements etc. agreed with Contractor. Add and refer to an attached document if needed]  Interface Requirements. [Specify any interface requirements, address and location of contact person, acceptance requirements etc. agreed with Contractor. Add and refer to an attached document if needed]1. 2. 3. Invoicing. [Advise of invoicing instructions]1. 2. 3. AUTHORISED Public Authority Purchaser  Name of the Public Authority/Approved CUA User: __________________________________________ Contact Person Name: __________________________________________________________________ Contact Person Title: ___________________________________________________________________ Phone number: ________________________________________________________________________ Email address: ________________________________________________________________________ Facsimile number: _____________________________________________________________________ ________________________________________ __________________________________________ Name of the authorised purchaser of the Public Authority Signature of the authorised purchaser of the Public Authority  PART B: CONFIRMATION BY CONTRACTOR TO: ________________________________ (NAME OF PERSON) _____________________________________ (PUBLIC AUTHORITY) ( Your Purchase Order has been confirmed. ( Other details attached for your information see attachment. Name:____________________________ Signature:______________________ Contractor:______________________________ Note: The Contract Authority may modify this pro-forma from time to time. Buying processes: Step 1 Customer discusses / negotiates with Contractor and completes Part A; Step 2 Customer sends Pick and Buy Order to Contractor; Step 3 Contractor completes Part B and returns signed Form to Customer; Step 4 - Contractor delivers Services. 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