National Park Service Purchase Request (New Requirement & Modifications)
Completion of this form (in its entirety) is required to request a PR be generated in FBMS. Completed
forms should be submitted to a designated FBMS Requisitioner for processing. Regions/Offices may have
additional instructions or business processes. Fields in green should be left blank.
Date of Request
FBMS PR Number
Internal Tracking No.
PR Requisitioner & Requestor Information
Requestor Name
Requisitioner Name
Phone
YOU
Linda Whitson
Phone
360-598-4944
Ext.
Email
Ext.
Email
linda_whitson@nps.gov
PR Type (Check One) please use the AutoChoice PR form for GSA auto purchases
Funded – POs, Contracts, TOs/DOs, BPA calls, Inter-/Intra-Agency Agreements
Unfunded - IDIQ and BPA set-up
Pre-Award change to existing PR
Post-Award Modification (partial deobligation of award only)
Grants/Financial Assistance Only
Grant PR
All FA actions, including $0 Cooperative Agreements and changes to accounting information in
awarded FAs
Post-Award Grants (partial deobligation of award ONLY)
PR Header
PR Title
(40 characters)
Issuing Office
(Purchasing Group) PPO - PWR SF/SEA MABO
"Brief Project Title"
Requesting Park/Program
and Office/Division
FBMS COR/Receiving Official
N/A
Originating Office FBMS Code
Address
park address
4 letter code
City
park address
Originating park/office
State
Zip
PR Header Text (1,650 characters max.) - Include information such as project name and NP property numbers
IAGP # xx; "Project Title for CESU Project"; (optional: Modification XX to Task Agreement # PXXACXXXXX)
Suggested Vendor(s)
Fill in name of your cooperator.
Suggested Buyer/CO
SAF?
☐ Yes ☐ No
PMIS
Ratification? ☐ Yes ☐ No Existing PR No.
IDIQ/BPA/GSA Schedule
Existing PO No.
Master Cooperative Agreement
Fill in
FBMS PR Approvers – Supervisor and Funds approvers are required for all PRs. Additional approvers may be required depending
on the UPC.
Supervisory Approver
FBMS role approved
Email
fill in
Certifying Funds Approver
FBMS role approved
Email
fill in
IT Approver
Email
Radio Approver
Email
Personal Property Approver
Email
Real Property Approver
Email
Fleet Approver
Email
Ad Hoc Approver
Email
Version 8 (FBMS R9) – JANUARY 2015
1
PR Line Item Detail – If extra line items are needed, use the PR Attachment form.

PR
Line
Item
No.
Determining the UPC requires communication among requisitioners, COs, budget staff, property staff, and/or project managers.
Quantity
Short Text
Max. 40 characters
No special characters, such as $ * % -
Item
Category
For receiving “By
Dollars” or for Cap
Assets, enter “1”
Unit Price or
Lump Sum Price
10
By Dollars
Project year X or Phase X
1
$
20
By Dollars
one line here for each funding acct #
1
30
By Dollars
in your TA or mod.
1
Line
Total
UPC
$
0.00
$
$
0.00
$
$
0.00
40
$
$
0.00
50
$
$
0.00
60
$
$
0.00
TOTAL $
0.00
Total from PR Attachment
411C
$
PR Accounting Information – If extra accounting information is needed, use the PR Attachment form.


Only one line of accounting is allowed per line for financial assistance. Do not split accounts for these actions.
Multiple Account Assignments should be allocated by amount, if percentages are used they must be at least 1.0% and rounded to one decimal.
Delivery Date
PR
Line Allocation
Item
Amount/Percentage
No.
Chargeable Object
Cost Center
Functional Area
(WBS/ME01 Work Order)
(mm/dd/yyyy)
Partial Fund
OR
(Example: 155)
Period of Performance
(mm/dd/yyyy) to (mm/dd/yyyy)
10 100.00 WBS here if can
155
to
20 100.00
list corresponding acct #s
to
30 100.00
from prev section on these lines
to
to
to
to
to
to
Delivery Address - Special delivery instructions should be included in the header or as an attachment.
In Reference to PR Line
Item No(s).
FBMS Delivery
Address Code
Address
City
State
Zip
Accountable Property – If you have multiple line items with different cost centers, please use the PR Attachment form.
PR Line
Item No(s).
PR Line
Item No(s).
Responsible
Cost Center
Responsible
Cost Center
Custodial Property
Officer Name
Custodial Property
Officer Name
CPO
Code
CPO
Code
Acquisition Attachments
Additional PR page(s)
Statement of Work
Market Research
Statement of Need (IT)
Independent Government
Estimate
Justification for non-competitive
requirement
Compliance
Brand Name/Limited Source
justification
Specifications & Plans
(Construction)
Individual Acquisition Plan
Multi-Functional Devices
etc. Equipment
Drawings, Maps, Illustrations
FISMA
Interagency Agreement
Technical Evaluation documents
Other:
Financial Assistance Attachments
Draft Cooperative Agreement
Funding Opportunity Template
Draft Task Agreement
Draft Grant
Version 8 (FBMS R9) – JANUARY 2015
Youth Agreement
Worksheet
Proposed Budget
Justification for use of Financial
Assistance
Other
2