July 26, 2012
CHIEF FINANCIAL OFFICER MEMORANDUM NO. 01 (2012-2013)
SUBJECT: CONTRACT SUMMARY FORM
This memorandum supersedes Chief Financial Officer Memoranda No. 02 (2010-2011) and No. 7
(2011-2012).
The purpose of this memorandum is to clarify how and when the Contract Summary Form is to be
used.
FLAIR PAYMENTS
For all contract and grant agreements that are recorded in the Florida Accountability Contract Tracking
System (FACTS) and for which payments are processed in FLAIR, each agency will utilize the
Contract Summary Form that is found in FACTS. Agency contract managers should print, complete,
and sign the FACTS Contract Summary Form, certifying that services were satisfactorily received.
The signed Contract Summary Form will be sent to the Agency’s accounting office and included in the
FLAIR payment voucher. The Bureau of Auditing (Bureau) will return, to the Agency, any FLAIR
payment voucher that does not include a completed and signed FACTS Contract Summary Form.
Federal and state grant agreements are not currently required to be recorded in FACTS; however
payments for grant agreements processed in FLAIR will also need to be supported by a properly
completed and signed Contract Summary Form, which can be found on the DFS website at
http://www.myfloridacfo.com/aadir/summary_csa.htm.
MFMP PAYMENTS
For all contracts that are recorded in FACTS, but for which payments are processed through MFMP,
agencies must print the FACTS Contract Summary Form and attach it to the Purchase Requisition (PR)
or Contract Request (CR). The Contract Manager will provide the following certification statement in
the comment section field on the PR or the CR: “I <insert name> certify by evidence of the attached
Contract Summary Form, that I am the Contract Manager and the information on this form is true and
correct.” For every change to a FACTS agreement, an updated FACTS Contract Summary Form must
be attached along with the required contract manager certification statement.
For all MFMP service payments, the Contract Manager must provide on the Invoice Reconciliation
(IR) the following certification statement: “I <insert name> certify that I am the Contract Manager and
the provided information is true and correct; the goods and services have been satisfactorily received
and payment is now due. I understand that the office of the State Chief Financial Officer reserves the
right to require additional documentation and/or to conduct periodic post-audits of any agreements.”
In lieu of the contract manager providing the certification statement on the IR, the FACTS Contract
Summary Form or the Contract Summary Form, as applicable, may be completed, signed and attached.
The Contract Summary Form may be found at http://www.myfloridacfo.com/aadir/summary_csa.htm.
The Bureau has previously determined that the agreements for certain service types listed below are
exempted from the Contract Summary Form requirements. However, an acknowledgement of
satisfactory receipt and approval of services or a receiving report, as applicable, must be provided.
Utility payments
Property and Equipment Leases
Phone Services
Building Construction
Commodity purchases
The requirements of this memorandum are effective for contractual service and grant payments
submitted by agencies on or after August 1, 2012.
Please contact Laura Anderson at 850-413-5730, Laura.Anderson@myfloridacfo.com or Cheri Greene
at 850-413-5593, Cheri.Greene@myfloridacfo.com if you have questions regarding this memorandum.
SUMMARY OF CONTRACTUAL SERVICES AGREEMENT/PURCHASE ORDER
OLO/Department:
Agency Contact:
FLAIR Contract #:
Telephone #:
Agency Contract #:
PO #:
Contractor/Vendor/
Payee:
Original Contract
Amount:
Total Contract
Amount:
Contract Type:
Contract Start Date:
Contract Last
Signed Date:
Contract End Date:
Advance Funded
YES
NO
METHOD OF PROCUREMENT:
AGENCY REFERENCE #:
Invoice Number:
Invoice Period:
Total Amount of Previous Payments:
CONTRACT MANAGER CERTIFICATION:
I certify, by evidence of my signature below, the information on this form is true and correct; the goods and services have been
satisfactorily received and payment is now due. I understand that the office of the State Chief Financial Officer reserves the right to
require additional documentation and/or to conduct periodic post-audits of any agreements.
Contract Manager Name printed:
Contract Manager Signature:
Date:
Amendments/Renewals/Extensions
CHANGE TYPE:
CHANGE DESCRIPTION:
Contract Last Signed Date:
Agency Amendment
Reference:
Amendment Amount:
New Ending Date:
CHANGE TYPE:
CHANGE DESCRIPTION:
Contract Last Signed Date:
Agency Amendment
Reference:
Amendment Amount:
New Ending Date:
CHANGE TYPE:
CHANGE DESCRIPTION:
Contract Last Signed Date:
Agency Amendment
Reference:
Amendment Amount:
New Ending Date:
OLO/Department:
FLAIR Contract #:
Agency Contract #:
PO #:
Deliverables
Deliverables as stated
in the Contract
Minimum Performance Levels
Payment
Amount
Type of Services
Method of
Payment
Instructions to complete the Summary of Contractual Services Agreement/Purchase Order Form:
This form should be completed in its entirety, signed and dated by the appropriate agency personnel and
submitted with each payment request. Please ensure each field on the form is completed according to the
guidance provided.
OLO/Department:
Agency’s numeric identifier (i.e. 640000/Department of
Health).
Agency Contact:
Agency designated personnel to answer questions regarding
payment.
Telephone #:
Designated personnel phone number.
FLAIR Contract #:
Identify FLAIR ID number assigned to agreement.
Agency Contract #:
Identify the agency number assigned to the agreement.
PO #:
Identify the agency number assigned to the purchase order.
Contractor/Vendor/Payee:
Identify Vendor/Payee (including d/b/a if applicable).
Original Contract Amount:
Provide the original contract amount when executed.
Total Contract Amount:
Provide the contract amount; amount must equal the total
amount of the contract; including
amendments/renewals/extension.
Contract Type:
Provide the FACTS contract type.
http://www.myfloridacfo.com/aadir/docs/FACTSUserManual051
112.pdf
Contract Start Date:
Identify date contract begins.
Contract End Date:
Identify date contract ends.
Contract Last Signed Date:
Identify date of execution.
Advance Funded:
Identify if the payment for which certification is provided is an
advance payment.
Method of Procurement:
Identify the appropriate competitive or non-competitive
method of procurement.
Agency Reference #:
Identify specific ITB, RFP or ITN number. If first payment is
being submitted on a competitively procured agreement,
provide documentation evidencing procurement (e.g. bid tab).
If the procurement was non-competitive provide the specific
exemption, statute, CSFA, CFDA or GAA line item.
Invoice Number:
Identify the invoice number associated with this payment
request.
Invoice Period:
Identify the invoice period this payment request covers.
Total Amount of Previous Payments:
Provide the cumulative total of the payments to date,
excluding current invoice amount(s).
Contract Manager Certification:
This section is to be completed by the employee designated by
the agency to function as the contract manager to certify the
information provided on this form is true and accurately
reflects the terms and conditions in the executed contract
document and approve the identified invoice for payment
based on direct knowledge of satisfactory receipt of the goods
or services. If the individual completing this section is not the
designated contract manager, please provide justification or
delegation of authority for the individual to sign this form.
Contract Manager Name printed:
Print name of the appropriate agency personnel.
Contract Manager Signature:
Signature of the appropriate agency personnel.
Date:
Enter the date signed by appropriate agency personnel.
AMENDMENTS/RENEWAL/EXTENSIONS:
Change Type:
Identify the type of change-amendment, renewal or extension.
Change Description:
Brief statement describing the changes that have occurred.
Contract Last Signed Date:
Identify date of execution.
Agency Amendment Reference:
Identify the agency amendment, renewal or extension number,
as applicable.
Amendment Amount:
Provide the amendment, renewal or extension amount, as
applicable.
New Ending Date:
Provide the new ending date, if applicable. If the end date
changed the contract end date on page 1 should be updated to
reflect the new date.
DELIVERABLES:
Deliverables as stated in the contract:
Identify the deliverables as stated in the contract.
Minimum Performance Levels:
Identify the minimum levels of service to be completed as
stated in the contract.
Payment Amount:
Identify the compensation amount for each deliverable.
Type of Services:
Provide a brief description of the services being provided.
Method of Payment:
Identify the payment method for each deliverable. For
example, fixed-price, fixed-rate, cost reimbursement.