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<br />A IT ACHMENT F <br />ADVANCE PAYMENT JUSTIFICATON FORM <br /> <br />Use of this forrn is not required unless the advance requested requires the prior approval of the Comptroller. For advance <br />requests that are equal to or less than the purchasing threshold of category two as defined in Section 287.017, Florida <br />Statutes, and meet one of the advance payment requirements identified in Section 215.422(14), Florida Statutes, use of <br />this form is waived. However, the purchase requisition or contract review form must clearly identify the criteria being met <br />under 215.422(14), Florida Statutes that allows the advance to be made without prior Comptroller approval. <br /> <br /> Name/Address of the Vendor/Recipient: <br /> Contact Person/Phone No.: <br />Agreement No./Purchase Order No. (if known): LP06013 <br /> Commodities/Services/Project Description: <br />(i.e. local aov't Organizational Structure <br />non-orofit corooration etc.) <br /> Value of Purchase or Grant: <br /> Advance Payment Amount Requested: <br /> Period Advance Payment to Cover: o 90 days startup 18 Full Contract Period <br /> o Quarterly other (specify): <br /> Indicate Statutory Authority: o 215.422, F.S I 0 216.181, F.S. <br /> GAA Year and Line Item Info: SFY: I I Line !tern: I <br />1. Reason advance payment is required: <br />2. The following information required for advances requested pursuant to 215.422, Florida Statues <br />(and the Comptroller's Voucher Processing Handbook) which exceed the purchasing threshold of <br />cateaorv two as defined in 287.017, Florida Statues. <br />A. Document, if applicable, the cost savings to be incurred as a result of an advance payment that are equal or <br />greater than the amount the State would earn by investing the funds and paying in arrears. Include the percent <br />(%) savings to be realized. In calculating the percent savings as compared to the percent that can be earned by <br />the State, information may be obtained from the Department of Insurance, Division of Treasury at 850/413-2776 <br />or SunCom 293-2776 regarding the current Treasury earnings rate. <br />B. Document, if applicable, how the goods or services are essential to the operation of the Department and why <br />they are available only if advance payment is made: <br /> <br />DEP 55-222 (03-02) <br />DEP Agreement No. LP6013, Attachment F <br /> <br />SIB <br />