CITY OF ATLANTA

DEPARTMENT OF PROCUREMENT

VENDOR COMPLAINT FORM

This form is to be completed and sent to the Department of Procurement (DOP) when the user agency feels the vendor has not performed satisfactorily, in order that necessary action may be taken by DOP. Examples of complaints are: Non or late delivery; whether or not inside delivery was made if required; packaging and condition of items(s) upon receipt; whether or not items(s) met specifications; etc.

The complaint form should be completed by the user/receiver of the item/service. It should be signed by the Commissioner of authorized representative before routing to DOP. The Chief Procurement Officer along with consultation with the Law Department will then take action, as necessary.

Date:
Vendor Number:

Purchase Order Number:
Vendor Name:

Purchase Order Date:
Address:

Using Bureau:

Contact Name:
City	ST	Zip

Contact Telephone #
Vendor Telephone #

Complaint:

Signature/ User Agency

Form 29-123A 10/14

Department of Procurement

CITY OF ATLANTA

AJordan

2004-09-08

Atlanta Police Department