A	B	C	D	E	F	G	H	I	J	K	L	M	N	O	P	Q
1												Form last updated on:				10/31/2018
2		WIPAC Purchase Requisition Form
3
4		Requestor						For Purchasing Use						PSL Work Orders:
5		Name:	Dennis Comerford					WIPAC requisition#:		WRC-7892	Eligible Vendor (Yes/No):	Y		Funding end date:
6		Email:	helpdeskmanager@wipac.wisc.edu					Date order placed:			Match Code:	0		PSL project name:
7		Date:	05/07/2020					WISDM / MP PO#:			Invoice approval by:
8		Date required:	05/08/2020											PSL project#:
9								For Purchasing Use - Order Comments
10		Vendor
11		Name:	Altium LLC
12		Number:												Capital Equipment System
13		Address:	4225 Executive Square											Number:
14			Suite 800											Name:
15			La Jolla, CA 92037 UNITED STATES											Label:
16		Phone / Fax	858-864-1500 / 858-864-1710					Shipping
17		Web Address:	www.altium.com					Shipping locations:		222 W Washington Ave. 5Th Floor, Madison, WI 53703
18		Contact:						Shipping method:		Ground
19		Email:	sales.na@altium.com					Partial shipment acceptable: (Yes/No)			NO
20
21		Additional Information
22		Special instructions:	The standalone license is being used by Perry Sandstrom for IceCube Upgrade. The shared licenses are being used by the following: Thomas Meures and his student for CTA ; Kael and Delia for IceCube Upgrade ; other license is for anyone. Quote: Q-271192-1
23
24		Reason for purchase:	Annual renewal of our licenses for Altium Designer. It is software used to design electronic components within various test instruments. (e.g.: SOLIDWORKS is used to design the IceCube DOM, Altium Designer is used to design the circuit boards that control the DOM.)
25
26
27		Item description			Qty	Unit		Unit price	Total $	Funding & Project #		Cost code	Cost category		Comments
28		Altium Designer License (Academic On-Demand)			5	EA		$100.00	$500.00	50% IceCube Upgrade 400115.010 Project Engineering 50% FS8 20060.001 Technical & Science		3150/3521
29		Altium Designer License (Academic Standalone)			1	EA		$100.00	$100.00	50% IceCube Upgrade 400115.010 Project Engineering 50% FS80 20060.001 Technical & Science		3150/3521
30
31
32
33
34
35
36
37		Total	Unit = Each, Package, /k						$600.00
38
39		Authorization		Autorization required for					Date	Signature	Comment
40		Functional Area Manager		Total purchase $500 - $5,000
41		Resource Coordinator		Total purchase in excess of $5,000
42		Director / Associate Director		Total purchase in excess of $5,000
43
44		Acknowledgement		Acknowledge required for					Date	Signature	Comment
45		WIPAC Purchasing		capital equip. system, cost codes, funding					05/11/2020	Debbie Sewell
46		Purchasing Agent		processing the work order
47		Vendor Contact Person		receiving and processing the work order
48
49
50