Fillable Printable Form 1381

Form 1381

NOTIFICATION OF SURPLUS STATE-OW NE D PROPE RTY

State Form 13812 (R6 / 4-14)

Approved by State Board of Accounts, 2014

DEPARTMENT OF ADMINISTRATION

State Surplus Property

601 W. McCarty Street, Suite 100

Indianapolis, IN 46225

INSTRUCTIONS:

1. Complete all areas with the exception of “DO NOT WRITE HERE” section. Incomplete forms will not be approved and will be returned.

2. When the number of line items exceed the space on this form, please indicate “SEE ATTACHED SPREADSHEET” and attach an Excel spreadsheet to include all required

information as indicated on this form.

3. When the property has no asset tag number, please indicate “none”.

4. The agency completing the form is prohibited from disposing of surplus property without authorization from Department of Administration, State Surplus Property Division.

5. After authorization is given by Surplus Property Section, disposition agent(s) must make changes to inventory

in Encompass.

6. Detailed information is printed on the reverse side of this form.

Transferor (owning agency) Account Number

Transferee (receiving agency) Account Number

Address (number and street, city, ZIP code)

Disposition Agent of Owning Agency Telephone Number

Disposition Agent of Receiving Agency Telephone Number

Request for Disposition to sell, transfer to Surplus, transfer between agencies, trade-in, recycle, or dispose

Quantity

and Unit

Description of Item(s)

(List Make, Model, Year, Serial Number or VIN)

Asset Tag

Number

Item Condition

(good, fair, poor)

Disposition(s)

Requested

If requesting to SELL item(s), indicate name of contact,

telephone number and minimum bid required.

Original

Unit

Acquisition

Cost

Original

Purchase

Fund

If applicable, all data has been removed from the computer storage devices(s) (hard drives, PDA’s, etc.) per the State of Indiana

Enterprise Information Technology Security Policy Guideline.

Yes No ___________ Initials

When transferring property from one State Agency to another State Agency, the disposition agents of both agencies must sign below.

I hereby affirm that the above listed state surplus property is as described and has not been disposed of by this agency

without proper authorization from the Department of Administration. All necessary changes will be made to our inventory

records. All information listed on this form is true and accurate.

I hereby affirm that our agency as the transferee, accepts this property from the transferor agency and will adjust our

inventory records to reflect receipt of all property. All information listed on this form is true and accurate.

Signature of Disposition Agent (transferor)

Date (month, day, year)

Signature of Disposition Agent (transferee)

Date (month, day, year)

Distribution of Copies DO NOT WRITE HERE – STATE SURPLUS USE ONLY

Original: Department of Administration (Surplus Property Division)

Copies: Department of Administration (Procurement Division)

Disposition Agent File

Receiving Agency (for transfer only)

State Surplus will distribute copies after approval .

State Surplus Signature of Approval

Date (month, day, year)

Reset Form

NOTIFICATION OF SURPLUS STATE-OWNED P ROPERTY INFORMATION

Please refer to the Indiana Accounting and Unifor m Compliance Guidelines Manual for State and Quasi Agencies, IV. Summar y of Agency Responsibilities. All transfers, sales, retirements and other disposals of capital assets must be

processed through and approved by State Surplus Property division of IDOA by submitting Form 13812, Notification of Surplus State-Owned Property.

Each agency has one employee assigned as the Disposition Agent to keep t rack of their agency’s state-owned surplus property. This employee is responsible for requesting disposition by completi ng this form before submitting it to State Surplus for

approval. The disposition agent is also responsible for offering its agency surplus property to other division within their agency, (see Transfers Between Divisions of Same Agency) and offering the property to other State Agencies, (see Transfers

from One State Agency to Another State Agency).

Transfers Between Divisions of Same Agency

A 13812 form has never been required to transfer property from one division to another division of the same State Agency. It is the responsibility of the disposition agent to keep an internal track record. Before requesting approval for disposition of

property, the disposition agent should take a picture of the property and email it t o all its divisions to see if they have another division in need.

Usable and Non-Usable Property

Use one form for both, but make sure to indicate the condit i on of the property beside each item. Example of conditions: good is reusable, f air is reusable but may need cleaned or minor repair, poor is non-usable and disposal or recycle should be

requested. (See IC 5-22-21-6)

Multiple Property

Instead of using several forms for several items which exceed the forms allotted space, type on the form “SEE ATTACHED LISTING” and attach a spreadsheet which lists the property and the information required by State Board of Accounts. The

13812 can be scanned and emailed to State Surplus along with an Excel spreadsh eet (not scanned

), so we can copy and paste off the Excel spreadsheet t o update our database instead of entering each line manually.

Sparse Property Forms

The agency should combine the property on one form or follow the procedures set forth under Multiple Property.

Transfers from One State Agency to Another State Agency

Before requesting approval for disposition of property, the disposition agent should take a picture of their property and email it to the disposition agents of other State Agencies within their county to see if another State Agency in that county has a

need. State Surplus can provide the disposition agent email listing. If anot her State Agency accepts the offer, the “Letter of Acceptance” provided by the transf eree is no longer required. The disposition agents of the transferor (owning agency) and

transferee (accepting agency) are both required to sign the form as approval on their ends before the transferor submits t he form to State Surplus.

Non-Usable Property

The letter of justification, method of disposal, and picture requirements are eliminated if “poor or broken” is indicated under Item Condition on the form. It will be the owning agency’s disposition agent’s* responsibility to keep internal records to

present to State Board of Account as to why and how it was disposed of. When no ot her disposit ion is efficient or economical; contact the Recycling Program Manager in the Operations Division of the Depart m ent of Administration

prior to disposal.

(See 8.4.3 Retirement of Capital Assets and IC 5-22-21-6)

Property Located in Vari ous Locations

A form for each location is not required and is discouraged. It is the responsibility of the owning agency’s disposition agent to keep internal track records of that information.

Transfers to State Surplus

Only usable state-owned property that is in good enough condition to offer to other agencies will be accepted. Examples of state-owned property are: furniture, office equipment and machines, and items with an original acquisition cost of $500.00 or

more which require an asset number. Example of items State Surplus will not accept include, but is not limited to: used office supplies, State Agency manuals, State Agency books, Stat e Agency videos, State Agency DVDs or CDs, mattresses,

agency records, and broken or non-usable items. (see Non-Usabl e Property and IC 5-22-21-6)

Trade-In for New Purchases

Since a purchase is involved here, IDOA Procurement and Surplus property must be involved; requisitions for the new items must include the price without trade-in, the trade-in value, and the price with trade-in and must be attached to this form.

(see 8.4.3 Retirement of Capital Assets)

Sale of State-Owned Surplus Property

If the owning agency request State Surplus to sell property located at their site, the owing agency must submit this form which lists a contact person, phone number, minimum bid required and pictures of the property in jpg form

. State Surplus

Property will conduct the sale by public auction, online auction, or sealed bid. The proceeds minus the fees will be deposited into the owning agency’s account as per requirements of State Board of Accounts. The property may be offered to local

units of government and/or the general public. (see 8.4.3 Retirement of Capital Assets and I C 5-22-21-10)

Technology Items

All computer equipment, usable and non-usable, is to be transferred to State Surplus for recondit ioning or recycling. With the exception of transfer between divisions or other State agencies, all elect ronics are to be transferred to State Surplus or

sent to a reputable recycle program. Please contact the Recycling Program Manager in the Operations Division of the Department of Administration

prior to disposal and only after receiving approval from State Surplus. (See 8.4.3 Retirement of

Capital Assets)