INTERNATIONAL RESCUE COMMITTEE

Sequential PR#:PR2CAF/CFBNG/1118471
PROGRAM PURCHASE REQUEST
(for internal use only)
National Procurement PR Date 26 Dec 2023

Page 1 of 1 Country Program/US Office: Central African Republic International Procurement Date Edited 26 Dec 2023

Asset?
Goods / Category T1 Grant Grant Closing
Item # Line Description QTY UOM T2 Grant Line Code T3 Project Code Account Code Estimated Unit Price Estimated Total Price Actual Total Price (SC Use) Y/N (SC
Service # Code Date
Use)

1 Data internet 100Gb 75571402/ Décembre 2023 1.00 Month U1118 OADM 72100 106,000.000 106,000.000
2 Data internet 100Gb 75130509/ Décembre 2023 1.00 Month PF001 OADM 72205 106,000.000 106,000.000
3 Data internet 100Gb 75789295/ Décembre 2023 1.00 Month PF001 OADM 72205 106,000.000 106,000.000
4 Data internet 100Gb 75789322/ Décembre 2023 1.00 Month PF001 OADM 72205 106,000.000 106,000.000
5 Data internet 100Gb 75789398/ Décembre 2023 1.00 Month PF001 OADM 72205 106,000.000 106,000.000
6 Data internet 100Gb 75789569/ Décembre 2023 1.00 Month PF001 OADM 72205 106,000.000 106,000.000
7 Data internet 100Gb 75789590/ Décembre 2023 1.00 Month PF001 OADM 72205 106,000.000 106,000.000

Total 742,000.00
Date Required by Requester Agreed Delivery Date by Supply Chain Aditional Specifications Freight 0.00

Dec 27, 23 PAIEMENT DATA INTERNET TELECEL DECEMBRE 2023 Grand Total 742,000.00
Currency FCFA
Any restricted commodities included above? Yes NO
If this is the first time purchasing this restricted item with this grant, review from Grants Unit Delivery Address and Contact Person:
must be attached. If this is a subsequent purchase, double check previous documents to
ensure compliance. KOKASSE Leonel
KOKASSE Leonel
Donor Specific Regulations:
75460066
Paoua
Central African Republic

Requested By Budget Holder Finance Review Executive/Country Director (20,000 USD and above)

Printed Name DIM Yvan Patrick Printed Name Brahima Bamba Printed Name Printed Name

Title Title Deputy Director of Operations Title Title

Date Date Date Date

Signature Signature Signature Signature

Purchase may proceed if actual cost is no more than 10% greater or 20% less than estimated price. If actual price exceeds this range, PR must be reviewed. No Regional or HQ approval required for any PR.
Form Distribution: Original to Finance, copy #1 to Supply Chain, last copy retained for Requesting Officer's Records (in the PR book) Purchases greater than $20,000 must be reviewed and countersigned by Executive/Country Director

P1 Date PR Received by Supply Chain: ______________ Date PR Completed: ______________