The University of
Connecticut Health Center The University of
Connecticut Health Center
Office of Materials Management
SUPPLY INVENTORY CERTIFICATE
DATE: __/__/__
TO: Jack Ferraro,
Director of Materials Management and Operations Manager
Building J, MC 6170
Telephone: 679-1927 Fax: 679-1993
FROM:
Responsible Person: ______________________________________________________
Department: ______________________________________________________
Division: ______________________________________________________
Telephone No.: _____________ Room No.: _______________ MC: __________
CERTIFIED STATEMENT:
The
Annual Physical Inventory for the department and/or division stated above was completed on __/__/__, and is certified to be true and correct. The total value of the Inventory was $____________.____. The original copy of the Physical Inventory will be kept on file in my office for future reference. I realize that this Inventory Report must be kept on file for three (3) years or until audited by the State of Connecticut.AUTHORIZED SIGNATURES:
__________________________________________________ __/__/__
Responsible
Person
Date
__________________________________________________ __/__/__
Department
Head
Date
MM-5 -- 5/02