2-Sole Source Impact Technologies (1).pdf

i This Page Not Intended for Public Posting

AWARD OF CONTRACT WITHOUT ENGAGING IN A STANDARD PROCUREMENT PROCESS

REQUEST FORM

NOTICE: ALL REQUESTS OVER $1,000 MUST BE PRE-APPROVED BY UDOT PROCUREMENT, UNLESS R33- 5-104 (Small Purchases) OF THE ADMINISTRATIVE RULES APPLIES TO THE PROCUREMENT. THIS

FORM IS FOR THIS REQUIRED PRE-APPROVAL PROCESS

Submit this completed form along with a copy of the quote from the vendor to UDOT Procurement through PSO.

Award cannot be made unless UDOT Procurement pre-approves in writing that: there is only one source for the procurement item; transitional costs are a significant consideration in selecting a procurement item; or the award of a contract is under circumstances that make awarding the contract through a standard procurement process impractical and not in the best interest of the procurement unit.

An urgent or unexpected circumstance or requirement for a procurement item does not justify the award of contract without engaging in a standard procurement process.

Complete each section and provide as much information as needed to fully respond.

Attach the proposed Scope of Work that your department/division has developed as part of this Notice of

Intent to Award of Contract without Engaging in a Standard Procurement Process Request Form.

Attach the quote received from the vendor, so that UDOT Procurement can confirm the quote. Quotes cannot be marked as confidential, as they may be published.

Requests missing information will be rejected and returned to the contact person for completion.

o UDOT Procurement may seek additional information from the contact person.

Attach a copy of the terms and conditions provided to the vendor, if any.

The first two pages of this form will not be posted; however, all of the subsequently numbered pages may be posted, as is, for public notice and comment. Please be complete in your answers.

For Technology Contracts or Purchase Orders Only:

Information Technology (IT) award of contract without engaging in a standard procurement process procurements must be submitted to the Department of Technology Services for initial review. DTS will send the request to UDOT Procurement. “Information Technology” is defined in Utah Code 63F-1-102.

IT requests resulting in a contract must be sent to dtscontracts@utah.gov IT requests resulting in a purchase orders must be sent to dtsprocurement@utah.gov

Complete the following vendor information:

Vendor Name: Impact Technologies VI LLC Vendor Contact Person: Michael Kempen Vendor E-mail Address: mkempen@nyc.rr.com Vendor Telephone Number: 646-752-3810 Vendor Ordering Address: P.O. Box 9368 St. Thomas, VI 00801 Vendor Remittance Address: P.O. Box 9368 St. Thomas, VI 00801 FINET Vendor Number (if available): VC 244582 All items in the above section are required.

Complete the following if no FINET number exists:

Vendor Federal Tax ID# (TIN): (9 Digits): 66-0934497 Type of Vendor: Partnership

Requesting Unit Contact Information:

Department/Division Name: Region 1 Contact Person and Title: Tom Roylance Region 1 District Engineer E-mail Address: troylance@utah.gov Telephone Number: 801-620-1650

DTS Contact (Required for IT related SS):

DTS Business Case Title:

mailto:dtscontracts@utah.gov mailto:dtsprocurement@utah.gov ii This Page Not Intended for Public Posting

DTS Business Case Number: ELCID Number:

Required Documents:

1. Scope of Work: Has the proposed Scope of Work been attached to this Request Form? Yes No

(NOTE: UDOT Procurement cannot process this Request Form until it has received the proposed Scope of Work.)

2. Vendor Quote: Attach the quote received from the vendor. Quotes cannot be marked as confidential, as they may be published.

3. Other (if applicable): Please provide a copy to UDOT Procurement

THIS SECTION RESERVED FOR UDOT PROCUREMENT

The public notice shall be (Check the box that applies):

a.

If the cost of the procurement exceeds $50,000 then the publication of the notice must be made in accordance with Section 63G-6a-112. Procurements under $50,000.00 are not required to be published, but may be published at the discretion of the chief procurement officer or head of a procurement unit with independent procurement authority.

Published: Not Published:

b. Publication is not required for procurement pursuant to a trial use contract.

c.

Publication is waived for an award of contract without engaging in a standard procurement process procurement:

For any procurement item identified in R33-8-101e.(2a)(i-xii);

For award to a specific supplier, service provider, or contractor is a condition of a donation or grant that will fund the full cost of the supply, service, or construction item;

For other circumstances as determined in writing by the chief procurement officer or head of a procurement unity with independent procurement authority (i.e. public utility services, compatibility considerations, unique or specialized or time-limited opportunity).

The Terms and Conditions that will be attached to the awarded agency contract/purchase order:

Agency Contract: Goods Services IT for DTS only Att. B IT Non-DTS (include DTS Exception Form, if applicable) Purchase Order: Goods Services IT for DTS only Att. B IT Non-DTS (include DTS Exception Form, if applicable)

Posting Information Agent:

Notice#:

Additional Research & Comments:

Summary of Contest(s) Received & Determination:

Recommend Award: Approved by Management for Award:

Cody Nelson UDOT Procurement Agent Date UDOT Procurement Management Date

1 revision date: 01-07-2020

STATE OF UTAH - DEPARTMENT OF TRANSPORTATION

UDOT Procurement

NOTICE OF INTENT TO AWARD A CONTRACT WITHOUT ENGAGING IN A STANDARD PROCUREMENT

PROCESS

UDOT Procurement is publishing this notice pursuant to the Utah Procurement Code. The Requesting Unit submitted this form to UDOT Procurement claiming that it intends to award a contract without competition if it is determined by UDOT Procurement, in writing, that:

there is only one source for the procurement item;

transitional costs are a significant consideration in selecting a procurement item; or the award of a contract is under circumstances, described in rules adopted by the applicable rulemaking authority, that make awarding the contract through a standard procurement process impractical and not in the best interest of the procurement unit.

In the subsequent pages the Requesting Unit has identified its justification for pursuing this process.

Determination of Other Interested Providers The intent of this notice is to determine if there are any other interested and qualified providers that meet the specifications of this notice. Any such providers must submit the following information:

The name of the provider; and A detailed explanation of the challenge, including documentation showing that there are other competing sources for the procurement item.

In addition, a provider should include:

Documentation that the provider can provide a comparable or better procurement item that meets or exceeds the specifications;

Documentation that the provider can also provide the same proprietary procurement item or an equivalent procurement item;

and If transitional costs are identified as the justification for this notice, submit a cost comparison of the identified transitional costs with the provider’s anticipated transitional costs.

Regardless of any prior communications with UDOT Procurement or the State, all providers interested in responding to this notice must submit a response to this posting containing complete responses to all of the information requested above.

DO NOT CONTACT THE REQUESTING UNIT. Any questions regarding this notice, including obtaining additional information, must be obtained through UDOT Procurement during the publication period. No action is required if you agree with this Notice.

If, after the public notice period has passed, UDOT Procurement determines that there are other interested and qualified providers that meet the specifications of this notice; UDOT Procurement will not award a contract pursuant to this notice.

If, after the public notice period has passed, no valid challenges have been received, then the UDOT Division of Procurement may award a contract to the identified vendor without competition.

Please read the entire form very carefully before responding to this notice.

2 revision date: 01-07-2020

It is anticipated that this procurement will result in a:

RESULT ACTION

UDOT Agency Contract

1. The term of this contract will be: 5 year and renewal options: .

2. NOTICE: The Requesting Unit may not make the procurement until the solicitation process is completed and a contract is written and signed by the Requesting Unit, the vendor, and UDOT Procurement.

Purchase Order

1. The Requesting Unit may not make the procurement until after the solicitation process is completed, the purchase order is signed by UDOT Procurement, and the purchase order is delivered to both the Requesting Unit and the vendor.

2. Insert the Accounting Coding: Example: 8301 XDA B87E12

Other

___ GAX

___ P Card

1. NOTICE: The GAX option is for EXTENUATING circumstances only. Requesting Unit may not make the procurement until after the solicitation process is completed and the method of payment has been approved by UDOT Procurement.

2. Insert the Accounting Coding: Example: 8301 XDA B87E12

Description of procurement item to be purchased: Replacement parts for truck escape ramp arrestor system.

Estimated Total Term Cost/Cost per quote: 150,000.00 Freight Cost (F.O.B. Destination, Freight Prepaid):

Vendor Name: Impact Technologies VI LLC

Explain in detail the service or product to be procured (additional information is found on any attached Scope of Work):

Replacement parts for truck escape ramp arrestor system, UDOT maintenance staff will complete the repairs.

Complete disclosure must be included with this request if the requestor has any personal, financial, or fiduciary relationship with the vendor. (Please Attach)

CHECK THE BOX THAT IDENTIFIES WHY A CONTRACT SHOULD BE AWARDED WITHOUT ENGAGING IN A

STANDARD PROCUREMENT PROCESS:

There is only one source for the procurement item, or Compatibility of equipment, technology, software, accessories, replacement parts, or service, including professional services, is the paramount consideration.

Complete section A

Transitional costs are a significant consideration in selecting a procurement item and the results of a cost-benefit analysis demonstrate that transitional costs are unreasonable or cost-prohibitive.

Complete section B

The award of a contract is under circumstances, described in rules adopted by the applicable rulemaking authority, that make awarding the contract through a standard procurement process impractical and not in the best interest of the procurement unit.

Complete section C

A procurement item is needed for trial use or testing to determine whether the procurement item will benefit the agency. Complete section D

SECTION A: ONLY ONE SOURCE

1. What is unique about this procurement item to justify an award of contract without engaging in a standard procurement process? (Explain in detail why the service or product is only available from a single supplier.)

Impact Technologies owns the patent on this technology and are the only supplier for these replacement parts.

2. Could the procurement item be reasonably modified to allow for competition?

Not at this time.

3. Explain the market research performed.

This system is the first of it’s kind in the state of Utah, Impact Technologies owns the patent at this time.

4. What research have you conducted to ensure the requested item is not available on an existing state cooperative contract?

Inquired Interwest safety and Safety supply and sign, was also informed of patent holder by Region 1 PE.

3 revision date: 01-07-2020

5. If there is only one source for the procurement item, list the names of other similar vendors contacted, contact person, and a summary of their response, Interwest Safety Supply, Dave Krantz, They do not currently stock nor supply arrestor system parts.

6. If the requestor has any personal, financial, or fiduciary relationship with the recommended vendor it must be disclosed in space below.

SECTION B: TRANSITIONAL COSTS

1. Describe the existing equipment, technology, software, accessories, replacement parts, or service, hereafter referred to as equipment; include the original purchase price and date of purchase for the existing equipment.

2. Please supply the following:

a. Procurement method that was used to purchase the existing equipment? (IFB, RFP, Sole Source):

b. Solicitation number, RQS number, or sole source number for the existing equipment:

c. Contract number for the existing equipment:

3. Attach the cost-benefit analysis, as required by Utah Code Section 63G-6a-802 that demonstrates that transitional costs are unreasonable or cost-prohibitive.

SECTION C: STANDARD PROCUREMENT PROCESS IMPRACTICABLE

1. Cite the applicable rule that provides that awarding the contract through a standard procurement process is impractical and not in the best interest of the procurement unit under the circumstances; including any supporting documentation.

2. Please supply the following, if applicable:

a. Procurement method that was used to purchase the existing equipment? (IFB, RFP, Sole Source):

b. Solicitation number, RQS number, or sole source number for the existing equipment:

c. Contract number for the existing equipment

SECTION D: PROCUREMENT ITEM IS NEEDED FOR TRIAL USE OR TESTING TO DETERMINE WHETHER

THE PROCUREMENT ITEM WILL BENEFIT THE AGENCY

1. Why is the trial use or testing necessary? (Explain the purpose of the trial use or testing of the procurement item.)

2. What is the anticipated end result of the trial or test?

3. Do any other similar vendors provide this product or service?

a. If yes, list the company names, and whether their products will be tested:

4. What criteria were used to choose this vendor?

5. What is the scope, size, and location of test or trial?

6.

Contracts for trial and testing must follow the criteria listed in UCA 63G-6a-802.3, and the period for a trial use or testing of a procurement item under a trial use contract may not exceed 18 months, unless the procurement officer provides a written exception documenting the reason for a longer period. Exception attached yes: no:

LEASING PERSONAL PROPERTY (Not Real Property) Lease requests must include an approved FI 9 State of Utah Lease Obligation Record form from the Division of Finance. The FI 9 State of Utah Lease Obligation Record form can be found on the Division of Finance website finance.utah.gov under Forms.

The Finance policy FIACCT 09-21.00 Fixed Assets – Leases can be found on the Division of Finance website under Accounting Policies and Procedures. Approved FI 9 attached.