23-416CMS-BOPM4-P41059.53 PO.PDF
PDF 15 KB Posted
- Contract number
- 23-416CMS-BOPM4-P-41059
- Issued by
- Illinois
About this file
This document is a Purchase Order (PO) issued by the Illinois Department of Human Services (DHS), specifically for the Mabley Developmental Center located in Dixon, IL. The vendor is Triton Testing and Design, a company based in Freeport, IL, with contact details and vendor number V00003144. The purchase order is associated with Master Contract #9100001463 and is part of a state procurement process.
The purchase order covers two primary line items for the fourth year of the contract: (1) Basic hourly labor rate for services performed Monday through Friday, 8 am-5 pm, priced at $144 per hour with a total of 84 hours, amounting to $12,096, and (2) Materials at cost for repair, priced at a flat rate of $3,780. The total contract value is $15,876, with no additional tax or freight charges. The release period for this purchase order is from October 3, 2025, to December 31, 2025, indicating a specific service timeframe for the fourth year of the contract.
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| File | Type | Posted |
|---|---|---|
| Triton Bid for Dishwasher Installation.pdf |
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Text version
23-416CMS-BOPM4-P-41059:53
Vendor Number: V00003144 Triton Testing and Design
145 S Stephenson St Freeport, IL 61032 scl@tritontestbalance.com
(866) 874-8662
Purchase Order
DHS - Human Services
23-416CMS-BOPM4-P-
41059:53
Contract/PO #:
Release Order Number
Master Contract? Y
S H I P
T O
Mabley Developmental Center 1120 Washington Avenue Dixon, IL 61021
US
Email: toni.naeve@illinois.gov
(815) 288-8335
VENDOR INSTRUCTIONS:
PURCHASE ORDER REQUIREMENTS - STATE OF ILLINOIS AGENCIES
Prior to commencement of billable work, delivery of supplies or rendering of any service on a Purchase Order:
--Initial Purchase Order/Contract - All parties, including the State and vendor, must fully execute the contract in its entirety.
--Release from an existing Purchase Order/Contract - The vendor must receive a Purchase Order signed by the State Agency and attached in BidBuy. Note, for any additional requirements see specific State Agency instruction.
PURCHASE ORDERS REQUIREMENTS - OTHER PURCHASING ENTITIES
--Please see specific requirements provided by the purchasing entity.
B I L L
T O
Mabley Developmental Center 1120 Washington Avenue Dixon, IL 61021
US
Email: toni.naeve@illinois.gov
(815) 288-8335
Solicitation (Bid) No.: N/A
Shipping Method:
Shipping Terms:
Release Begin Date: 10/03/2025 Release End Date: 12/31/2025
V E N D O R
Freight Terms:
Payment Terms: NA
Delivery Calendar Day(s) A.R.O.: 1
Master Con/Ref #: 9100001463
Item # 1
Class-Item 914-68
Region 2: Basic hourly labor rate Mon-Fri 8 am-5 pm for the fourth year.
Quantity UOMUnit Price Discount % Total Discount
Tax Rate Tax Amount
Freight Total Cost
84.00 HR$ 144.00 0.00 % $ 0.00 $ 0.00 $ 0.00 $ 12,096.00
Item # 2
Class-Item 914-68
Region 2: Materials at cost for repair for the fourth year.
Quantity UOMUnit Price Discount % Total Discount
Tax Rate Tax Amount
Freight Total Cost
1.00 EA$ 3,780.00 0.00 % $ 0.00 $ 0.00 $ 0.00 $ 3,780.00
TOTAL: $ 15,876.00
TAX: $ 0.00
FREIGHT: $ 0.00
APPROVED
By:
Phone#:
Toni Naeve
(815) 288-8335
BUYER
The undersigned agree to the Terms and Conditions as acknowledged by the Vendor and maintained in the State of Illinois' e-procurement system. This agreement consists of all terms as maintained in the state's e-procurement system inclusive of attached documents. The Vendor affirms that the Certifications and Financial Disclosures and Conflicts of Interest are true and accurate as of the date of the Vendor's execution of this Agreement. State documents will prevail in the event of a conflict between State and Vendor documents and information. The undersigned agree to the Terms and Conditions of this agreement:
OFFICIAL SIGNATURES:
Vendor Name: _______________________________
Vendor Signature: _________________________________
Printed Name: ______________________________
Title: _____________________________________
Phone #: ___________________________________
Email:______________________________________
Date: ______________________________________
State of Illinois Agency or Other Purchasing Entity Procuring State Agency or Entity: __________
Official Signature: _________________________________
Printed Name: ______________________________
Title: _____________________________________
Designee Signature: ________________________
Printed Name: ______________________________
Title: _____________________________________
Date: ______________________________________
Legal Signature: _________________________________
Printed Name: ______________________________
Title: _____________________________________
Date: ______________________________________
Fiscal Signature: _________________________________
Printed Name: ______________________________
Title: _____________________________________
Date: ______________________________________
FOR STATE OF ILLINOIS USE ONLY:
Acq. Type: ________________Source Sel. Method: _______________ Using Agency Funding Source:__________________________________ Detailed Expenditure Object Code:_____________________________ Approp. Acct Code: ___________________________________________ Award Code: __________________________________________________ Original Proc. Method:________________________________________ Subcontractors Disclosed:_____________________________________ Subcontractors Utilized:______________________________________ Publication Date:____________________ Financing Needed:_______ IPG Cert/Disclosure Yes_________ No__________________________
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