26292 ADO AED Superstore 1 of 2.pdf

IL 532 3050

ADM 237 Rev. 4/2025 Purchase Request Form Page 1 of 3

Illinois Environmental Protection Agency 2520 West Iles Avenue P.O. Box 19276 Springfield Illinois 62794-9276 (217) 782-3397

Purchase Request Form Important: This form must be completed within Acrobat. It cannot be printed and completed by hand.

Requestor Name: Katie Mauger-Sonnek

Email Address: kathryn.mauger-sonnek@illinois.gov

Phone: 217-306-3537

Date: 8/7/2025

Location: Headquarters

Bureau: Associate Director

Section: Office of Emergency Response

Request Type:Small Purchase over $10,000

Type of Procurement:Equipment, Non-IT

Delivery Address: OER Mail Code #29, 2520 W Iles Ave, PO Box 19276, Springfield IL 62794-9276

Proposed Contract Dates

Start:

End:

↓↓ For Staff Use Only ↓ ↓ Tracking Number: 26292

Approver Approvals Bureau Chief

Accounts Payable

Cost Recovery / Grants

Finance Manager

CFO

IT/DoIT Manager

(if applicable)

Suggested Vendor #1

Name: AED Superstore

Address: 5000 Bradenton Ave

City: Dublin State: OH Zip: 43017

Contact:

Email:

Phone: (800) 544-0048

Suggested Vendor #2

Name: Second Chance Cardiac Solutions

Address: 103 S. Bridge Street

City: Yorkville State: IL Zip: 60460

Contact:

Email: sales@sccsolutions.net

Phone:

ADM 237 Rev. 4/2025 Purchase Request Form Page 2 of 3

Description of Services Describe what it is that you intend to procure (software, hardware, services, maintenance, etc.) including quantity if relevant. Describe business need for the procurement, and how the procurement will meet objectives of your agency and the State. Please make sure to spell out acronyms. Explain the potential consequences if this procurement is not approved. If other than a one-time purchase, explain solicitation method and pricing structure (hourly, per item, not-to-exceed, etc.).

The IEPA regional offices need new AEDs and AED supplies. I used AEDSuperstore just for reference. I recommend ordering the ZOLL AED Plus due to its ease of use.

Chicago and Elgin need 3 AEDs total (1 for Chicago and 1 for each level in Elgin). They do not have any equipment so they need the whole kits. Rockford, Des Plaines, Champaign, and Marion need new everything (Basic AED, CPR/AED Pack, except for cabinets. Des Plaines need 2 of everything (1 for each level).

It is recommended to have back up CPR pads and batteries so I have included the appropriate number for regional offices. Also AED check tags are needed to keep track of maintenance. I prefer pads that have feedback built in as it walks the responder through appropriate compression depth and speed- higher quality. Collinsville, Peoria, and Labs have a different brand of AED that is in good working condition, so they need different replacement pads and batteries. Peoria currently has 2 AEDs, one on each level. Peoria and Collinsville have all expired pads and Labs just needs 1 backup pad.

Object Code Item Description (Include catalog # or MFG) 1 Equipment? 2 Quantity Unit of Measure Unit Price Total Price

BVPAEDPLUSPB ZOLL AED Plus Small Business Value Package Yes 3 1 2,034 $6,102.00

8900-0800-01 ZOLL Replacement CPR-D-Padz Yes 8 1 230 $1,840.00

8000-0807-01 ZOLL AED Plus Replacement Lithium Batteries Yes 8 1 100 $800.00

201000001020110 ZOLL AED Plus Yes 5 1 2,021 $10,105.00

AMP1011 RespondER Premium CPR/AED Pack Yes 8 1 20.79 $166.32

AMP3737 AED CHECK Tag Yes 12 1 5.95 $71.40

XELAED002A Cardiac Science Powerheart G5 Adult Intell Pads Yes 6 1 274 $1,644.00

XBTAED001A Cardiac Science Powerheart AED G5 Intel Battery Yes 4 1 495 $1,980.00 1 Any IT purchases must be approved by EPA DoIT COI.

2 Mark "No" if unit price is under $100.

Shipping

Note: Attach detailed specification, if required, on separate sheet of paper. Request Total $22,708.72

Add a row Delete last row

Procurement Justification

Yes✔ No Is the combined total of this purchase over $10,000?

If Yes, download the Procurement Justification form from the Chief Procurement Office's BidBuy forms web page, then complete and attach it when you submit this form.

Small Purchase with Sole Source Conditions Justification

Yes No✔ Is this a small purchase with sole source conditions?

ADM 237 Rev. 4/2025 Purchase Request Form Page 3 of 3

Cost Recovery or Potential Cost Recovery

Yes No✔

Quality Management Plans (EPA QA/R-2)

Yes No✔ Is data generation being performed under a Quality Management Plan (QMP), Quality Assurance Project Plan (QAPP), and/or Standard Operating Procedure (SOP) for this agreement? (View QMP details here.)

Estimated Multi-Year Funding

FY Amount FY Amount

↓↓ For Fiscal Use Only ↓ ↓

Funding Source(s)

Fund Functional Area Cost Center GL Internal Order Amount

0065000000 19000006PY000000 5321001300 SEE MIKE 900000 $7,569.57

0065000000 19000006PY000000 5323001300 SEE MIKE 900000 $7,569.57

0065000000 19000006PY000000 5326001300 SEE MIKE 900000 $7,569.58

IL 532 3050 ADM 237 Rev. 4/2025 Purchase Request Form Page of .\EPA logo B&W (no words).gif Illinois Environmental Protection Agency 2520 West Iles Avenue P.O. Box 19276 Springfield Illinois 62794-9276

(217) 782-3397 Purchase Request Form Important: This form must be completed within Acrobat. It cannot be printed and completed by hand.

Proposed Contract Dates ↓↓ For Staff Use Only ↓ ↓ Approver Approvals Bureau Chief Accounts Payable Cost Recovery / Grants Finance Manager

CFO

IT/DoIT Manager(if applicable) (Person authorized to sign agreement for grantee) New Contract Job Order Costs Work Order Costs Amendment Costs or Term Changes Funding Update Suggested Vendor #1 Suggested Vendor #2 Object Code Item Description (Include catalog # or MFG) 1 Equipment? 2 Quantity Unit of Measure Unit Price Total Price 1 Any IT purchases must be approved by EPA DoIT COI.

2 Mark "No" if unit price is under $100.

Shipping Note: Attach detailed specification, if required, on separate sheet of paper.

Request Total Procurement Justification Is the combined total of this purchase over $10,000?

If Yes, download the Procurement Justification form from the Chief Procurement Office's BidBuy forms web page, then complete and attach it when you submit this form.

Sole Source Justification Did you include and email to the assigned buyer the Sole Source Justification Form?

If No, download the Sole Source Justification form from the Illinois Procurement Policy Board web page, then complete and attach it when you submit this form.

Small Purchase with Sole Source Conditions Justification Is this a small purchase with sole source conditions?

If Yes, download the Small Purchase Sole Source Justification form from the Illinois Chief Procurement Office for General Services web page, then complete and attach it when you submit this form.

Federal Source Is funding from a federal source?

Cost Recovery or Potential Cost Recovery Quality Management Plans (EPA QA/R-2) Is data generation being performed under a Quality Management Plan (QMP), Quality Assurance Project Plan (QAPP), and/or Standard Operating Procedure (SOP) for this agreement? (View QMP details here.)

If Yes, the Bureau should work with the assigned QA staff and must provide specifications outlining requirements to procurement.

Estimated Multi-Year Funding

FY

Amount

FY

Amount ↓↓ For Fiscal Use Only ↓ ↓ Funding Source(s) Fund Functional Area Cost Center

GL

Internal Order Amount Illinois EPA Procurement Officer Wally Hartshorn Andrew Shackleford, Monique Wantland, Max Paller 8/3/2020 Purchase Request Form 4/16/2025 Office of Emergency Response Office of Community Relations Office of Environmental Justice Office of Energy Safety/Training Environmental Education Contract Number:

Contract Name:

Vendor Name:

Vendor Project Contact:

Vendor Email:

Vendor Phone:

Amount:

Yes No Cooperative Agreement Number:

Agreement Expiration Date:

No No

It is recommended to have back up CPR pads and batteries so I have included the appropriate number for regional offices. Also AED check tags are needed to keep track of maintenance. I prefer pads that have feedback built in as it walks the responder through appropriate compression depth and speed- higher quality. Collinsville, Peoria, and Labs have a different brand of AED that is in good working condition, so they need different replacement pads and batteries. Peoria currently has 2 AEDs, one on each level. Peoria and Collinsville have all expired pads and Labs just needs 1 backup pad.