6309 DOA-3831 STAR Piggybacking Request.doc
DOC document 695 KB Posted
- Contract number
- 410014-M18-CJO6309-RFB-01
- Issued by
- Wisconsin
About this file
This is a Wisconsin State STAR Piggybacking Request form (DOA-3831) that allows state agencies to utilize existing contracts established by other agencies. The document involves the Wisconsin Department of Corrections (agency business unit 410) as the originating/contracting agency, with contact person Charlene Orsted from Purchasing Services. The form indicates that another unspecified agency is requesting to piggyback on this existing contract, and that the Department of Corrections has agreed to allow this usage.
The contract (410014-M18-CJO6309-RFB-01) is with Pan-O-Gold Baking Company (supplier ID 0000029813) for the purchase and delivery of fresh bakery products. The contract was competitively bid under RFB #CJO-6309 and covers commodity/service codes 37500 and 37515 with an estimated annual spend of $422,313. The contract runs from October 1, 2017, through September 30, 2018, with four one-year renewal options available. The scope includes emergency needs and short notice deliveries to Department of Corrections and Department of Health Services locations, with additional potential usage by the Wisconsin School for the Deaf, Wisconsin Center for the Blind and Visually Impaired, and Wisconsin Challenge Academy. Pan-O-Gold has also agreed to extend contract pricing to municipalities upon request.
View the file
Other files
Show all 39
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
State of Wisconsin
Department of Administration
DOA-3831 (r08/2017)
S. 16.71 Wis. Stats
State Bureau of Procurement
101 East Wilson Street, 6th Floor
P. O. Box 7867
Madison, WI 53707-7867
STAR Piggybacking Request Instructions: Send the completed form via e-mail to:
Section 1: Agency Requesting Piggyback
| Agency Requesting Piggyback: |
| Agency Business Unit Number: |
| Agency Contact Name: |
| Phone Number: |
| E-Mail Address: |
FORMCHECKBOX
My agency has notified the Originating/Contracting Agency identified in Section 2 below that we intend to use their contract and they have agreed.
Section 2: Originating/Contracting Agency
| Originating/Contracting Agency: |
| Agency Business Unit Number: |
| Department of Corrections |
| 410 |
| Originating/Contracting Agency Contact Name: |
| Phone Number: |
| E-Mail Address: |
| Charlene Orsted, Purchasing Services |
| (608) 240-5583 |
| charlene.orsted@wisconsin.gov |
Section 3: Contract Information
| Contract Number |
| Supplier Name |
| Supplier ID Number |
| 410014-M18-CJO6309-RFB-01 |
| Pan-O-Gold Baking Company |
| 0000029813 |
| Commodity/Service Codes: |
| 37500, 37515 |
| Estimated Annual Spend: |
| $422,313.00 |
Is the purchase of software included in this request? If “yes”, complete Section 5 below. Yes FORMCHECKBOX No FORMCHECKBOX
N/A FORMCHECKBOX
Section 4: Eligibility Check
FORMCHECKBOX
My agency has validated the following, in compliance with the requirements of the State Procurement Manual, PRO-D-29.
FORMCHECKBOX
Contract is Open
| Contract Effective Dates: |
| 10/01/2017-9/30/2018 |
| Renewal Options: |
| 4, one-year renewals |
FORMCHECKBOX
Competitively Bid
| Request for Bid/Proposal Number: |
| RFB #CJO-6309 |
FORMCHECKBOX
Supplier(s) is/are not on the Certification for Collection of Sales and Use Tax Ineligible Vendor Directory
FORMCHECKBOX
Supplier(s) is/are not on the Contract Compliance Ineligible Vendor Directory
Impact, if any, on any minority business enterprise, disabled veteran-owned business or work center:
No impact.
FORMCHECKBOX
Contract scope matches my agency’s need.
Description of the scope of the original procurement and how it corresponds to the commodity/service to be purchased:
Purchase and delivery of fresh bakery products to DOC and DHS locations. Emergency Needs, short notice, supplier to any DOC DHS location. Option for Wisconsin School for the Deaf, Wisconsin Center for the Blind and Visually Impaired and Wisconsin Challenge Academy noted as locations that have expressed interest in utilizing the contract. Pan-O-Gold agrees to allow Municipalities to utilize this contract, and provide products at contract price, if they request to do so.
State Bureau of Procurement Use Only
Request Approved:
FORMCHECKBOX
Yes FORMCHECKBOX No Date:
Approved By (Initial):
If UW, STAR Contract Number Assigned:
Section 5: Software Purchase Impact on STAR System
State agency software purchases must be compliant with the STAR Software Purchasing Policy (see PIM 17-001 and additional reference material attached therein). Please complete Section 5 for software purchases and include a technical contact that can be reached for questions related to your agency’s request.
Agency Technical Contact Name:
Phone Number:
E-Mail Address:
FORMCHECKBOX
My agency has reviewed the in-scope modules of the STAR System and we do not consider the requested software to overlap or conflict with system functionality.
FORMCHECKBOX
My agency has reviewed the in-scope modules of the STAR System and the requested software does appear to overlap or conflict, in whole or in part, with system functionality. We hereby request that approval be granted to make the purchase.
Provide a rationale for approval of the request where there appears to be a conflict or overlap with the STAR System:
This document can be made available in alternate formats to individuals with disabilities upon request.
_1567252809.unknown
File details come from the government source that posted it. Updated .