9.22.2021 CTR053476 CI HRPP for Flagstaff Medical Center executed.pdf

Provide full description of services or materials

Estimated Cost Commodity

Requesting Term Supplier ID

Supplier

Contract ID CI Type

SECTION II - Background

Service / Materials

Requestor Email

Title Telephone

SECTION I - Agency Request

Agency

Procurement Determination:

Competition Impracticable Authorization R2-7-E303

SECTIONS 1 THROUGH 3 MUST BE COMPLETED BY THE REQUESTOR

USE ADDITIONAL PAGE AS NECESSARY

Page 1 of 3 SPO 101 - Competition Impracticable Procurement Authorization (rev 03-21)

In accordance with the Procurement Rules, the Arizona Uniform Terms and Conditions must be made a part of all Contracts. If you will be required to sign a software licensing agreement or sign any other agreement containing terms and conditions, which will be made part of the final Contract, you must receive prior approval from the Office of the Attorney General. Approval of this request does not allow for agencies to exceed their dollar acquisition amount of delegated authority.

Date of request Signature

Describe the procurement process, strategy to promote competition and details about fair and reasonable price determination pursuant to R2-7-702

Provide details of the procurement need, the competition impracticable and how the proposed procurement is advantageous to the State

I have conducted research and determined no statewide solution is available for the goods / servcies.

SECTION III - Justification

Rationale

Page 2 of 3 SPO 101 - Competition Impracticable Procurement Authorization (rev 03-21)

Title

Approved Expiration Date

Comments, conditions or restrictions (as applicable)

Use section as necessary

Signature

AGENCY NOTICE: This is an official written determination in response to a procurement authorization request. A copy of the request shall be maintained by the State Procurement Office.

Print name Date

Determination

TO BE COMPLETED BY PROCUREMENT AUTHORITY

SECTION IV - Approval

Page 3 of 3 SPO 101 - Competition Impracticable Procurement Authorization (rev 03-21)

SPO 101 Standard Work

Version

SECTION II

Background

Provide full description of services or materials Detailed description of the agency need

SECTION III

Justification Rationale

Select applicable option in accordance with A.A.C R2‐7‐E303.A and E303.C.1

‐ Compliance with A.R.S. § 41‐2533, 41‐2534, 41‐2538, or 41‐2578 is impracticable

‐ Compliance with A.R.S. § 41‐2533, 41‐2534, 41‐2538, or 41‐2578 is unnecessary

‐ Compliance with A.R.S. § 41‐2533, 41‐2534, 41‐2538, or 41‐2578 is contrary to public interest

‐ Documented lack of suppliers

‐ Procurement requires an open and continuous availability of offerors

SECTION II

Background Commodity APP Commodity code(s)

SECTION II

Background CI Type

Select applicable option:

‐ Authorization Request for a new CI

‐ Modification pursuant to R2‐7‐E303.E for a CI modification

SECTION II

Background Requesting Term

Specify contract term or extension period, as applicable, based on the CI Type selected in the previous section

SECTION II

Background Supplier ID APP Supplier ID

SECTION II

Background Estimated Cost Forecasted expenditures for the duration of the CI Term

SECTION II

Background Supplier Name of supplier(s)

SECTION II

Background Contract ID APP contract number (if available)

Telephone Telephone number of the requestor

SECTION II

Background Service / Materials Description of service / materials, or Contract title (APP Label)

Owner

Form Number SPO 101 ‐ Competition Impracticable Procurement Authorization rev 03‐21

Sections I through III to be completed by the Requestor (in collaboration with the Procurement Officer):

Process Standard Work / Instructions for completion and submittal of the SPO 101 form. The form is available on the

SPO website, section Resources / Standard Forms and Documents.

Section Action Action Detail / Key Points

State Procurement Office, Compliance Unit

SECTION I

Agency Request Agency Name of the requesting agency

SECTION I

Agency Request Requestor Name of the requestor

SECTION I

Agency Request Title Job title of the requestor

SECTION I

Agency Request Email Email of the requestor

SECTION I

Agency Request

Page 1 of 2 SPO 101 Standard Work (rev 03-21)

SPO 101 Standard Work

SECTION IV

Approval

Upon completion, forward the form to the agency Chief Procurement Officer (CPO) or designee.

If anticipated expenditure is above agency's delegation, the CPO shall forward document to SPOCompliance@azdoa.gov.

Approved Expiration Date

Date Specify date of approval

Signature Signature of the approving authority

SECTION IV

Approval

SECTION IV

Approval

Print name

Title

Printed name of the approver

Complete as needed

SECTION IV

Approval

Job title of the approver

Specify date or term

SECTION IV

Approval

SECTION IV

Approval

I have conducted research and determined no statewide solution is available for the goods / services.

SECTION III

Justification

Check the box confirming research was conducted. If the CI pertains to modification pursuant to R2‐7‐E303.E, leave field empty.

SECTION III

Justification

Provide details of the procurement need, the competition impracticable and how the proposed procurement is advantageous to the state

Detail information regarding the rationale selected in the previous section;

agency use of the materials or services; if statewide contracts were explored;

the limitation which led to competition impracticable and how the state would benefit from the procurement. If there is previous contract which requires modification pursuant to R2‐7‐E303.E or contract that reached out max. 5 year term, provide the contract number and copy of the CI.

Specify date

Section IV to be completed by the Procurement Authority:

SECTION IV

Approval

SECTION III

Justification Signature Signature of the authorized requestor

SECTION III

Justification

Describe the procurement process, strategy to promote competition and details about fair and reasonable price determination pursuant to R2‐

7‐702

Detail strategy for the proposed procurement; considered competition, reason for selecting specific supplier and negotiations strategy.

SECTION III

Justification Date of request

Comments, conditions or restrictions

Determination

Select applicable option in accordance with A.A.C R2‐7‐E303.D:

‐ Request Authorized Pursuant to R2‐7‐E303

‐ Request Authorized with Conditions/Restrictions R2‐7‐E303

‐ Request Returned for Additional Information

‐ Request Denied

Section may be used by any party in case the fields within the document were insufficient

Additional section

Page 2 of 2 SPO 101 Standard Work (rev 03-21)

The High Risk Perinatal Contracts, which include transportation, are covered by a classification Competition Impracticable Determination. Any Supplier that can meet the Scope of services required is given a contract to ensure sufficient HRPP coverage across Arizona.

The price is the current rates set by ADHS for ambulance EMS services so the price is considered fair and reasonable.