B-23442 Emergency Purchase Stmt PPE Signed.pdf

EMERGENCY PURCHASE STATEMENT

Statement Page 1 of 1 State of Illinois Chief Procurement Office Emergency Purchase Statement Version 20.1

Zip: 60439State: IL City: LemontAddress: 1256 Janus Lane

Vendor: The Moving Concierge

Zip: 62702State: ilCity: SpringfieldAddress: 410 N. 4th Street Centrum No. 2nd Floor

Division: Office of Clinical Administrative and Program SupportAgency: Department of Human Services

Emergency Purchase Details Reference #:

Emergency Category (select the appropriate option from the drop-down menu below):

Involving threat to public health or public safety

Reason for selection of this particular vendor:

Established vendor and master contract holder with multi-year relationship with IDHS was able to procure and deliver personal protection equipment for COVID19 Crisis in a relatively short timeframe.

Description of supplies or services to be provided:

10,000 Gloves; 15,000 Face Shields; 1,000,000 KN95 masks or equivalent in compliance with CDC standard for COVID19; 1,000,000 surgical masks.

UNABLE TO SIGN FORM AT TIME OF FILING DUE TO SHELTER AT HOME ORDER.

Is there an existing State contract available for the required supplies or services? Yes No

Expected Start Date: Apr 1, 2020 Estimated End Date*: Jun 29, 2020

Amount of this expenditure is: 3672500.00 Actual or Estimated*: Estimated *

*Actual end date and cost will be reported later.

Select the type of funding to be used: Federal Funds State Appropriated Funds State Grant Funds Other

Signatures

I am making this statement and providing it to the CPO Office, the Auditor General, and the Procurement Policy Board in compliance with the Illinois Procurement Code and within 10 days after award of the contract.

I have authorized the emergency procurement in accordance with the requirements of the Illinois Procurement Code (30 ILCS 500) and the applicable administrative rule. I know and understand the contents of this statement and all statements herein are true and correct to the best of my knowledge.

Agency Signature: Title: Agency Procurement Officer

Printed Name: Jean Sandstrom Date: Apr 1, 2020

EMERGENCY PURCHASE EXTENSION

Extension Page 1 of 2 State of Illinois Chief Procurement Office Emergency Purchase Statement Version 20.1

Zip: 60439State: IL City: LemontAddress: 1256 Janus Lane

Vendor: The Moving Concierge

Zip: 62702State: ilCity: SpringfieldAddress: 410 N. 4th Street Centrum No. 2nd Floor

Division: Office of Clinical Administrative and Program SupportAgency: Department of Human Services

Extension Justification Reference #:

Original Emergency Term Start Date: Original Emergency Term End Date:

Amount of original: Actual or Estimated*:

Expected Extension Start Date: Expected Extension End Date*:

Amount of extension expenditure: Actual or Estimated*:

Select the type of funding to be used: Federal Funds State Appropriated Funds State Grant Funds Other

Describe the scope of the original emergency (supply, service, etc.):

Describe the scope of the extension (supply, service, etc.). Show justification for extending the original emergency contract, and explain why the extension need cannot be met through a competitive process:

Was authorization to proceed verbally given? No Yes NA

Term of emergency procurement shall not exceed 90 days. Contract may be extended beyond 90 days if CPO determines additional time is necessary; however, prior to execution of extension, CPO must hold a public hearing and provide written determination

*Actual end date and cost will be reported later.

EMERGENCY PURCHASE EXTENSION

Extension Page 2 of 2 State of Illinois Chief Procurement Office Emergency Purchase Statement Version 20.1

Zip: 60439State: IL City: LemontAddress: 1256 Janus Lane

Vendor: The Moving Concierge

Zip: 62702State: ilCity: SpringfieldAddress: 410 N. 4th Street Centrum No. 2nd Floor

Division: Office of Clinical Administrative and Program SupportAgency: Department of Human Services

Signatures Reference #:

I am requesting an extension of the requested emergency contract. I know and understand the contents of this statement and all statements herein are true and correct to the best of my knowledge.

Agency Signature: Title:

Printed Name: Date:

Approved CPO/SPO Signature: Date:

EMERGENCY PURCHASE FINAL COST AND TERM

Final Cost and Term Page 1 of 1 State of Illinois Chief Procurement Office Emergency Purchase Statement Version 20.1

Zip: 60439State: IL City: LemontAddress: 1256 Janus Lane

Vendor: The Moving Concierge

Zip: 62702State: ilCity: SpringfieldAddress: 410 N. 4th Street Centrum No. 2nd Floor

Division: Office of Clinical Administrative and Program SupportAgency: Department of Human Services

Final Costs and Term Reference #: B-14104 & B-23442

Final total cost of supplies and services: 3672500.00 Final total term of contract: 2 months

I am reporting the final costs and term for the referenced emergency contract to the CPO and the Auditor General.

Agency Signature: Title: Agency Procurement Officer

Printed Name: Jean Sandstrom Date: Jun 27, 2021

Page of

EMERGENCY PURCHASE STATEMENT

State of Illinois Chief Procurement Office Emergency Purchase Statement Version 20.1 .\CPO Letterhead\CPO Letterhead.png

EMERGENCY PURCHASE STATEMENT

Statement Page of State of Illinois Chief Procurement Office Emergency Purchase Statement Version 20.1 .\CPO Letterhead\CPO Letterhead.png Emergency Purchase Details Emergency Category (select the appropriate option from the drop-down menu below):

Reason for selection of this particular vendor:

Description of supplies or services to be provided:

Is there an existing State contract available for the required supplies or services?

If Yes is checked above, explain why the existing contract does not meet the need:

Actual or Estimated*:

*Actual end date and cost will be reported later.

Select the type of funding to be used:

Signatures I am making this statement and providing it to the CPO Office, the Auditor General, and the Procurement Policy Board in compliance with the Illinois Procurement Code and within 10 days after award of the contract.

I have authorized the emergency procurement in accordance with the requirements of the Illinois Procurement Code (30 ILCS 500) and the applicable administrative rule. I know and understand the contents of this statement and all statements herein are true and correct to the best of my knowledge.

EMERGENCY PURCHASE EXTENSION

Extension Page of State of Illinois Chief Procurement Office Emergency Purchase Statement Version 20.1 .\CPO Letterhead\CPO Letterhead.png Extension Justification Actual or Estimated*:

Actual or Estimated*:

Select the type of funding to be used:

Describe the scope of the original emergency (supply, service, etc.):

Describe the scope of the extension (supply, service, etc.). Show justification for extending the original emergency contract, and explain why the extension need cannot be met through a competitive process:

Was authorization to proceed verbally given?

Term of emergency procurement shall not exceed 90 days. Contract may be extended beyond 90 days if CPO determines additional time is necessary; however, prior to execution of extension, CPO must hold a public hearing and provide written determination *Actual end date and cost will be reported later.

Signatures I am requesting an extension of the requested emergency contract. I know and understand the contents of this statement and all statements herein are true and correct to the best of my knowledge.

EMERGENCY PURCHASE FINAL COST AND TERM

Final Cost and Term Page of State of Illinois Chief Procurement Office Emergency Purchase Statement Version 20.1 .\CPO Letterhead\CPO Letterhead.png Final Costs and Term I am reporting the final costs and term for the referenced emergency contract to the CPO and the Auditor General.

11.0.0.20130303.1.892433.887364

UNABLE TO SIGN FORM AT TIME OF FILING DUE TO SHELTER AT HOME ORDER.