cc882_R-290170_RAY OHERRON_QM Sam Browne Belts_6147.60_cec.pdf

Division: Budget Period: Date:

Initials

Procurement Description:

Is procurement a release from CMS/DoIT master contract? Yes No

Is procurement an order against an Agency-specific contract? Yes No

Is the amount of this MRF an estimate (DO NOT OBLIGATE)? Yes No Request for Earmarked Funds? Establish Decrease

Commitment Item NIGP Code

Budget Period:

Fund Center: Fund Center: Budget Period:

Fund: Fund: Budget Period:

Functional Area: Functional Area: Budget Period:

Internal Order No.: Internal Order No.: Budget Period:

Amount: Amount:

Analyst Approval: TOTAL

Fund Center: Fund Center:

Fund: Fund:

Functional Area: Functional Area:

Internal Order No.: Internal Order No.:

Amount: Amount:

Analyst Approval:

EMF No. Date:

Req No. Bid No. PO No.

Are inventory tags required?: Yes No

Name: Location Code:

Address: Inventory Custodian:

City, State, Zip: Custodian Telephone No.:

FEIN: Is there a Parent Asset?: Yes No SAP Supplier No.: If yes, Parent Asset No.:

Is the equipment Military Surplus?: Yes No

IL 493-0620 ISP 2-43 (1/22)

Fund #2 COMMENTS

Fund #3

Fund #4

Analyst Approval:

Analyst Approval:

BIDBUY PROCUREMENT TRACKING

FISCAL INFORMATION

Asset Shell No.

Current Budget

Period Total Cost NAME OF ITEM INCLUDING size, color, and full description or description of services to be performed.

Supervisor Name

Fund #1

FOR MULTI-YEAR PROCUREMENTS

INVENTORY INFORMATION (If Inventory Equipment purchase)

Initials

If yes, Contract No.:

If yes, Contract No.:

If increase/decrease, EMF No.:

PROCUREMENT INFORMATION

Division Head Name

Term of Services:

Unit of Measure

ILLINOIS STATE POLICE

MATERIAL REQUEST FORM

Initials

Increase

Requested by Name

SOURCE OF SUPPLY

Quantity Unit Price

Tot

MG

ISP 2-618 (6/17)

Material Request Form (MRF) - CHECKLIST

Project Title: PBC#:

ISP Division: IPB#: _____________________

Please check the appropriate box as it relates to the Relevant Category on the PBC:

Commodities/Equipment Facilities General Services

Health/Medical IT Telecom

Attach this Checklist and the following documents to the MRF:

YES N/A Initials

_____ Copy of draft Procurement Business Case

_____ MRF with:

YES N/A

appropriate approvals (including Budget) master contract number IPB posting # (for all P&A, & other purchases > the Small Purchase level)

PBC #

_____ Procurement Justification Form with appropriate Division approval

_____ Sole Source Justification Form with approvals

_____ Screen print from small business database or approved small business waiver

_____ Copy of request for quote (includes Sell2Illinois email sent to SBSA vendors) (attach to PBC)

_____ All vendor responses to request for quote (attach to PBC)

_____ Service Procurement and Contracting Checklist signed by authorized Labor Relations representative, if procurement includes services (attach to PBC)

_____ Specifications (if CMS will be bidding, to be entered into IGPS)

_____ Cost Justification form with signatures (for printing devices)

_____ Surplus Property form (for printing devices)

_____ Acknowledgement that the various CPO (count 4) suspensions / disbarments websites have been checked to verify Vendor is not currently listed

_____ Other documents

Contact Name:

Phone #:

Date:

REQUISITION Printed: 10/06/2025

Date: 10/06/2025

Required 06/30/2026

Requisition No.

26-493ISP-ADMIN-R-

290170

S H I P

T O

3740 E. Lake Shore Drive Springfield, IL 62712 Email: Matthew.haywood@illinois.gov Phone: 2177867196

Master Sergeant Matthew Haywood

3740 E. Lake Shore Drive Springfield, IL 62712 Email: Matthew.haywood@illinois.gov Phone: 2177867196

Master Sergeant Matthew Haywood

Requesting Department Requestor Phone # Requisition Type

Administration Cody Suttles (217) 786-7130 Standard Release

QuantityItem Unit TotalClass-Item and Description Unit Price

ISP - Illinois State Police Illinois State Police 801 South 7th Street Springfield, IL 62703

B I L L

T O

1.00

60.00 EA $ 102.46 $ 6,147.60 Sam Browne Style Belts with Right Shoulder Strap COLOR:

BLACK CLARINO-HIGH GLOSS. BUCKLE: BRASS.

SIZINGS 30"-60". LINING: FULLY LINED. SEE PICTURE

INCLUDED IN IFB.

LN/FY/Account Code Dollar Amount

1.000 / 26 / NOT APPLICABLE-------- $ 6,147.60

SubTotal:

TOTAL:

Tax:

Discount:

$ 6,147.60

$ 0.00

$ 0.00

$ 6,147.60

Freight: null

Illinois Chief Procurement Officer

Vendor Suspensions & Debarments As of 10/1/2025

CPO General Services:

None

CPO Higher Education:

CPO Department of Transportation:

CPO Capital Development Board:

https://www.illinois.gov/cpo/HigherEd/Pages/VendorSuspensionsDebarments.aspx https://www.illinois.gov/cpo/HigherEd/Documents/Suspensions/Abatement%20Management-Stephen%20Sweet.pdf https://www.illinois.gov/cpo/HigherEd/Pages/VendorSuspensionsDebarments.aspx https://www.illinois.gov/cpo/HigherEd/Pages/VendorSuspensionsDebarments.aspx https://www.illinois.gov/cpo/HigherEd/Documents/Suspensions/Abatement%20Management-Stephen%20Sweet.pdf https://www.illinois.gov/cpo/HigherEd/Documents/Suspensions/Abatement%20Management-Stephen%20Sweet.pdf https://www.illinois.gov/cpo/HigherEd/Documents/Suspensions/Abatement%20Management-Stephen%20Sweet.pdf https://www.illinois.gov/cpo/cdb/Pages/SuspensionsDebarments.aspx https://www.illinois.gov/cpo/cdb/Pages/SuspensionsDebarments.aspx