CoopPurchaseAgreement_ADJC_Transportation_Services_under_DCS_contract_12.20.22_-_DCS_signed_01-09-23_-_signed.pdf

Page 1 of 5 SPO Form 106A Standard Work (Rev 11/22)

Owner State Procurement Office, Compliance Unit

Form Number SPO 106A - Single-Agency Cooperative Contract Purchase Authorization Version 11/15/2022

Process Standard Work / Instruction for completion of the SPO Form 106A

Form Completion Process

No. Action Action Detail / Key Points

Sections I through II to be completed by the requesting State Governmental Unit:

SECTION I - Agency Request

1 Agency Name of the requesting agency

2 Requestor Name of the requestor

3 Email Email of the requestor 4 Title Job title of the requestor 5 Telephone Telephone number of the requestor

SECTION II - Background

6 Description Description of service(s)/material(s) or Contract title (eProcurement Label)

7 Contractor Name of the contractor

8 Contract ID eProcurement contract number (if available)

9 Purchase Type

Select applicable option:

- One Time Purchase

- Full Use of Contract

10 Maximum End Date Select from the drop-down calendar the maximum end date of the contract

11 Estimated Spend Forecasted expenditures for the duration of the Cooperative purchase

Detail the efforts made to secure a contract for the specific Materials or Services requested and explain why purchasing from a Cooperative Contract (piggyback) is in the best interest of the State per Technical Bulletin 005.

Detail the efforts made to secure a contract for the specific Materials or Services requested and explain why purchasing from a Cooperative Contract (piggyback) is in the best interest of the State per Technical Bulletin 005.

Page 2 of 5 SPO Form 106A Standard Work (Rev 11/22)

Was the contract awarded through the competitive process? A.A.C. R2-7-1003 (B)(1)

Select applicable option:

- Yes

- No

- Solicitation Pending

14 Date of request Select the date of request from the drop-down calendar

15 Requester Signature Signature of the authorized requestor

16 Requester: Upon completion of Section I and II, send this signed form to Contract Owner listed in the eProcurement System for review

SECTION III - Contract Owner Review

17 Comments, conditions, and restrictions (as applicable) Complete as needed

I acknowledge that upon approval of SPO Form 106A, the Contract will require an amendment to add the additional agency and the additional agency will need to be added as a user in the state’s eProcurement System.

This completed form will be included in the request to the help desk.

Click the box to acknowledge that upon approval of SPO Form 106A, the Contract will require an amendment to add the additional agency and the additional agency will need to be added as a user in the state’s eProcurement System. This completed form will be included in the request to the help desk.

19 Print Name Select the date from the drop-down calendar

20 Title Job title of the Contract Owner

21 Signature Signature of the contract owner

22 Date of Review Select the date of review from the drop-down calendar

23 Contract Owner: Upon completion of Section III, send this signed form to SPOCompliance@azdoa.gov and cc Requestor for processing

Section IV to be completed by SPO:

24 Determination

Select applicable option in accordance with A.A.C. R2-7-1001:

- Request Authorized

- Request Authorized with Conditions/Restrictions

- Request Returned for Additional Information

- Request Denied

25 Approved Expiration Date Select the date from the drop-down calendar

Comments, conditions or restrictions (as applicable) Complete as needed

27 Print name Printed name of the approver

28 Date Select the date of approval from the drop-down calendar

29 Title Job title of the approver 30 Signature Signature of the approving authority

Use this addition page as necessary

31 the document were insufficientUse this additional section as necessary Section may be used by requesting agency or SPO, in case the fields within

Page 3 of 5 SPO Form 106A Standard Work (Rev 11/22)

Procurement Determination:

Single-Agency Cooperative Purchase Authorization A.A.C. R2-7-1001

SECTIONS I-II MUST BE COMPLETED BY THE REQUESTOR

SECTION I - Agency Request*

1. Agency

2. Requestor 3. Email

4. Title 5. Telephone

* For limited delegation agencies, please work with your Enterprise Procurement Services (EPS) liaison.

SECTION II - Background

6. Description

7. Contractor

8. Contract ID 9. Purchase Type

10. Maximum End Date

11. Estimated Spend

12. Detail the efforts made to secure a contract for the specific Materials or Services requested and explain why purchasing from a Cooperative Contract (piggyback) is in the best interest of the State per Technical Bulletin 005.

Arizona Department of Juvenile Corrections

Kerry Wells kerry.wells@azdoa.gov

Acting Chief Procurement Officer 602-377-2322

Non-Medical Transportation Broker Services

Nebco Associates Inc - Medical Transportation Brokerage of Arizona

CTR055722 - Full Use of Contract

6/30/26 $100,000

Page 4 of 5 SPO Form 106A Standard Work (Rev 11/22)

13. Was the contract awarded through the competitive process? A.A.C. R2-7-1003(B)(1)

14. Date of request 15. Requester Signature

16. Requester: Upon completion of Section I and II, send this signed form to Contract Owner listed in the eProcurement System for review

Approval of this request does not allow for agencies to exceed their delegated authority.

TO BE COMPLETED BY THE CONTRACT OWNER

SECTION III - Contract Owner Review

17. Comments, conditions, and restrictions (as applicable)

18. I acknowledge that upon approval of SPO Form 106A, the Contract will require an amendment to add the additional agency and the additional agency will need to be added as a user in the state’s eProcurement System. This completed form will be included in the request to the help desk.

19. Print Name 20. Title

21. Signature 22. Date of Review

23. Contract Owner: Upon completion of Section III, send this signed form to SPOCompliance@azdoa.gov and cc Requestor for processing

ADCS has no objections to adding ADJC as a user agency of this contract. The impact to the current capacity appears to be minimal and the contractor has indicated its willingness and ability to meet ADJC's needs.

Jesse Atoigue Digitally signed by Jesse Atoigue Date: 2023.01.09 09:15:09 -07'00'

- Yes

12/20/22

Jesse Atoigue (Acting) Chief Procurement Officer

01/09/2023

Page 5 of 5 SPO Form 106A Standard Work (Rev 11/22)

SECTION IV - Approval

TO BE COMPLETED BY PROCUREMENT AUTHORITY

24. Determination

25. Approved Expiration Date

26. Comments, conditions or restrictions (as applicable)

27. Print name 28. Date

29. Title 30. Signature

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

31. Use this additional section as necessary

- Request Authorized

6/20/2026

Deputy SPA

Jessica Klein Jan 9, 2023 https://azadoagov.na1.echosign.com/verifier?tx=CBJCHBCAABAALS2VOKyE5b4PW44IzTy4fIvyLNLtgag4