DOA-3831STARPiggybackingRequest Detention Locks.doc
DOC document 703 KB Posted
- Attached to
- Detention Locks
- Contract number
- 435252-O19-786DLDOOR-00
- Issued by
- Wisconsin
About this file
This document is a STAR Piggybacking Request form (DOA-3831) from the Wisconsin Department of Administration's State Bureau of Procurement, allowing state agencies to utilize existing contracts established by other agencies. The originating/contracting agency is the Wisconsin Department of Health Services (Business Unit 43500), with Monica Mooberry serving as the contact. The form facilitates access to contracts with two suppliers: Craftmaster Hardware (Supplier ID 0000001952) under contract 435252-O19-786DLDOOR-01, and Sentry Security Fasteners (Supplier ID 0000009129) under contract 435252-O19-786DLDOOR-02.
The contracts cover detention locks and related security hardware, classified under commodity/service codes 45055, 6800, and 68072. The original procurement was conducted through Request for Bid RFB S-0786 DCTS-19, with contract terms running from July 1, 2019 through June 30, 2020, and includes two additional one-year renewal options. The document indicates software purchases may be involved, requiring compliance review with the STAR Software Purchasing Policy. The form confirms the contracts were competitively bid and that suppliers are eligible for state contracting, with no impact identified on minority business enterprise, disabled veteran-owned business, or work center participation.
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Text version
State of Wisconsin
Department of Administration
DOA-3831 (r04/2018)
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 Health Services |
| 43500 |
| Originating/Contracting Agency Contact Name: |
| Phone Number: |
| E-Mail Address: |
| Monica Mooberry |
| 608-261-6846 |
| monicaa.mooberry@dhs.wisconsin.gov |
Section 3: Contract Information
| Contract Number |
| Supplier Name |
| Supplier ID Number |
| 435252-O19-786DLDOOR-01 |
| Craftmaster Hardware |
| 0000001952 |
| 435252-O19-786DLDOOR-02 |
| Sentry Security Fastners |
| 0000009129 |
| Commodity/Service Codes: |
| 45055, 6800, 68072 |
| Estimated Annual Spend: |
| $ |
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: |
| 7/1/19-6/30/20 |
| Renewal Options: |
| two (2) one year |
FORMCHECKBOX
Competitively Bid
| Request for Bid/Proposal Number: |
| RFB S-0786 DCTS-19 |
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:
N/A
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:
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.
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