Emergency Purchase Statement v.22.1 - signed.pdf

EMERGENCY PURCHASE STATEMENT

Statement Page 1 of 1 State of Illinois Chief Procurement Office Emergency Purchase Statement Version 22.1

Zip: 62791State: ILCity: SpringifeldAddress: 3550 Great Northern Ave.

Vendor: Henson Robinson Company

Zip: 62764State: ILCity: SpringfieldAddress: 2300 S. Dirksen Pkwy.

Division: Bureau of BusinessAgency: Illinois Department of Transportation

Emergency Purchase Details Reference #: 22-494DOT-FINAD-B-25635

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

Immediate expenditure is necessary for repairs to State property to protect against further loss or damage

Reason for selection of this particular vendor:

This Vendor has been used by IDOT for similar work in the past. This Vendor is local to the work that must be performed and is able to perform the work in the time frame required.

Description of supplies or services to be provided:

Emergency repair of roof for IDOT building located at 400 West Wabash, Effingham, IL.

Remove all materials to be replaced. Install new roof joists and roofing materials. Install new flashing, scuppers, and downspouts as required. The roof has deteriorated to the point where it may collapse and is a danger to property and personnel.

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

Expected Start Date: Oct 29, 2021 Estimated End Date*: Jan 29, 2022

Amount of this expenditure is: 17000 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: Bureau Chief- Business Services

Printed Name: Aundra Williams Date: Nov 1, 2021

EMERGENCY PURCHASE EXTENSION

Extension Page 1 of 2 State of Illinois Chief Procurement Office Emergency Purchase Statement Version 22.1

Zip: 62791State: ILCity: SpringifeldAddress: 3550 Great Northern Ave.

Vendor: Henson Robinson Company

Zip: 62764State: ILCity: SpringfieldAddress: 2300 S. Dirksen Pkwy.

Division: Bureau of BusinessAgency: Illinois Department of Transportation

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 22.1

Zip: 62791State: ILCity: SpringifeldAddress: 3550 Great Northern Ave.

Vendor: Henson Robinson Company

Zip: 62764State: ILCity: SpringfieldAddress: 2300 S. Dirksen Pkwy.

Division: Bureau of BusinessAgency: Illinois Department of Transportation

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:

CPO Signature

Based on my review, I authorize the Agency to proceed in accordance with the published Notice referenced above.

Based upon my review, I authorize the Agency to proceed with the following changes:

Approved CPO 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 22.1

Zip: 62791State: ILCity: SpringifeldAddress: 3550 Great Northern Ave.

Vendor: Henson Robinson Company

Zip: 62764State: ILCity: SpringfieldAddress: 2300 S. Dirksen Pkwy.

Division: Bureau of BusinessAgency: Illinois Department of Transportation

Final Costs and Term Reference #:

Final total cost of supplies and services: Final total term of contract:

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

Agency Signature: Title:

Printed Name: Date:

Page of

EMERGENCY PURCHASE STATEMENT

State of Illinois Chief Procurement Office Emergency Purchase Statement Version 22.1 .\CPO Letterhead\CPO Letterhead.png

EMERGENCY PURCHASE STATEMENT

Statement Page of State of Illinois Chief Procurement Office Emergency Purchase Statement Version 22.1 .\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 22.1 .\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.

CPO Signature

EMERGENCY PURCHASE FINAL COST AND TERM

Final Cost and Term Page of State of Illinois Chief Procurement Office Emergency Purchase Statement Version 22.1 .\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

Remove all materials to be replaced. Install new roof joists and roofing materials. Install new flashing, scuppers, and downspouts as required. The roof has deteriorated to the point where it may collapse and is a danger to property and personnel.