Final_CSSD_0506_EPS2700000001_1_WV_CSSD_FORM.PDF
PDF 736 KB Posted
- Solicitation number
- CSSD 0506 EPS2700000001 1
- Issued by
- Kanawha County, West Virginia
About this file
Summary
This is a Cooperative Purchasing Statement of Designations and Conflict of Interest Disclosure form for the West Virginia Central Service Supply Depot (CSSD), related to a direct award contract for Immunization Information System maintenance and support. The form documents the procurement process and internal designations for this contract award, which falls under the CSSD's cooperative purchasing authority. The contract represents a direct award arrangement rather than a competitive bid process, indicating the vendor was selected through a streamlined procurement method. The document establishes the official record of the contract opportunity designation and identifies relevant parties involved in the procurement decision.
The form includes conflict of interest disclosures and establishes the framework for the CSSD's administration of this maintenance and support contract for the Immunization Information System. As a direct award, this procurement bypasses traditional competitive bidding procedures, suggesting the selected vendor demonstrated unique qualifications or capabilities for maintaining and supporting the state's immunization database system. The document serves as the formal designation paperwork required for state procurement compliance, ensuring proper documentation of the award rationale and any potential conflicts of interest among decision-makers.
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| File | Type | Posted |
|---|---|---|
| CSSD EPS2700000001_Direct Award Documents.pdf |
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Text version
Date Printed: Oct 13, 2026 Page: 1 FORM ID: WV-PRC-CSSD-002 2020/05
Department of Administration Purchasing Division 2019 Washington Street East Post Office Box 50130 Charleston, WV 25305-0130
State of West Virginia Central Sole Source Determination
Info Technology
Proc Folder: 2016248 Reason for Modification:
Doc Description: DIRECT AWARD-IMMUNIZATION INFORMATION SYSTEM MAINT/
SUPPORT
Proc Type: Central Sole Source
Date Issued Solicitation Closes Solicitation No Version
2026-10-13 2026-10-27 13:30 CSSD 0506 EPS2700000001 1
BID RECEIVING LOCATION
BID CLERK
DEPARTMENT OF ADMINISTRATION
PURCHASING DIVISION
2019 WASHINGTON ST E
CHARLESTON
US
VENDOR
Vendor Customer Code:
Vendor Name :
Address :
Street :
City :
State : Country : Zip :
Principal Contact :
Vendor Contact Phone: Extension:
FOR INFORMATION CONTACT THE BUYER
Crystal G Hustead
(304) 558-2402 crystal.g.hustead@wv.gov
Vendor Signature X FEIN# DATE All offers subject to all terms and conditions contained in this solicitation
Date Printed: Oct 13, 2026 Page: 2 FORM ID: WV-PRC-CSSD-002 2020/05
ADDITIONAL INFORMATION
DIRECT AWARD POSTING
THE WEST VIRGINIA PURCHASING DIVISION HAS BEEN REQUESTED TO APPROVE A DIRECT AWARD FOR MAINTENANCE AND SUPPORT FOR THE WEST VIRGINIA STATEWIDE IMMUNIZATION INFORMATION SYSTEM (WVSIIS).
PURSUANT TO WV CODE 5A-3-10C, THE PURCHASING DIVISION IS ATTEMPTING TO DETERMINE WHETHER THE
COMMODITY OR SERVICE IS A DIRECT AWARD PROCUREMENT.
***INTEREST IN PROVIDING THE COMMODITY OR SERVICE MUST BE SENT IN WRITING PRIOR TO THE SOLICITATION
CLOSE DATE AND TIME TO CRYSTAL.G.HUSTEAD@WV.GOV***
SEE THE ATTACHED APPROVED WV-65 FOR ADDITIONAL INFORMATION.
INVOICE TO SHIP TO
HEALTH AND HUMAN RESOURCES
BPH - TUBERCULOSIS CONTROL
350 CAPITOL ST, RM 125
CHARLESTON WV 25301-3715
US
HEALTH AND HUMAN RESOURCES
500 SUMMERS STREET
2ND FLOOR
CHARLESTON WV 25301
US
Line Comm Ln Desc Qty Unit Issue Unit Price Total Price 1 MyIR Consumer Support and Matching
Support Package yr 1
Comm Code Manufacturer Specification Model # 43232915
Extended Description:
MyIR Consumer Support and Matching Support Package
INVOICE TO SHIP TO
HEALTH AND HUMAN RESOURCES
BPH - TUBERCULOSIS CONTROL
350 CAPITOL ST, RM 125
CHARLESTON WV 25301-3715
US
HEALTH AND HUMAN RESOURCES
500 SUMMERS STREET
2ND FLOOR
CHARLESTON WV 25301
US
Line Comm Ln Desc Qty Unit Issue Unit Price Total Price 2 Complete Interoperability Operations yr 1
Comm Code Manufacturer Specification Model # 43232915
Extended Description:
Complete Interoperability Operations
Date Printed: Oct 13, 2026 Page: 3 FORM ID: WV-PRC-CSSD-002 2020/05
INVOICE TO SHIP TO
HEALTH AND HUMAN RESOURCES
BPH - TUBERCULOSIS CONTROL
350 CAPITOL ST, RM 125
CHARLESTON WV 25301-3715
US
HEALTH AND HUMAN RESOURCES
500 SUMMERS STREET
2ND FLOOR
CHARLESTON WV 25301
US
Line Comm Ln Desc Qty Unit Issue Unit Price Total Price 3 Ongoing Data Quality Monitoring for HL7
Providers yr 1
Extended Description:
Ongoing Data Quality Monitoring for HL7 Providers
INVOICE TO SHIP TO
HEALTH AND HUMAN RESOURCES
BPH - TUBERCULOSIS CONTROL
350 CAPITOL ST, RM 125
CHARLESTON WV 25301-3715
US
HEALTH AND HUMAN RESOURCES
500 SUMMERS STREET
2ND FLOOR
CHARLESTON WV 25301
US
Line Comm Ln Desc Qty Unit Issue Unit Price Total Price 4 MyIR Consumer Support and Matching
Support Package yr2
Extended Description:
MyIR Consumer Support and Matching Support Package
Date Printed: Oct 13, 2026 Page: 4 FORM ID: WV-PRC-CSSD-002 2020/05
INVOICE TO SHIP TO
HEALTH AND HUMAN RESOURCES
BPH - TUBERCULOSIS CONTROL
350 CAPITOL ST, RM 125
CHARLESTON WV 25301-3715
US
HEALTH AND HUMAN RESOURCES
500 SUMMERS STREET
2ND FLOOR
CHARLESTON WV 25301
US
Line Comm Ln Desc Qty Unit Issue Unit Price Total Price 5 Complete Interoperability Operations yr 2
Comm Code Manufacturer Specification Model # 43232915
Extended Description:
Complete Interoperability Operations
INVOICE TO SHIP TO
HEALTH AND HUMAN RESOURCES
BPH - TUBERCULOSIS CONTROL
350 CAPITOL ST, RM 125
CHARLESTON WV 25301-3715
US
HEALTH AND HUMAN RESOURCES
500 SUMMERS STREET
2ND FLOOR
CHARLESTON WV 25301
US
Line Comm Ln Desc Qty Unit Issue Unit Price Total Price 6 Ongoing Data Quality Monitoring for HL7
Providers yr 2
Extended Description:
Ongoing Data Quality Monitoring for HL7 Providers
SCHEDULE OF EVENTS
Line Event Event Date
Document Phase Document Description Page
EPS2700000001 Final DIRECT AWARD-IMMUNIZATION
INFORMATION SYSTEM MAINT/
SUPPORT
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