ICI - IL River Emergency Pancake and Waffle EPS R-71790.pdf

EMERGENCY PURCHASE STATEMENT

Statement Page 1 of 2 State of Illinois Chief Procurement Office Emergency Purchase Statement Version 20.1

Zip: 92010State: CACity: CarlsbadAddress: 3115 Melrose Dr.

Vendor: Good Source Solutions, Inc.

Zip: 61520State: ILCity: CantonAddress: 1300 W. Locust

Division: ICI - IL RiverAgency: IDOC

Emergency Purchase Details Reference #: R-71790

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

To prevent or minimize serious disruption in critical State services that affect health, safety, or collection of substantial State revenues

Reason for selection of this particular vendor:

This vendor has provided the items in the past on time and at a cost that is in the best interests of the State of Illinois.

Description of supplies or services to be provided:

The vendor will provide pancakes and waffles to ICI. This will allow ICI to provide these items to customers on time without interruption in service.

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

Expected Start Date: Jul 13, 2020 Estimated End Date*: Oct 11, 2020

Amount of this expenditure is: $151,420.00 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

If other, explain: 301 - Revolving Capital

Statement Page 2 of 2 State of Illinois Chief Procurement Office Emergency Purchase Statement Version 20.1

Zip: 92010State: CACity: CarlsbadAddress: 3115 Melrose Dr.

Vendor: Good Source Solutions, Inc.

Zip: 61520State: ILCity: CantonAddress: 1300 W. Locust

Division: ICI - IL RiverAgency: IDOC

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: ICI Procurement Liaison

Printed Name: Justin Weigler Date: Jul 9, 2020

EMERGENCY PURCHASE EXTENSION

Extension Page 1 of 2 State of Illinois Chief Procurement Office Emergency Purchase Statement Version 20.1

Zip: 92010State: CACity: CarlsbadAddress: 3115 Melrose Dr.

Vendor: Good Source Solutions, Inc.

Zip: 61520State: ILCity: CantonAddress: 1300 W. Locust

Division: ICI - IL RiverAgency: IDOC

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 20.1

Zip: 92010State: CACity: CarlsbadAddress: 3115 Melrose Dr.

Vendor: Good Source Solutions, Inc.

Zip: 61520State: ILCity: CantonAddress: 1300 W. Locust

Division: ICI - IL RiverAgency: IDOC

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:

Approved CPO/SPO 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 20.1

Zip: 92010State: CACity: CarlsbadAddress: 3115 Melrose Dr.

Vendor: Good Source Solutions, Inc.

Zip: 61520State: ILCity: CantonAddress: 1300 W. Locust

Division: ICI - IL RiverAgency: IDOC

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

State of Illinois Chief Procurement Office Emergency Purchase Statement Version 20.1 .\CPO Letterhead\CPO Letterhead.png

EMERGENCY PURCHASE STATEMENT

Statement Page of State of Illinois Chief Procurement Office Emergency Purchase Statement Version 20.1 .\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 20.1 .\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.

EMERGENCY PURCHASE FINAL COST AND TERM

Final Cost and Term Page of State of Illinois Chief Procurement Office Emergency Purchase Statement Version 20.1 .\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.

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